Joyce Frieden

For Sen. John McCain (R-Ariz.), having health insurance is desirable but not mandatory.

“I don't think there should be a mandate for every American to have health insurance,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “I think one of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans,” he said.

As Sen. McCain sees it, health insurance is something many people decide they don't want. “The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. He added, however, that some people with chronic illnesses and other preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them, including additional trust funds for Medicaid payments [for people] who need this kind of coverage.”

Instead of mandating that people have health insurance, Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “I'm not going to force Americans to do it; I don't think that's the role of government,” he said. “But if we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [health insurance]. The panacea isn't all just health care costs, but unless you address health care costs, you're never going to solve the other aspects of the health care crisis.”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure—the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results. That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

To expand access to health insurance, Sen. McCain is proposing a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance policies. To pay for the tax credits—which would cost the government an estimated $3.5 trillion over 10 years—he proposes abolishing the tax deduction that employees currently take when they pay premiums on their employer-sponsored health plans. He would, however, leave intact the deduction that employers currently take on their portion of the premiums as an incentive for employers to continue offering coverage.

“The important thing about the … refundable tax credit for employees is for them to go out and make choices,” Sen. McCain said during the forum. “When it's their money and their decision, I think they make much wiser decisions than when it's provided by somebody else.” And because the tax credit is refundable, low-income Americans who currently pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost of a family health insurance policy is more than $12,000 per year—far higher than the amount of the proposed family tax credit—Sen. McCain said the credit still would be beneficial. “One thing it does is if someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said. “Another thing it does that I think is very important is that for low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted that the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher. But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.” The senator said he did not have an estimate of how many uninsured people would be able to buy health insurance coverage because of the tax credit.

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does and that would be obviously something that I would not approve of.” Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents. “I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

Sen. McCain also said he hoped the tax credit plan would encourage more people to open health savings accounts (HSAs). “I think they are a good idea; I don't think they've been publicized nearly as much as they should be,” he said. “Rightly or wrongly, HSAs are viewed by most Americans as something for rich people. But if you can only use that refundable tax credit for purchasing health insurance or HSAs, I think you may see a stimulus in that; at least, I believe that's a strong possibility.”

On another front, the senator said in an interview that he favors reforms to the malpractice system. “I would like to see that any medical provider or doctor who stayed within medical guidelines would then not be sued. Right now, it's a lottery for trial lawyers.” He is in favor of damage caps, “but more importantly, I've opposed punitive damages. … Punitive damages are something that I have not supported in anything.”

Sen. McCain also noted that although he is against abortion, “after a lot of agonizing thought and consultation, I believe in stem cell research. I think stem cell research holds great promise in addressing some of these terrible afflictions that face our nation and the world, such as Alzheimer's and Parkinson's.”

'Unless you address health care costs, you're never going to solve the other [crisis] aspects.' SEN. MCCAIN

For Sen. John McCain (R-Ariz.), having health insurance is desirable but not mandatory.

“I don't think there should be a mandate for every American to have health insurance,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “I think one of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans,” he said.

As Sen. McCain sees it, health insurance is something many people decide they don't want. “The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. He added, however, that some people with chronic illnesses and other preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them, including additional trust funds for Medicaid payments [for people] who need this kind of coverage.”

Instead of mandating that people have health insurance, Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “I'm not going to force Americans to do it; I don't think that's the role of government,” he said. “But if we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [health insurance]. The panacea isn't all just health care costs, but unless you address health care costs, you're never going to solve the other aspects of the health care crisis.”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure—the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results. That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

To expand access to health insurance, Sen. McCain is proposing a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance policies. To pay for the tax credits—which would cost the government an estimated $3.5 trillion over 10 years—he proposes abolishing the tax deduction that employees currently take when they pay premiums on their employer-sponsored health plans. He would, however, leave intact the deduction that employers currently take on their portion of the premiums as an incentive for employers to continue offering coverage.

“The important thing about the … refundable tax credit for employees is for them to go out and make choices,” Sen. McCain said during the forum. “When it's their money and their decision, I think they make much wiser decisions than when it's provided by somebody else.” And because the tax credit is refundable, low-income Americans who currently pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost of a family health insurance policy is more than $12,000 per year—far higher than the amount of the proposed family tax credit—Sen. McCain said the credit still would be beneficial. “One thing it does is if someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said. “Another thing it does that I think is very important is that for low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted that the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher. But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.” The senator said he did not have an estimate of how many uninsured people would be able to buy health insurance coverage because of the tax credit.

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does and that would be obviously something that I would not approve of.” Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents. “I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

Sen. McCain also said he hoped the tax credit plan would encourage more people to open health savings accounts (HSAs). “I think they are a good idea; I don't think they've been publicized nearly as much as they should be,” he said. “Rightly or wrongly, HSAs are viewed by most Americans as something for rich people. But if you can only use that refundable tax credit for purchasing health insurance or HSAs, I think you may see a stimulus in that; at least, I believe that's a strong possibility.”

On another front, the senator said in an interview that he favors reforms to the malpractice system. “I would like to see that any medical provider or doctor who stayed within medical guidelines would then not be sued. Right now, it's a lottery for trial lawyers.” He is in favor of damage caps, “but more importantly, I've opposed punitive damages. … Punitive damages are something that I have not supported in anything.”

Sen. McCain also noted that although he is against abortion, “after a lot of agonizing thought and consultation, I believe in stem cell research. I think stem cell research holds great promise in addressing some of these terrible afflictions that face our nation and the world, such as Alzheimer's and Parkinson's.”

'Unless you address health care costs, you're never going to solve the other [crisis] aspects.' SEN. MCCAIN

For Sen. John McCain (R-Ariz.), having health insurance is desirable but not mandatory.

“I don't think there should be a mandate for every American to have health insurance,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “I think one of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans,” he said.

As Sen. McCain sees it, health insurance is something many people decide they don't want. “The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. He added, however, that some people with chronic illnesses and other preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them, including additional trust funds for Medicaid payments [for people] who need this kind of coverage.”

Instead of mandating that people have health insurance, Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “I'm not going to force Americans to do it; I don't think that's the role of government,” he said. “But if we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [health insurance]. The panacea isn't all just health care costs, but unless you address health care costs, you're never going to solve the other aspects of the health care crisis.”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure—the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results. That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

To expand access to health insurance, Sen. McCain is proposing a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance policies. To pay for the tax credits—which would cost the government an estimated $3.5 trillion over 10 years—he proposes abolishing the tax deduction that employees currently take when they pay premiums on their employer-sponsored health plans. He would, however, leave intact the deduction that employers currently take on their portion of the premiums as an incentive for employers to continue offering coverage.

“The important thing about the … refundable tax credit for employees is for them to go out and make choices,” Sen. McCain said during the forum. “When it's their money and their decision, I think they make much wiser decisions than when it's provided by somebody else.” And because the tax credit is refundable, low-income Americans who currently pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost of a family health insurance policy is more than $12,000 per year—far higher than the amount of the proposed family tax credit—Sen. McCain said the credit still would be beneficial. “One thing it does is if someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said. “Another thing it does that I think is very important is that for low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted that the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher. But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.” The senator said he did not have an estimate of how many uninsured people would be able to buy health insurance coverage because of the tax credit.

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does and that would be obviously something that I would not approve of.” Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents. “I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

Sen. McCain also said he hoped the tax credit plan would encourage more people to open health savings accounts (HSAs). “I think they are a good idea; I don't think they've been publicized nearly as much as they should be,” he said. “Rightly or wrongly, HSAs are viewed by most Americans as something for rich people. But if you can only use that refundable tax credit for purchasing health insurance or HSAs, I think you may see a stimulus in that; at least, I believe that's a strong possibility.”

On another front, the senator said in an interview that he favors reforms to the malpractice system. “I would like to see that any medical provider or doctor who stayed within medical guidelines would then not be sued. Right now, it's a lottery for trial lawyers.” He is in favor of damage caps, “but more importantly, I've opposed punitive damages. … Punitive damages are something that I have not supported in anything.”

Sen. McCain also noted that although he is against abortion, “after a lot of agonizing thought and consultation, I believe in stem cell research. I think stem cell research holds great promise in addressing some of these terrible afflictions that face our nation and the world, such as Alzheimer's and Parkinson's.”

'Unless you address health care costs, you're never going to solve the other [crisis] aspects.' SEN. MCCAIN

For Sen. John McCain (R-Ariz.), having health insurance is desirable but not mandatory.

“I don't think there should be a mandate for every American to have health insurance,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “One of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans.”

As Sen. McCain sees it, health insurance is something many people decide they don't want. “The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. He added, however, that some people with chronic illnesses and other preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them, including additional trust funds for Medicaid payments [for people] who need this kind of coverage.”

Instead of mandating that people have health insurance, Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “If we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [health insurance].”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure–the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results. That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

To expand access to health insurance, Sen. McCain is proposing a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance policies. To pay for the tax credits–which would cost the government an estimated $3.5 trillion over 10 years–he proposes abolishing the tax deduction that employees currently take when they pay premiums on their employer-sponsored health plans. He would, however, leave intact the deduction that employers currently take on their portion of the premiums as an incentive for employers to continue offering coverage.

