Democrats Biden and Kucinich Offer Health Care Reform Plans

  • by Contributing Writer, MedPage Today
WASHINGTON, Oct. 26 -- Democratic presidential candidates Joseph Biden and Dennis Kucinich offered sharply contrasting visions for health care reform. Still, both said that the government's role must expand before any progress can be made.

Biden, who has represented Delaware in the Senate since 1972, would have the government reimburse employers and insurers for catastrophic health costs. He'd also expand SCHIP to cover all children and allow people older than 55 to buy into the Medicare system. The price tag? Between $90 billion and $120 billion a year.

Kucinich, an Ohio congressman since 1996 and former mayor of Cleveland, said the profit motive is to blame for most health care woes. He'd use treasury bonds to buy out private health insurers and create a single-payer, nonprofit system controlled by the government, similar to the British National Health Service. He'd pay for it through payroll taxes, repealing tax cuts for the wealthy and bringing American troops home from Iraq.

Polls show the two candidates are part of the second tier seeking the nomination behind frontrunners Hillary Clinton, Barack Obama and John Edwards. Biden and Kucinich spoke at forums sponsored by the Kaiser Family Foundation in Washington.

The Biden plan

Biden's proposals stop short of mandating universal coverage but he insists that Americans will voluntarily buy policies if they are given better options.

Unlike most Democratic candidates, Biden opposes government mandates on employers and individuals to buy insurance. "Americans don't like the word mandate and it isn't going to pass Congress anyway," he said.

Instead, Biden stressed that getting a handle on catastrophic health costs is more effective. About 5% of people with the greatest costs account for half of health care spending in this country. "Just one employee with high medical expenses can push premiums up for all and make insurance unaffordable," he said. "One major illness can bankrupt a family. Middle class people are getting killed by the way our health care system is set up."

He'd establish a federal reinsurance pool to reimburse employers and insurers for 75% of catastrophic health costs (those exceeding $50,000 per individual) for active and retired employees and their families. To participate in the rebate program, employers would have to cover all employees and apply best practices to chronic disease management.

Biden would allow uninsured Americans to buy into a program that mirrors the Federal Employee Health Benefit Plan (FEHBP). He'd also allow people between 55 and 64 to buy in to the Medicare program. Like the FEHBP buy-in proposal, the federal government would provide a subsidy for low-income individuals.

Insurance reform, greater use of electronic medical records, and federal funding to support the creation of a universal claim form to be used by all insurers also are part of his plan.

Biden spoke of his experience having an operation for a near-fatal brain aneurysm, with a health bill of more than $1 million in today's dollars. "Because I had insurance, I had the assurance of knowingâ€¦that my family wasn't going to be in debt for the rest of their lives."

Biden stressed that he's the only "pragmatic" candidate with the ability to generate a national consensus that could win the votes of 15 to 20 Republican senators needed for any serious reform. "I take on divisive issues and can work across the aisle to get things done."

The Kucinich plan

"Government-run health care" is a taunt Republicans have hurled at the leading Democratic presidential candidates, who deny that's what they want. Kucinich wears the accusation as a badge of honor.

"Health care is a moral imperative, a basic right for all Americans, not a privilege," he said. "Government has to play a much larger role. What a novel idea. Government acting in the public interest."

Kucinich has co-authored a bill (H.R. 676), known as "Medicare for All," to establish a national, not-for-profit health insurance plan that would cover all Americans without premiums, deductibles, or co-payments.

The American public is ready for a single-payer government system, Kucinich says. "They know that insurance companies make their money by not providing health care. Insurance- and pharmaceutical-company profits make the system unfair and inefficient."

To cope with the endless bureaucracy of private insurers, health care providers maintain huge administrative staffs, he said. Administration today consumes approximately 31% of the money spent for health care. "The potential savings of a single payer system -- as much as $350 billion per year -- are enough to provide comprehensive coverage to every American without paying any more than we already do," he said on his campaign Web site.

Stating that both political parties have failed the nation on this issue, Kucinich zeroes in on the leading Democratic presidential candidates. "It is a scandal thatâ€¦they are putting forth half-measures, flawed strategies, and highly suspect schemes in the name of reform."

He singles out frontrunners Clinton, Obama, and Edwards. "As the candidates currently drawing the most media attention, they have the greatest opportunity to use that bully pulpit to advocate sweeping reforms. Insteadâ€¦their plans protect and preserve the roles of private, for-profit companies; and, in some cases, open the door for even greater profits at the expense of taxpayers and everyday Americans."

Kucinich favors providing coverage to undocumented immigrants. Biden opposes that, except in emergency cases.

Although Biden and Kucinich said health care is the top domestic issue, both said ending American involvement in Iraq is a higher priority -- and savings from reducing the Defense Department budget could fund their health care proposals.