When it's the employee's money and their decision, “I think they make much wiser decisions than when it's provided by somebody else.” And because the tax credit is refundable, low-income Americans who currently pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost of a family health insurance policy is more than $12,000 per year–far higher than the amount of the proposed family tax credit–Sen. McCain said the credit still would be beneficial. “One thing it does is if someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said. “Another thing it does that I think is very important is that for low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted that the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher. But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.” The senator said he did not have an estimate of how many uninsured people would be able to buy health insurance coverage because of the tax credit.

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does and that would be obviously something that I would not approve of.” Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents. “I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

Sen. McCain also said he hoped the tax credit plan would encourage more people to open health savings accounts (HSAs).

Every American should own their own home, 'but I'm not going to mandate that. … I feel the same way about health care.' SEN. MCCAIN

For Sen. John McCain (R-Ariz.), having health insurance is desirable but not mandatory.

“I don't think there should be a mandate for every American to have health insurance,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “One of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans.”

As Sen. McCain sees it, health insurance is something many people decide they don't want. “The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. He added, however, that some people with chronic illnesses and other preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them, including additional trust funds for Medicaid payments [for people] who need this kind of coverage.”

Instead of mandating that people have health insurance, Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “If we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [health insurance].”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure–the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results. That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

To expand access to health insurance, Sen. McCain is proposing a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance policies. To pay for the tax credits–which would cost the government an estimated $3.5 trillion over 10 years–he proposes abolishing the tax deduction that employees currently take when they pay premiums on their employer-sponsored health plans. He would, however, leave intact the deduction that employers currently take on their portion of the premiums as an incentive for employers to continue offering coverage.

When it's the employee's money and their decision, “I think they make much wiser decisions than when it's provided by somebody else.” And because the tax credit is refundable, low-income Americans who currently pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost of a family health insurance policy is more than $12,000 per year–far higher than the amount of the proposed family tax credit–Sen. McCain said the credit still would be beneficial. “One thing it does is if someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said. “Another thing it does that I think is very important is that for low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted that the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher. But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.” The senator said he did not have an estimate of how many uninsured people would be able to buy health insurance coverage because of the tax credit.

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does and that would be obviously something that I would not approve of.” Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents. “I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

Sen. McCain also said he hoped the tax credit plan would encourage more people to open health savings accounts (HSAs).

Every American should own their own home, 'but I'm not going to mandate that. … I feel the same way about health care.' SEN. MCCAIN

For Sen. John McCain (R-Ariz.), having health insurance is desirable but not mandatory.

“I don't think there should be a mandate for every American to have health insurance,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “One of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans.”

As Sen. McCain sees it, health insurance is something many people decide they don't want. “The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. He added, however, that some people with chronic illnesses and other preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them, including additional trust funds for Medicaid payments [for people] who need this kind of coverage.”

Instead of mandating that people have health insurance, Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “If we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [health insurance].”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure–the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results. That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

To expand access to health insurance, Sen. McCain is proposing a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance policies. To pay for the tax credits–which would cost the government an estimated $3.5 trillion over 10 years–he proposes abolishing the tax deduction that employees currently take when they pay premiums on their employer-sponsored health plans. He would, however, leave intact the deduction that employers currently take on their portion of the premiums as an incentive for employers to continue offering coverage.

When it's the employee's money and their decision, “I think they make much wiser decisions than when it's provided by somebody else.” And because the tax credit is refundable, low-income Americans who currently pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost of a family health insurance policy is more than $12,000 per year–far higher than the amount of the proposed family tax credit–Sen. McCain said the credit still would be beneficial. “One thing it does is if someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said. “Another thing it does that I think is very important is that for low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted that the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher. But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.” The senator said he did not have an estimate of how many uninsured people would be able to buy health insurance coverage because of the tax credit.

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does and that would be obviously something that I would not approve of.” Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents. “I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

Sen. McCain also said he hoped the tax credit plan would encourage more people to open health savings accounts (HSAs).

Every American should own their own home, 'but I'm not going to mandate that. … I feel the same way about health care.' SEN. MCCAIN

Feds Launch Sickle Cell Campaign

The National Institute of Diabetes and Digestive and Kidney Diseases is spearheading a campaign to stress the importance of careful hemoglobin A_1c testing in people with diabetes who have sickle cell trait or similar blood disorders. “If you see a significant discrepancy between a patient's A_1c reading and the results of routine blood glucose monitoring, consider the possibility that your patient may have a hemoglobin variant and find out if your lab is using an accurate method to measure A_1c,” Dr. Griffin P. Rodgers, NDDK director, said in a statement. In diabetes patients of African, Mediterranean, or Southeast Asian descent, several situations may raise suspicions of a hemoglobin variant, such as an HbA_1c test result that does not correlate with results of self-blood glucose monitoring, a result that radically differs from a previous test result after a change in lab methods, or a result higher than 15%. “In the United States, more than 3,000 labs rely on 20 different methods to measure A_1c in people with diabetes,” Randie Little, Ph.D., who heads the National Glycohemoglobin Standardization Program, said in a statement. “However, six of these methods yield unreliable results in patients with sickle cell trait.” More information for physicians and patients can be found at

www.diabetes.niddk.nih.gov

Part D Plans Not Tracking Costs

Medicare drug plans have not met all requirements for tracking out-of-pocket spending by beneficiaries in the Medicare Part D prescription drug program, according to a report from the Health and Human Services Department Office of Inspector General. Tracking out-of-pocket costs is needed to determine when each beneficiary has reached the required spending threshold at which Medicare's catastrophic drug coverage starts. “Implementing the program has been a large undertaking for [the Centers for Medicare and Medicaid Services], its contractors, and the private Part D plans,” said HHS Inspector General Daniel Levinson in a statement. “[Medicare] should place more emphasis on conducting Part D oversight.” The report found that 29% of Part D plans did not submit required information to the Centers for Medicare and Medicaid Services (CMS) on enrollees' additional drug coverage data. And 34% of Part D plans—covering nearly half of Part D enrollees—did not submit prescription drug event data to CMS in the required time frames. In addition, the limited oversight CMS has conducted so far on Part D plans' tracking of out-of-pocket costs relied on plans' self-reported data. And even then, about half of the plans were not in compliance with one or more of four CMS requirements in this area. The full report is available at

www.oig.hhs.gov

FDA Can't Fulfill Mission

Three members of the Food and Drug Administration's Science Board issued a damning report on the state of the agency, saying that “the agency suffers from serious scientific deficiencies and is not positioned to meet current or emerging regulatory responsibilities.” The authors wrote that the FDA has become weak and unable to fulfill its mission because of the increasing number of demands and an inability to respond because of a lack of resources. “FDA's inability to keep up with scientific advances means that American lives are at risk,” wrote the panelists, adding that the agency can't fulfill its mission “without substantial and sustained additional appropriations.” The report was written by Gail Cassell, Ph.D., vice president of scientific affairs at Eli Lilly & Co.; Dr. Allen D. Roses, Jefferson-Pilot Corp. Professor of Neurobiology and Genetics at Duke University; and Dr. Barbara J. McNeil, head of the health care policy department at Harvard Medical School. Members of the Coalition for a Stronger FDA and the FDA Alliance urged Congress to heed the report's warnings. “FDA can't improve its science, prepare for the future, or protect American consumers without significant additional resources,” said coalition member Don Kennedy, Ph.D., a former FDA commissioner and editor in chief of the journal Science, in a statement.

Access Reduced by Cost

Forty million Americans can't get access to needed health care, and 20% said the main reason was because they could not afford the services, according to a report issued in December by the Centers for Disease Control and Prevention. Health, United States, 2007, is a compilation of pertinent data gathered by the CDC's National Center for Health Statistics. According to the report, in 2005, 1 in 10 people between the ages of 18 and 64 years reported that they had not been able to get prescription drugs in the past year because of the cost. Another 10% said they had delayed necessary medical care because of cost issues. The report also found that 30% of 18- to 24-year-olds were uninsured, and another 30% of that age group did not have a usual source of medical care. Ten percent of 45- to 64-year-olds did not have a usual source of care. The report highlighted some other age-specific data as well. For instance, about 70% of men and more than 80% of women over age 75 either had hypertension or were taking antihypertensives in 2001–2004, compared with about 35% of adults aged 45–54. And about 20% of 16- to 17-year-olds, and more than 40% of 18- to 25-year-olds reported binge alcohol use in 2005; 20% of the latter age group reported illicit drug use in the previous month.

DEA Accused of Electronic Stalling

The Drug Enforcement Administration, which investigates crimes involving illicit use of controlled substances, has been criticized for stalling implementation of a national electronic prescribing system for controlled substances. Sen. Sheldon Whitehouse (D-R.I.), speaking at a Senate Judiciary Committee hearing, faulted the DEA's tardiness in developing regulations for such a system and its reluctance to commit to a deadline for completing the regulations. Currently, doctors write prescriptions for controlled substances but can prescribe noncontrolled substances electronically. DEA official Joseph T. Rannazzisi told the committee that the agency is concerned an electronic system would be susceptible to abuse.

Feds Launch Sickle Cell Campaign

The National Institute of Diabetes and Digestive and Kidney Diseases is spearheading a campaign to stress the importance of careful hemoglobin A_1c testing in people with diabetes who have sickle cell trait or similar blood disorders. “If you see a significant discrepancy between a patient's A_1c reading and the results of routine blood glucose monitoring, consider the possibility that your patient may have a hemoglobin variant and find out if your lab is using an accurate method to measure A_1c,” Dr. Griffin P. Rodgers, NDDK director, said in a statement. In diabetes patients of African, Mediterranean, or Southeast Asian descent, several situations may raise suspicions of a hemoglobin variant, such as an HbA_1c test result that does not correlate with results of self-blood glucose monitoring, a result that radically differs from a previous test result after a change in lab methods, or a result higher than 15%. “In the United States, more than 3,000 labs rely on 20 different methods to measure A_1c in people with diabetes,” Randie Little, Ph.D., who heads the National Glycohemoglobin Standardization Program, said in a statement. “However, six of these methods yield unreliable results in patients with sickle cell trait.” More information for physicians and patients can be found at

www.diabetes.niddk.nih.gov

Part D Plans Not Tracking Costs

Medicare drug plans have not met all requirements for tracking out-of-pocket spending by beneficiaries in the Medicare Part D prescription drug program, according to a report from the Health and Human Services Department Office of Inspector General. Tracking out-of-pocket costs is needed to determine when each beneficiary has reached the required spending threshold at which Medicare's catastrophic drug coverage starts. “Implementing the program has been a large undertaking for [the Centers for Medicare and Medicaid Services], its contractors, and the private Part D plans,” said HHS Inspector General Daniel Levinson in a statement. “[Medicare] should place more emphasis on conducting Part D oversight.” The report found that 29% of Part D plans did not submit required information to the Centers for Medicare and Medicaid Services (CMS) on enrollees' additional drug coverage data. And 34% of Part D plans—covering nearly half of Part D enrollees—did not submit prescription drug event data to CMS in the required time frames. In addition, the limited oversight CMS has conducted so far on Part D plans' tracking of out-of-pocket costs relied on plans' self-reported data. And even then, about half of the plans were not in compliance with one or more of four CMS requirements in this area. The full report is available at

www.oig.hhs.gov

FDA Can't Fulfill Mission

Three members of the Food and Drug Administration's Science Board issued a damning report on the state of the agency, saying that “the agency suffers from serious scientific deficiencies and is not positioned to meet current or emerging regulatory responsibilities.” The authors wrote that the FDA has become weak and unable to fulfill its mission because of the increasing number of demands and an inability to respond because of a lack of resources. “FDA's inability to keep up with scientific advances means that American lives are at risk,” wrote the panelists, adding that the agency can't fulfill its mission “without substantial and sustained additional appropriations.” The report was written by Gail Cassell, Ph.D., vice president of scientific affairs at Eli Lilly & Co.; Dr. Allen D. Roses, Jefferson-Pilot Corp. Professor of Neurobiology and Genetics at Duke University; and Dr. Barbara J. McNeil, head of the health care policy department at Harvard Medical School. Members of the Coalition for a Stronger FDA and the FDA Alliance urged Congress to heed the report's warnings. “FDA can't improve its science, prepare for the future, or protect American consumers without significant additional resources,” said coalition member Don Kennedy, Ph.D., a former FDA commissioner and editor in chief of the journal Science, in a statement.

Access Reduced by Cost

Forty million Americans can't get access to needed health care, and 20% said the main reason was because they could not afford the services, according to a report issued in December by the Centers for Disease Control and Prevention. Health, United States, 2007, is a compilation of pertinent data gathered by the CDC's National Center for Health Statistics. According to the report, in 2005, 1 in 10 people between the ages of 18 and 64 years reported that they had not been able to get prescription drugs in the past year because of the cost. Another 10% said they had delayed necessary medical care because of cost issues. The report also found that 30% of 18- to 24-year-olds were uninsured, and another 30% of that age group did not have a usual source of medical care. Ten percent of 45- to 64-year-olds did not have a usual source of care. The report highlighted some other age-specific data as well. For instance, about 70% of men and more than 80% of women over age 75 either had hypertension or were taking antihypertensives in 2001–2004, compared with about 35% of adults aged 45–54. And about 20% of 16- to 17-year-olds, and more than 40% of 18- to 25-year-olds reported binge alcohol use in 2005; 20% of the latter age group reported illicit drug use in the previous month.

DEA Accused of Electronic Stalling

The Drug Enforcement Administration, which investigates crimes involving illicit use of controlled substances, has been criticized for stalling implementation of a national electronic prescribing system for controlled substances. Sen. Sheldon Whitehouse (D-R.I.), speaking at a Senate Judiciary Committee hearing, faulted the DEA's tardiness in developing regulations for such a system and its reluctance to commit to a deadline for completing the regulations. Currently, doctors write prescriptions for controlled substances but can prescribe noncontrolled substances electronically. DEA official Joseph T. Rannazzisi told the committee that the agency is concerned an electronic system would be susceptible to abuse.

Feds Launch Sickle Cell Campaign

The National Institute of Diabetes and Digestive and Kidney Diseases is spearheading a campaign to stress the importance of careful hemoglobin A_1c testing in people with diabetes who have sickle cell trait or similar blood disorders. “If you see a significant discrepancy between a patient's A_1c reading and the results of routine blood glucose monitoring, consider the possibility that your patient may have a hemoglobin variant and find out if your lab is using an accurate method to measure A_1c,” Dr. Griffin P. Rodgers, NDDK director, said in a statement. In diabetes patients of African, Mediterranean, or Southeast Asian descent, several situations may raise suspicions of a hemoglobin variant, such as an HbA_1c test result that does not correlate with results of self-blood glucose monitoring, a result that radically differs from a previous test result after a change in lab methods, or a result higher than 15%. “In the United States, more than 3,000 labs rely on 20 different methods to measure A_1c in people with diabetes,” Randie Little, Ph.D., who heads the National Glycohemoglobin Standardization Program, said in a statement. “However, six of these methods yield unreliable results in patients with sickle cell trait.” More information for physicians and patients can be found at

www.diabetes.niddk.nih.gov

Part D Plans Not Tracking Costs

Medicare drug plans have not met all requirements for tracking out-of-pocket spending by beneficiaries in the Medicare Part D prescription drug program, according to a report from the Health and Human Services Department Office of Inspector General. Tracking out-of-pocket costs is needed to determine when each beneficiary has reached the required spending threshold at which Medicare's catastrophic drug coverage starts. “Implementing the program has been a large undertaking for [the Centers for Medicare and Medicaid Services], its contractors, and the private Part D plans,” said HHS Inspector General Daniel Levinson in a statement. “[Medicare] should place more emphasis on conducting Part D oversight.” The report found that 29% of Part D plans did not submit required information to the Centers for Medicare and Medicaid Services (CMS) on enrollees' additional drug coverage data. And 34% of Part D plans—covering nearly half of Part D enrollees—did not submit prescription drug event data to CMS in the required time frames. In addition, the limited oversight CMS has conducted so far on Part D plans' tracking of out-of-pocket costs relied on plans' self-reported data. And even then, about half of the plans were not in compliance with one or more of four CMS requirements in this area. The full report is available at

www.oig.hhs.gov

FDA Can't Fulfill Mission

Three members of the Food and Drug Administration's Science Board issued a damning report on the state of the agency, saying that “the agency suffers from serious scientific deficiencies and is not positioned to meet current or emerging regulatory responsibilities.” The authors wrote that the FDA has become weak and unable to fulfill its mission because of the increasing number of demands and an inability to respond because of a lack of resources. “FDA's inability to keep up with scientific advances means that American lives are at risk,” wrote the panelists, adding that the agency can't fulfill its mission “without substantial and sustained additional appropriations.” The report was written by Gail Cassell, Ph.D., vice president of scientific affairs at Eli Lilly & Co.; Dr. Allen D. Roses, Jefferson-Pilot Corp. Professor of Neurobiology and Genetics at Duke University; and Dr. Barbara J. McNeil, head of the health care policy department at Harvard Medical School. Members of the Coalition for a Stronger FDA and the FDA Alliance urged Congress to heed the report's warnings. “FDA can't improve its science, prepare for the future, or protect American consumers without significant additional resources,” said coalition member Don Kennedy, Ph.D., a former FDA commissioner and editor in chief of the journal Science, in a statement.

Access Reduced by Cost

Forty million Americans can't get access to needed health care, and 20% said the main reason was because they could not afford the services, according to a report issued in December by the Centers for Disease Control and Prevention. Health, United States, 2007, is a compilation of pertinent data gathered by the CDC's National Center for Health Statistics. According to the report, in 2005, 1 in 10 people between the ages of 18 and 64 years reported that they had not been able to get prescription drugs in the past year because of the cost. Another 10% said they had delayed necessary medical care because of cost issues. The report also found that 30% of 18- to 24-year-olds were uninsured, and another 30% of that age group did not have a usual source of medical care. Ten percent of 45- to 64-year-olds did not have a usual source of care. The report highlighted some other age-specific data as well. For instance, about 70% of men and more than 80% of women over age 75 either had hypertension or were taking antihypertensives in 2001–2004, compared with about 35% of adults aged 45–54. And about 20% of 16- to 17-year-olds, and more than 40% of 18- to 25-year-olds reported binge alcohol use in 2005; 20% of the latter age group reported illicit drug use in the previous month.

DEA Accused of Electronic Stalling

The Drug Enforcement Administration, which investigates crimes involving illicit use of controlled substances, has been criticized for stalling implementation of a national electronic prescribing system for controlled substances. Sen. Sheldon Whitehouse (D-R.I.), speaking at a Senate Judiciary Committee hearing, faulted the DEA's tardiness in developing regulations for such a system and its reluctance to commit to a deadline for completing the regulations. Currently, doctors write prescriptions for controlled substances but can prescribe noncontrolled substances electronically. DEA official Joseph T. Rannazzisi told the committee that the agency is concerned an electronic system would be susceptible to abuse.

WASHINGTON — Anyone who asks Rep. Dennis Kucinich (D-Ohio) about health care policy should be prepared for the conversation to evolve into other areas—like the Iraq war.

“Health care spending does not occur in a vacuum,” Rep. Kucinich said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “You cannot separate this from war.”

Rep. Kucinich, who is seeking the Democratic nomination for president, noted that money spent on the war in Iraq—an estimated $1.5 trillion, according to a report he cited from the Congressional Budget Office—is money not being spent on domestic concerns like education and health care. “As we speak, our government is planning to bomb Iran,” which will divert more money from health care concerns, he said at the forum, part of a series of forums with the presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

Although he sometimes connects health care policy with other topics, the fifth-term congressman and former mayor of Cleveland is very direct when it comes to universal health care coverage for Americans: He is the only candidate who supports a single-payer system financed by the government.

“Is health care a right or a privilege? If it's a right, then it's appropriate for the government to have a role” in providing it, he said. “If it's a privilege, and it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck. And you know what—47 million [uninsured] Americans are now out of luck.”

He noted that studies show health care debt is responsible for half of bankruptcies in the United States. “The median income is $48,000 per year, and some families are paying $12,000 a year for health insurance; that's a quarter of their gross. I'm talking about breaking the shackles insurance companies have on American families.”

Under Rep. Kucinich's proposal, which has been introduced in Congress as H.R. 676, all for-profit health care entities would be converted to nonprofit entities, with shareholders being compensated by the government. That compensation would be financed through Treasury bonds, he said. Physicians would continue to have private practices, but they, along with hospitals and other providers, would be paid by the federal government, which would disseminate federal funds through a series of regional budgets. There would also be separate budgets for capital expenditures and for medical education.

Coverage under Rep. Kucinich's plan would include inpatient and outpatient services as well as dental care, vision care, mental health care, and long-term care. There would be no deductibles or cost sharing.

When a reporter pointed out that other countries with government-financed health care ended up seeing a private system develop alongside the public one for those who could afford it, Rep. Kucinich said that was no surprise. “Privatizers are at work in every country,” he said. “If health care is such a losing proposition, why are these companies trying to privatize it? Because there's huge amounts of money to be made. But the minute you have a for-profit system, you're going to have people cut out of it.”

Another government-run system that people are trying to privatize is Medicare, Rep. Kucinich said. “Right now, Medicare is discouraging doctors by cutting their fees. There's a strategy to privatize Medicare by getting doctors to walk away from [it].” The passage of the Medicare prescription drug benefit was another part of that plan, he added.

A for-profit system puts the wrong type of pressure on physicians, Rep. Kucinich said in an interview after the forum. “Doctors are under pressure from private insurance not to provide health care,” he said. And when that collides with efforts such as Medicare's pay-for-performance initiative, “there's built-in inertia. Of course we want to encourage doctors to improve their performance, but under a for-profit system, doctors have cost pressures. That's sure not to encourage the results you want.”

During the forum, Rep. Kucinich contrasted his proposal with those offered by two other Democratic presidential candidates, Sen. Hillary Rodham Clinton (D-N.Y.) and former senator John Edwards (D-N.C.). Under their proposals, Americans would be required to purchase health insurance; they could choose from a variety of private health care plans as well as a public plan modeled after Medicare. “If you can't afford it under the current system, how are you going to afford it under [their] system?” he said. “And if you do buy it, you're forced into plans that inevitably are going to have extraordinary copays and deductibles, and a limited level of coverage,” he continued. But with his proposal, “I'm talking about a plan where everyone's covered, [and it] covers everything. And the fact is, we're already paying for it—we're just not getting it.”

He also said he was not concerned that a universal coverage plan would strain the system by having people who were previously without health insurance suddenly come in for lots of services.

“Years ago, when I was a city councilman in Cleveland, I had a proposal I thought would do a lot to protect the environment and move people around our community efficiently. I proposed free [public] transit,” he said. “And the people who attacked the idea threw up their arms and said, 'My God! If we have free transit, everyone's going to be riding the bus!' Exactly. That's what we want. You want people to use the health care system, so that they're healthy.”

'Is health care a right or a privilege? If it's a right, then it's appropriate for government to have a role.' REP. KUCINICH

WASHINGTON — Anyone who asks Rep. Dennis Kucinich (D-Ohio) about health care policy should be prepared for the conversation to evolve into other areas—like the Iraq war.

“Health care spending does not occur in a vacuum,” Rep. Kucinich said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “You cannot separate this from war.”

Rep. Kucinich, who is seeking the Democratic nomination for president, noted that money spent on the war in Iraq—an estimated $1.5 trillion, according to a report he cited from the Congressional Budget Office—is money not being spent on domestic concerns like education and health care. “As we speak, our government is planning to bomb Iran,” which will divert more money from health care concerns, he said at the forum, part of a series of forums with the presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

Although he sometimes connects health care policy with other topics, the fifth-term congressman and former mayor of Cleveland is very direct when it comes to universal health care coverage for Americans: He is the only candidate who supports a single-payer system financed by the government.

“Is health care a right or a privilege? If it's a right, then it's appropriate for the government to have a role” in providing it, he said. “If it's a privilege, and it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck. And you know what—47 million [uninsured] Americans are now out of luck.”

He noted that studies show health care debt is responsible for half of bankruptcies in the United States. “The median income is $48,000 per year, and some families are paying $12,000 a year for health insurance; that's a quarter of their gross. I'm talking about breaking the shackles insurance companies have on American families.”

Under Rep. Kucinich's proposal, which has been introduced in Congress as H.R. 676, all for-profit health care entities would be converted to nonprofit entities, with shareholders being compensated by the government. That compensation would be financed through Treasury bonds, he said. Physicians would continue to have private practices, but they, along with hospitals and other providers, would be paid by the federal government, which would disseminate federal funds through a series of regional budgets. There would also be separate budgets for capital expenditures and for medical education.

Coverage under Rep. Kucinich's plan would include inpatient and outpatient services as well as dental care, vision care, mental health care, and long-term care. There would be no deductibles or cost sharing.

When a reporter pointed out that other countries with government-financed health care ended up seeing a private system develop alongside the public one for those who could afford it, Rep. Kucinich said that was no surprise. “Privatizers are at work in every country,” he said. “If health care is such a losing proposition, why are these companies trying to privatize it? Because there's huge amounts of money to be made. But the minute you have a for-profit system, you're going to have people cut out of it.”

Another government-run system that people are trying to privatize is Medicare, Rep. Kucinich said. “Right now, Medicare is discouraging doctors by cutting their fees. There's a strategy to privatize Medicare by getting doctors to walk away from [it].” The passage of the Medicare prescription drug benefit was another part of that plan, he added.

A for-profit system puts the wrong type of pressure on physicians, Rep. Kucinich said in an interview after the forum. “Doctors are under pressure from private insurance not to provide health care,” he said. And when that collides with efforts such as Medicare's pay-for-performance initiative, “there's built-in inertia. Of course we want to encourage doctors to improve their performance, but under a for-profit system, doctors have cost pressures. That's sure not to encourage the results you want.”

During the forum, Rep. Kucinich contrasted his proposal with those offered by two other Democratic presidential candidates, Sen. Hillary Rodham Clinton (D-N.Y.) and former senator John Edwards (D-N.C.). Under their proposals, Americans would be required to purchase health insurance; they could choose from a variety of private health care plans as well as a public plan modeled after Medicare. “If you can't afford it under the current system, how are you going to afford it under [their] system?” he said. “And if you do buy it, you're forced into plans that inevitably are going to have extraordinary copays and deductibles, and a limited level of coverage,” he continued. But with his proposal, “I'm talking about a plan where everyone's covered, [and it] covers everything. And the fact is, we're already paying for it—we're just not getting it.”

He also said he was not concerned that a universal coverage plan would strain the system by having people who were previously without health insurance suddenly come in for lots of services.

“Years ago, when I was a city councilman in Cleveland, I had a proposal I thought would do a lot to protect the environment and move people around our community efficiently. I proposed free [public] transit,” he said. “And the people who attacked the idea threw up their arms and said, 'My God! If we have free transit, everyone's going to be riding the bus!' Exactly. That's what we want. You want people to use the health care system, so that they're healthy.”

'Is health care a right or a privilege? If it's a right, then it's appropriate for government to have a role.' REP. KUCINICH

WASHINGTON — Anyone who asks Rep. Dennis Kucinich (D-Ohio) about health care policy should be prepared for the conversation to evolve into other areas—like the Iraq war.

“Health care spending does not occur in a vacuum,” Rep. Kucinich said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “You cannot separate this from war.”

Rep. Kucinich, who is seeking the Democratic nomination for president, noted that money spent on the war in Iraq—an estimated $1.5 trillion, according to a report he cited from the Congressional Budget Office—is money not being spent on domestic concerns like education and health care. “As we speak, our government is planning to bomb Iran,” which will divert more money from health care concerns, he said at the forum, part of a series of forums with the presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

Although he sometimes connects health care policy with other topics, the fifth-term congressman and former mayor of Cleveland is very direct when it comes to universal health care coverage for Americans: He is the only candidate who supports a single-payer system financed by the government.

“Is health care a right or a privilege? If it's a right, then it's appropriate for the government to have a role” in providing it, he said. “If it's a privilege, and it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck. And you know what—47 million [uninsured] Americans are now out of luck.”

He noted that studies show health care debt is responsible for half of bankruptcies in the United States. “The median income is $48,000 per year, and some families are paying $12,000 a year for health insurance; that's a quarter of their gross. I'm talking about breaking the shackles insurance companies have on American families.”

Under Rep. Kucinich's proposal, which has been introduced in Congress as H.R. 676, all for-profit health care entities would be converted to nonprofit entities, with shareholders being compensated by the government. That compensation would be financed through Treasury bonds, he said. Physicians would continue to have private practices, but they, along with hospitals and other providers, would be paid by the federal government, which would disseminate federal funds through a series of regional budgets. There would also be separate budgets for capital expenditures and for medical education.

Coverage under Rep. Kucinich's plan would include inpatient and outpatient services as well as dental care, vision care, mental health care, and long-term care. There would be no deductibles or cost sharing.

When a reporter pointed out that other countries with government-financed health care ended up seeing a private system develop alongside the public one for those who could afford it, Rep. Kucinich said that was no surprise. “Privatizers are at work in every country,” he said. “If health care is such a losing proposition, why are these companies trying to privatize it? Because there's huge amounts of money to be made. But the minute you have a for-profit system, you're going to have people cut out of it.”

Another government-run system that people are trying to privatize is Medicare, Rep. Kucinich said. “Right now, Medicare is discouraging doctors by cutting their fees. There's a strategy to privatize Medicare by getting doctors to walk away from [it].” The passage of the Medicare prescription drug benefit was another part of that plan, he added.

A for-profit system puts the wrong type of pressure on physicians, Rep. Kucinich said in an interview after the forum. “Doctors are under pressure from private insurance not to provide health care,” he said. And when that collides with efforts such as Medicare's pay-for-performance initiative, “there's built-in inertia. Of course we want to encourage doctors to improve their performance, but under a for-profit system, doctors have cost pressures. That's sure not to encourage the results you want.”

During the forum, Rep. Kucinich contrasted his proposal with those offered by two other Democratic presidential candidates, Sen. Hillary Rodham Clinton (D-N.Y.) and former senator John Edwards (D-N.C.). Under their proposals, Americans would be required to purchase health insurance; they could choose from a variety of private health care plans as well as a public plan modeled after Medicare. “If you can't afford it under the current system, how are you going to afford it under [their] system?” he said. “And if you do buy it, you're forced into plans that inevitably are going to have extraordinary copays and deductibles, and a limited level of coverage,” he continued. But with his proposal, “I'm talking about a plan where everyone's covered, [and it] covers everything. And the fact is, we're already paying for it—we're just not getting it.”

He also said he was not concerned that a universal coverage plan would strain the system by having people who were previously without health insurance suddenly come in for lots of services.

“Years ago, when I was a city councilman in Cleveland, I had a proposal I thought would do a lot to protect the environment and move people around our community efficiently. I proposed free [public] transit,” he said. “And the people who attacked the idea threw up their arms and said, 'My God! If we have free transit, everyone's going to be riding the bus!' Exactly. That's what we want. You want people to use the health care system, so that they're healthy.”

'Is health care a right or a privilege? If it's a right, then it's appropriate for government to have a role.' REP. KUCINICH

WASHINGTON — Sen. Joseph R. Biden Jr. (D-Del.) will tell you right up front that health care would not be his top priority if he were elected president.

“Ending the war in Iraq will be my single highest priority, and preventing war in Iran will be one of my highest priorities as well,” the senator, a candidate for the Democratic presidential nomination, said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

That said, Sen. Biden, now in his sixth term, added that there is no reason he couldn't put several elements of his health care plan into motion in the first 6 months of his presidency.

Unlike Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.), Sen. Biden said he would not mandate that every citizen obtain health insurance. Instead, he would encourage employers to continue offering coverage by guaranteeing that the federal government would pay 75% of all costs for catastrophic health care that exceed $50,000 for an individual employee.

“The carrot is that [employers] get reinsurance, but the stick is they have to insure everybody,” he said at the forum, one in a series with presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

One reason politicians have backed away in recent years from proposing catastrophic health care coverage is that they remember what happened 20 years ago with the Medicare Catastrophic Coverage Act, the senator noted.

That law, signed by President Reagan in 1988, gave Medicare beneficiaries full coverage for hospital stays of any length after a $560 deductible for hospital costs and a $1,370 deductible for doctor bills. It was repealed in 1989 due to Medicare beneficiaries' concern over the additional premiums they would have to pay. But “that was a different world, and a lot has changed,” Sen. Biden said.

Another part of Sen. Biden's plan for the first 6 months of his administration would be getting all children covered. He would start by expanding the State Children's Health Insurance Program (SCHIP) to include children in families making up to $60,000 per year. “Anyone who thinks a couple who makes $60,000 a year and has four kids … is fat and happy and willing to spend $1,400 per month for health insurance, they ought to get out more,” the senator said.

Sen. Biden also proposes allowing the public to buy into the Federal Employees Health Benefits Program, even though he admits it may not be the best health insurance program available.

“My wife is a teacher, and when I was hospitalized, we used her insurance because it was better” than the federal employee health plan, he said. “Why not go out and pick a more perfect plan? The reason is, it's there, everybody understands it, and there's a sense of confidence about it—'If my senator has this, it must be good enough for me.'”

Using the federal employees' plan instead of another plan is an example of the kind of consensus-building that Sen. Biden said he hopes to do as president. “This is about whether or not you're going to be able to, as president, generate a national consensus, because if you're a Democrat, you're going to have to get 15%–20% of Republicans to vote for it; you can't do it with just Democrats. And you're going to have to be able to convince the American people that this is understandable.”

Another part of Sen. Biden's health care proposal includes letting anyone 55 years and older buy into Medicare. The government would provide subsidies for low-income citizens who couldn't afford to pay the Medicare premium.

He estimates the cost of all these proposals at $90-$110 billion annually, which he said can be partly achieved by rolling back tax breaks for the richest 1% of Americans, tax breaks “that they didn't ask for and don't need.” He would also eliminate tax breaks on capital gains and dividends, and end tax loopholes for hedge fund managers and private equity partners.

In addition to his health insurance proposal, Sen. Biden said he would like to see the federal government put more emphasis on prevention, although he admitted such an investment might not pay off for a while. “That's one reason I want to insure children at the front end,” he said. “You have children who don't have health insurance, and parents not being able to take them to a regular physician … they build up problems, so they end up being less healthy by [the] time they're 21 years old.”

Sen. Biden continued, “The whole notion is changing the paradigm—front end, costs; back end, significant savings. One of the problems with the mentality of American businesses and insurance companies is that they always think about the next quarter. Very seldom does anyone think about next year or 5 years or 7 years. If we're going to get these costs under control, it seems to me you've got to be investing now.”

Medicare costs will grow dramatically over the next decade, largely because the Baby Boom generation will be retiring, Sen. Biden said. He offered three suggestions for cutting Medicare costs.

First, “we should be reimbursing private insurers [who participate in the Medicare Advantage program] the same way we reimburse everyone else. We're reimbursing them about $10 billion a year beyond what we're reimbursing others.” Second, “being able to negotiate price relative to cost of drugs, like we do in the Veterans Administration, would significantly reduce the cost.” Third, if he can implement his plans for an increased focus on prevention, “by the time people hit the Medicare system who are now in their 30s and 40s, they'll have much more control of these chronic diseases.”

If other cost cuts are needed, “in the first year, I think I can cut the Defense Department by over $160 billion by ending the war in Iraq” and implementing other savings there, the senator said.

Medicare costs will grow dramatically over the next decade, largely because of Baby Boomers retiring. SEN. BIDEN

WASHINGTON — Sen. Joseph R. Biden Jr. (D-Del.) will tell you right up front that health care would not be his top priority if he were elected president.

“Ending the war in Iraq will be my single highest priority, and preventing war in Iran will be one of my highest priorities as well,” the senator, a candidate for the Democratic presidential nomination, said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

That said, Sen. Biden, now in his sixth term, added that there is no reason he couldn't put several elements of his health care plan into motion in the first 6 months of his presidency.

Unlike Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.), Sen. Biden said he would not mandate that every citizen obtain health insurance. Instead, he would encourage employers to continue offering coverage by guaranteeing that the federal government would pay 75% of all costs for catastrophic health care that exceed $50,000 for an individual employee.

“The carrot is that [employers] get reinsurance, but the stick is they have to insure everybody,” he said at the forum, one in a series with presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

One reason politicians have backed away in recent years from proposing catastrophic health care coverage is that they remember what happened 20 years ago with the Medicare Catastrophic Coverage Act, the senator noted.

That law, signed by President Reagan in 1988, gave Medicare beneficiaries full coverage for hospital stays of any length after a $560 deductible for hospital costs and a $1,370 deductible for doctor bills. It was repealed in 1989 due to Medicare beneficiaries' concern over the additional premiums they would have to pay. But “that was a different world, and a lot has changed,” Sen. Biden said.

Another part of Sen. Biden's plan for the first 6 months of his administration would be getting all children covered. He would start by expanding the State Children's Health Insurance Program (SCHIP) to include children in families making up to $60,000 per year. “Anyone who thinks a couple who makes $60,000 a year and has four kids … is fat and happy and willing to spend $1,400 per month for health insurance, they ought to get out more,” the senator said.

Sen. Biden also proposes allowing the public to buy into the Federal Employees Health Benefits Program, even though he admits it may not be the best health insurance program available.

“My wife is a teacher, and when I was hospitalized, we used her insurance because it was better” than the federal employee health plan, he said. “Why not go out and pick a more perfect plan? The reason is, it's there, everybody understands it, and there's a sense of confidence about it—'If my senator has this, it must be good enough for me.'”

Using the federal employees' plan instead of another plan is an example of the kind of consensus-building that Sen. Biden said he hopes to do as president. “This is about whether or not you're going to be able to, as president, generate a national consensus, because if you're a Democrat, you're going to have to get 15%–20% of Republicans to vote for it; you can't do it with just Democrats. And you're going to have to be able to convince the American people that this is understandable.”

Another part of Sen. Biden's health care proposal includes letting anyone 55 years and older buy into Medicare. The government would provide subsidies for low-income citizens who couldn't afford to pay the Medicare premium.

He estimates the cost of all these proposals at $90-$110 billion annually, which he said can be partly achieved by rolling back tax breaks for the richest 1% of Americans, tax breaks “that they didn't ask for and don't need.” He would also eliminate tax breaks on capital gains and dividends, and end tax loopholes for hedge fund managers and private equity partners.

In addition to his health insurance proposal, Sen. Biden said he would like to see the federal government put more emphasis on prevention, although he admitted such an investment might not pay off for a while. “That's one reason I want to insure children at the front end,” he said. “You have children who don't have health insurance, and parents not being able to take them to a regular physician … they build up problems, so they end up being less healthy by [the] time they're 21 years old.”

Sen. Biden continued, “The whole notion is changing the paradigm—front end, costs; back end, significant savings. One of the problems with the mentality of American businesses and insurance companies is that they always think about the next quarter. Very seldom does anyone think about next year or 5 years or 7 years. If we're going to get these costs under control, it seems to me you've got to be investing now.”

Medicare costs will grow dramatically over the next decade, largely because the Baby Boom generation will be retiring, Sen. Biden said. He offered three suggestions for cutting Medicare costs.

First, “we should be reimbursing private insurers [who participate in the Medicare Advantage program] the same way we reimburse everyone else. We're reimbursing them about $10 billion a year beyond what we're reimbursing others.” Second, “being able to negotiate price relative to cost of drugs, like we do in the Veterans Administration, would significantly reduce the cost.” Third, if he can implement his plans for an increased focus on prevention, “by the time people hit the Medicare system who are now in their 30s and 40s, they'll have much more control of these chronic diseases.”

If other cost cuts are needed, “in the first year, I think I can cut the Defense Department by over $160 billion by ending the war in Iraq” and implementing other savings there, the senator said.

Medicare costs will grow dramatically over the next decade, largely because of Baby Boomers retiring. SEN. BIDEN

WASHINGTON — Sen. Joseph R. Biden Jr. (D-Del.) will tell you right up front that health care would not be his top priority if he were elected president.

“Ending the war in Iraq will be my single highest priority, and preventing war in Iran will be one of my highest priorities as well,” the senator, a candidate for the Democratic presidential nomination, said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

That said, Sen. Biden, now in his sixth term, added that there is no reason he couldn't put several elements of his health care plan into motion in the first 6 months of his presidency.

Unlike Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.), Sen. Biden said he would not mandate that every citizen obtain health insurance. Instead, he would encourage employers to continue offering coverage by guaranteeing that the federal government would pay 75% of all costs for catastrophic health care that exceed $50,000 for an individual employee.

“The carrot is that [employers] get reinsurance, but the stick is they have to insure everybody,” he said at the forum, one in a series with presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

One reason politicians have backed away in recent years from proposing catastrophic health care coverage is that they remember what happened 20 years ago with the Medicare Catastrophic Coverage Act, the senator noted.

That law, signed by President Reagan in 1988, gave Medicare beneficiaries full coverage for hospital stays of any length after a $560 deductible for hospital costs and a $1,370 deductible for doctor bills. It was repealed in 1989 due to Medicare beneficiaries' concern over the additional premiums they would have to pay. But “that was a different world, and a lot has changed,” Sen. Biden said.

Another part of Sen. Biden's plan for the first 6 months of his administration would be getting all children covered. He would start by expanding the State Children's Health Insurance Program (SCHIP) to include children in families making up to $60,000 per year. “Anyone who thinks a couple who makes $60,000 a year and has four kids … is fat and happy and willing to spend $1,400 per month for health insurance, they ought to get out more,” the senator said.

Sen. Biden also proposes allowing the public to buy into the Federal Employees Health Benefits Program, even though he admits it may not be the best health insurance program available.

“My wife is a teacher, and when I was hospitalized, we used her insurance because it was better” than the federal employee health plan, he said. “Why not go out and pick a more perfect plan? The reason is, it's there, everybody understands it, and there's a sense of confidence about it—'If my senator has this, it must be good enough for me.'”

Using the federal employees' plan instead of another plan is an example of the kind of consensus-building that Sen. Biden said he hopes to do as president. “This is about whether or not you're going to be able to, as president, generate a national consensus, because if you're a Democrat, you're going to have to get 15%–20% of Republicans to vote for it; you can't do it with just Democrats. And you're going to have to be able to convince the American people that this is understandable.”

Another part of Sen. Biden's health care proposal includes letting anyone 55 years and older buy into Medicare. The government would provide subsidies for low-income citizens who couldn't afford to pay the Medicare premium.

He estimates the cost of all these proposals at $90-$110 billion annually, which he said can be partly achieved by rolling back tax breaks for the richest 1% of Americans, tax breaks “that they didn't ask for and don't need.” He would also eliminate tax breaks on capital gains and dividends, and end tax loopholes for hedge fund managers and private equity partners.

In addition to his health insurance proposal, Sen. Biden said he would like to see the federal government put more emphasis on prevention, although he admitted such an investment might not pay off for a while. “That's one reason I want to insure children at the front end,” he said. “You have children who don't have health insurance, and parents not being able to take them to a regular physician … they build up problems, so they end up being less healthy by [the] time they're 21 years old.”

Sen. Biden continued, “The whole notion is changing the paradigm—front end, costs; back end, significant savings. One of the problems with the mentality of American businesses and insurance companies is that they always think about the next quarter. Very seldom does anyone think about next year or 5 years or 7 years. If we're going to get these costs under control, it seems to me you've got to be investing now.”

Medicare costs will grow dramatically over the next decade, largely because the Baby Boom generation will be retiring, Sen. Biden said. He offered three suggestions for cutting Medicare costs.

First, “we should be reimbursing private insurers [who participate in the Medicare Advantage program] the same way we reimburse everyone else. We're reimbursing them about $10 billion a year beyond what we're reimbursing others.” Second, “being able to negotiate price relative to cost of drugs, like we do in the Veterans Administration, would significantly reduce the cost.” Third, if he can implement his plans for an increased focus on prevention, “by the time people hit the Medicare system who are now in their 30s and 40s, they'll have much more control of these chronic diseases.”

If other cost cuts are needed, “in the first year, I think I can cut the Defense Department by over $160 billion by ending the war in Iraq” and implementing other savings there, the senator said.

Medicare costs will grow dramatically over the next decade, largely because of Baby Boomers retiring. SEN. BIDEN

Senator John McCain (R-Ariz.) doesn't think there should be a mandate to have health insurance. “I think one of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

“The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. He added, however, that some people with chronic illnesses or preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them.”

Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “I'm not going to force Americans to do it; I don't think that's the role of government,” he said. “But if we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [insurance]. The panacea isn't all just health care costs, but unless you address health care costs, you're never going to solve the other aspects of the health care crisis.”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure—the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results. That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

Sen. McCain proposes a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance. To pay for the credits—which would cost an estimated $3.5 trillion over 10 years—he proposes abolishing the tax deduction employees take when they pay premiums on their employer-sponsored health plans. He would leave intact the deduction employers take on their portion of the premiums as an incentive for employers to continue offering coverage.

The “refundable tax credit for employees [allows] them to go out and make choices,” Sen. McCain said. “When it's their money and their decision, I think they make much wiser decisions than when it's provided by somebody else.” Low-income Americans who pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost for family health insurance is more than $12,000 per year—far higher than the amount of the proposed family tax credit—Sen. McCain said the credit still would be beneficial. “If someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said. Additionally, “For low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher. But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.”

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does.” Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents. “I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

The senator said in an interview that he favors reforms to the malpractice system. “I would like to see that any medical provider or doctor who stayed within medical guidelines would then not be sued.” Sen. McCain also noted that although he is against abortion, “I think stem cell research holds great promise in addressing some of these terrible afflictions that face our nation and the world, such as Alzheimer's and Parkinson's.”

A very large portion of the uninsured are healthy young Americans who simply choose not to sign up for it. SEN. MCCAIN

Senator John McCain (R-Ariz.) doesn't think there should be a mandate to have health insurance. “I think one of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

“The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. He added, however, that some people with chronic illnesses or preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them.”

Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “I'm not going to force Americans to do it; I don't think that's the role of government,” he said. “But if we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [insurance]. The panacea isn't all just health care costs, but unless you address health care costs, you're never going to solve the other aspects of the health care crisis.”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure—the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results. That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

Sen. McCain proposes a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance. To pay for the credits—which would cost an estimated $3.5 trillion over 10 years—he proposes abolishing the tax deduction employees take when they pay premiums on their employer-sponsored health plans. He would leave intact the deduction employers take on their portion of the premiums as an incentive for employers to continue offering coverage.

The “refundable tax credit for employees [allows] them to go out and make choices,” Sen. McCain said. “When it's their money and their decision, I think they make much wiser decisions than when it's provided by somebody else.” Low-income Americans who pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost for family health insurance is more than $12,000 per year—far higher than the amount of the proposed family tax credit—Sen. McCain said the credit still would be beneficial. “If someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said. Additionally, “For low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher. But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.”

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does.” Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents. “I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

The senator said in an interview that he favors reforms to the malpractice system. “I would like to see that any medical provider or doctor who stayed within medical guidelines would then not be sued.” Sen. McCain also noted that although he is against abortion, “I think stem cell research holds great promise in addressing some of these terrible afflictions that face our nation and the world, such as Alzheimer's and Parkinson's.”

A very large portion of the uninsured are healthy young Americans who simply choose not to sign up for it. SEN. MCCAIN

Senator John McCain (R-Ariz.) doesn't think there should be a mandate to have health insurance. “I think one of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

“The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. He added, however, that some people with chronic illnesses or preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them.”

Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “I'm not going to force Americans to do it; I don't think that's the role of government,” he said. “But if we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [insurance]. The panacea isn't all just health care costs, but unless you address health care costs, you're never going to solve the other aspects of the health care crisis.”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure—the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results. That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

Sen. McCain proposes a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance. To pay for the credits—which would cost an estimated $3.5 trillion over 10 years—he proposes abolishing the tax deduction employees take when they pay premiums on their employer-sponsored health plans. He would leave intact the deduction employers take on their portion of the premiums as an incentive for employers to continue offering coverage.

The “refundable tax credit for employees [allows] them to go out and make choices,” Sen. McCain said. “When it's their money and their decision, I think they make much wiser decisions than when it's provided by somebody else.” Low-income Americans who pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost for family health insurance is more than $12,000 per year—far higher than the amount of the proposed family tax credit—Sen. McCain said the credit still would be beneficial. “If someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said. Additionally, “For low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher. But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.”

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does.” Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents. “I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

The senator said in an interview that he favors reforms to the malpractice system. “I would like to see that any medical provider or doctor who stayed within medical guidelines would then not be sued.” Sen. McCain also noted that although he is against abortion, “I think stem cell research holds great promise in addressing some of these terrible afflictions that face our nation and the world, such as Alzheimer's and Parkinson's.”

A very large portion of the uninsured are healthy young Americans who simply choose not to sign up for it. SEN. MCCAIN

WASHINGTON — Sen. Joseph R. Biden Jr. (D-Del.) will tell you right up front that health care would not be his top priority if he were elected president.

“Ending the war in Iraq will be my single highest priority, and preventing war in Iran will be one of my highest priorities as well,” the senator, a candidate for the Democratic presidential nomination, said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

That said, Sen. Biden, now in his sixth term, added that unlike Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.), he would not mandate health insurance. Instead, he would encourage employers to continue offering coverage by guaranteeing the federal government would pay 75% of all costs for catastrophic health care that exceed $50,000 for an employee.

“The carrot is that [employers] get reinsurance, but the stick is they have to insure everybody,” he said at the forum, one in a series with presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

One reason politicians have backed away in recent years from proposing catastrophic health care coverage is that they remember what happened 20 years ago with the Medicare Catastrophic Coverage Act, the senator noted.

That law, signed by President Reagan in 1988, gave Medicare beneficiaries full coverage for hospital stays of any length after a $560 deductible for hospital costs and a $1,370 deductible for doctor bills. It was repealed in 1989 due to Medicare beneficiaries' concern over the additional premiums they would have to pay. But “that was a different world, and a lot has changed,” Sen. Biden said.

Another part of Sen. Biden's plan would be to expand the State Children's Health Insurance Program (SCHIP) to include children in families making up to $60,000 per year. “Anyone who thinks a couple who makes $60,000 a year and has four kids … is fat and happy and willing to spend $1,400 per month for health insurance, they ought to get out more,” he said.

Sen. Biden also proposes allowing the public to buy into the Federal Employees Health Benefits Program, even though he admits it may not be the best health insurance program available. “My wife is a teacher, and when I was hospitalized, we used her insurance because it was better” than the federal employee health plan, he said. “Why not go out and pick a more perfect plan? The reason is, it's there, everybody understands it, and there's a sense of confidence about it—'If my senator has this, it must be good enough for me.'”

Sen. Biden would also let anyone 55 years and older buy into Medicare. The government would provide subsidies for low-income citizens who couldn't afford to pay the Medicare premium.

He estimates the cost of his proposals at $90–$110 billion a year, to be partly achieved by rolling back tax breaks for the richest 1% of Americans. He would also halt tax breaks on capital gains and dividends, and end tax loopholes for hedge fund managers and private equity partners.

In addition to his health insurance proposal, Sen. Biden said he would like to see the federal government put more emphasis on prevention, although he admitted such an investment might not pay off for a while. “That's one reason I want to insure children at the front end,” he said. “You have children who don't have health insurance, and parents not being able to take them to a regular physician … they build up problems, so they end up being less healthy by [the] time they're 21 years old.”

Sen. Biden continued, “The whole notion is changing the paradigm—front end, costs; back end, significant savings. One of the problems with the mentality of American businesses and insurance companies is that they always think about the next quarter. Very seldom does anyone think about next year or 5 years or 7 years. If we're going to get these costs under control, it seems to me you've got to be investing now.”

Sen. Biden offered three suggestions for cutting Medicare costs.

First, “we should be reimbursing private insurers [who participate in the Medicare Advantage program] the same way we reimburse everyone else. We're reimbursing them about $10 billion a year beyond what we're reimbursing others.” Second, “being able to negotiate price relative to cost of drugs, like we do in the Veterans Administration, would significantly reduce the cost.” Third, if he can implement his plans for an increased focus on prevention, “by the time people hit the Medicare system who are now in their 30s and 40s, they'll have much more control of these chronic diseases.”

If other cost cuts are needed, “in the first year, I think I can cut the Defense Department by over $160 billion by ending the war in Iraq” and implementing other savings there, the senator said.

Sen. Joseph R. Biden Jr.

WASHINGTON — Sen. Joseph R. Biden Jr. (D-Del.) will tell you right up front that health care would not be his top priority if he were elected president.

“Ending the war in Iraq will be my single highest priority, and preventing war in Iran will be one of my highest priorities as well,” the senator, a candidate for the Democratic presidential nomination, said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

That said, Sen. Biden, now in his sixth term, added that unlike Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.), he would not mandate health insurance. Instead, he would encourage employers to continue offering coverage by guaranteeing the federal government would pay 75% of all costs for catastrophic health care that exceed $50,000 for an employee.

“The carrot is that [employers] get reinsurance, but the stick is they have to insure everybody,” he said at the forum, one in a series with presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

One reason politicians have backed away in recent years from proposing catastrophic health care coverage is that they remember what happened 20 years ago with the Medicare Catastrophic Coverage Act, the senator noted.

That law, signed by President Reagan in 1988, gave Medicare beneficiaries full coverage for hospital stays of any length after a $560 deductible for hospital costs and a $1,370 deductible for doctor bills. It was repealed in 1989 due to Medicare beneficiaries' concern over the additional premiums they would have to pay. But “that was a different world, and a lot has changed,” Sen. Biden said.

Another part of Sen. Biden's plan would be to expand the State Children's Health Insurance Program (SCHIP) to include children in families making up to $60,000 per year. “Anyone who thinks a couple who makes $60,000 a year and has four kids … is fat and happy and willing to spend $1,400 per month for health insurance, they ought to get out more,” he said.

Sen. Biden also proposes allowing the public to buy into the Federal Employees Health Benefits Program, even though he admits it may not be the best health insurance program available. “My wife is a teacher, and when I was hospitalized, we used her insurance because it was better” than the federal employee health plan, he said. “Why not go out and pick a more perfect plan? The reason is, it's there, everybody understands it, and there's a sense of confidence about it—'If my senator has this, it must be good enough for me.'”

Sen. Biden would also let anyone 55 years and older buy into Medicare. The government would provide subsidies for low-income citizens who couldn't afford to pay the Medicare premium.

He estimates the cost of his proposals at $90–$110 billion a year, to be partly achieved by rolling back tax breaks for the richest 1% of Americans. He would also halt tax breaks on capital gains and dividends, and end tax loopholes for hedge fund managers and private equity partners.

In addition to his health insurance proposal, Sen. Biden said he would like to see the federal government put more emphasis on prevention, although he admitted such an investment might not pay off for a while. “That's one reason I want to insure children at the front end,” he said. “You have children who don't have health insurance, and parents not being able to take them to a regular physician … they build up problems, so they end up being less healthy by [the] time they're 21 years old.”

Sen. Biden continued, “The whole notion is changing the paradigm—front end, costs; back end, significant savings. One of the problems with the mentality of American businesses and insurance companies is that they always think about the next quarter. Very seldom does anyone think about next year or 5 years or 7 years. If we're going to get these costs under control, it seems to me you've got to be investing now.”

Sen. Biden offered three suggestions for cutting Medicare costs.

First, “we should be reimbursing private insurers [who participate in the Medicare Advantage program] the same way we reimburse everyone else. We're reimbursing them about $10 billion a year beyond what we're reimbursing others.” Second, “being able to negotiate price relative to cost of drugs, like we do in the Veterans Administration, would significantly reduce the cost.” Third, if he can implement his plans for an increased focus on prevention, “by the time people hit the Medicare system who are now in their 30s and 40s, they'll have much more control of these chronic diseases.”

If other cost cuts are needed, “in the first year, I think I can cut the Defense Department by over $160 billion by ending the war in Iraq” and implementing other savings there, the senator said.

Sen. Joseph R. Biden Jr.

WASHINGTON — Sen. Joseph R. Biden Jr. (D-Del.) will tell you right up front that health care would not be his top priority if he were elected president.

“Ending the war in Iraq will be my single highest priority, and preventing war in Iran will be one of my highest priorities as well,” the senator, a candidate for the Democratic presidential nomination, said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

That said, Sen. Biden, now in his sixth term, added that unlike Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.), he would not mandate health insurance. Instead, he would encourage employers to continue offering coverage by guaranteeing the federal government would pay 75% of all costs for catastrophic health care that exceed $50,000 for an employee.

“The carrot is that [employers] get reinsurance, but the stick is they have to insure everybody,” he said at the forum, one in a series with presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

One reason politicians have backed away in recent years from proposing catastrophic health care coverage is that they remember what happened 20 years ago with the Medicare Catastrophic Coverage Act, the senator noted.

That law, signed by President Reagan in 1988, gave Medicare beneficiaries full coverage for hospital stays of any length after a $560 deductible for hospital costs and a $1,370 deductible for doctor bills. It was repealed in 1989 due to Medicare beneficiaries' concern over the additional premiums they would have to pay. But “that was a different world, and a lot has changed,” Sen. Biden said.

Another part of Sen. Biden's plan would be to expand the State Children's Health Insurance Program (SCHIP) to include children in families making up to $60,000 per year. “Anyone who thinks a couple who makes $60,000 a year and has four kids … is fat and happy and willing to spend $1,400 per month for health insurance, they ought to get out more,” he said.

Sen. Biden also proposes allowing the public to buy into the Federal Employees Health Benefits Program, even though he admits it may not be the best health insurance program available. “My wife is a teacher, and when I was hospitalized, we used her insurance because it was better” than the federal employee health plan, he said. “Why not go out and pick a more perfect plan? The reason is, it's there, everybody understands it, and there's a sense of confidence about it—'If my senator has this, it must be good enough for me.'”

Sen. Biden would also let anyone 55 years and older buy into Medicare. The government would provide subsidies for low-income citizens who couldn't afford to pay the Medicare premium.

He estimates the cost of his proposals at $90–$110 billion a year, to be partly achieved by rolling back tax breaks for the richest 1% of Americans. He would also halt tax breaks on capital gains and dividends, and end tax loopholes for hedge fund managers and private equity partners.

In addition to his health insurance proposal, Sen. Biden said he would like to see the federal government put more emphasis on prevention, although he admitted such an investment might not pay off for a while. “That's one reason I want to insure children at the front end,” he said. “You have children who don't have health insurance, and parents not being able to take them to a regular physician … they build up problems, so they end up being less healthy by [the] time they're 21 years old.”

Sen. Biden continued, “The whole notion is changing the paradigm—front end, costs; back end, significant savings. One of the problems with the mentality of American businesses and insurance companies is that they always think about the next quarter. Very seldom does anyone think about next year or 5 years or 7 years. If we're going to get these costs under control, it seems to me you've got to be investing now.”

Sen. Biden offered three suggestions for cutting Medicare costs.

First, “we should be reimbursing private insurers [who participate in the Medicare Advantage program] the same way we reimburse everyone else. We're reimbursing them about $10 billion a year beyond what we're reimbursing others.” Second, “being able to negotiate price relative to cost of drugs, like we do in the Veterans Administration, would significantly reduce the cost.” Third, if he can implement his plans for an increased focus on prevention, “by the time people hit the Medicare system who are now in their 30s and 40s, they'll have much more control of these chronic diseases.”

If other cost cuts are needed, “in the first year, I think I can cut the Defense Department by over $160 billion by ending the war in Iraq” and implementing other savings there, the senator said.

Sen. Joseph R. Biden Jr.

WASHINGTON — Anyone who asks Rep. Dennis Kucinich (D-Ohio) about health care policy should be prepared for the conversation to evolve into other areas—like the Iraq war.

“Health care spending does not occur in a vacuum,” Rep. Kucinich said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “You cannot separate this from war.”

Rep. Kucinich, who is seeking the Democratic nomination for president, noted that money spent on the war in Iraq—an estimated $1.5 trillion, according to a report he cited from the Congressional Budget Office—is money not being spent on domestic concerns like education and health care. He was speaking at the forum, part of a series of forums with the presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

Although he sometimes connects health care policy with other topics, the fifth-term congressman and former mayor of Cleveland is very direct when it comes to universal health care coverage for Americans: He is the only candidate who supports a single-payer system financed by the government.

“Is health care a right or a privilege? If it's a right, then it's appropriate for the government to have a role” in providing it, he said. “If it's a privilege, and it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck. And you know what—47 million [uninsured] Americans are now out of luck.”

He noted that studies show health care debt is responsible for half of bankruptcies in the United States. “The median income is $48,000 per year, and some families are paying $12,000 a year for health insurance; that's a quarter of their gross. I'm talking about breaking the shackles insurance companies have on American families.”

Under Rep. Kucinich's proposal, which has been introduced in Congress as H.R. 676, all for-profit health care entities would be converted to nonprofit entities, with shareholders being compensated by the government. That compensation would be financed through Treasury bonds, he said. Physicians would continue to have private practices, but they, along with hospitals and other providers, would be paid by the federal government, which would disseminate federal funds through a series of regional budgets. There would also be separate budgets for capital expenditures and for medical education.

Coverage under Rep. Kucinich's plan would include inpatient and outpatient services as well as dental care, vision care, mental health care, and long-term care. There would be no deductibles or cost sharing.

When a reporter pointed out that other countries with government-financed health care ended up seeing a private system develop alongside the public one for those who could afford it, Rep. Kucinich said that was no surprise. “Privatizers are at work in every country,” he said. “But the minute you have a for-profit system, you're going to have people cut out of it.”

Another government-run system that people are trying to privatize is Medicare, Rep. Kucinich said. “Right now, Medicare is discouraging doctors by cutting their fees. There's a strategy to privatize Medicare by getting doctors to walk away from [it].”

The passage of the Medicare prescription drug benefit was another part of that plan, he added.

A for-profit system puts the wrong type of pressure on physicians, Rep. Kucinich said in an interview after the forum. “Doctors are under pressure from private insurance not to provide health care,” he said. And when that collides with efforts such as Medicare's pay-for-performance initiative, “there's built-in inertia. Of course we want to encourage doctors to improve their performance, but under a for-profit system, doctors have cost pressures. That's sure not to encourage the results you want.”

During the forum, Rep. Kucinich contrasted his proposal with those offered by two other Democratic candidates, Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.). Under their proposals, Americans would be required to purchase health insurance; they could choose from a variety of private health care plans as well as a public plan modeled after Medicare. “If you can't afford it under the current system, how are you going to afford it under [their] system?” he said. “I'm talking about a plan where everyone's covered, [and it] covers everything. And the fact is, we're already paying for it—we're just not getting it.”

'The minute you have a for-profit system, you're going to have people cut out of it.' REP. KUCINICH

WASHINGTON — Anyone who asks Rep. Dennis Kucinich (D-Ohio) about health care policy should be prepared for the conversation to evolve into other areas—like the Iraq war.

“Health care spending does not occur in a vacuum,” Rep. Kucinich said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “You cannot separate this from war.”

Rep. Kucinich, who is seeking the Democratic nomination for president, noted that money spent on the war in Iraq—an estimated $1.5 trillion, according to a report he cited from the Congressional Budget Office—is money not being spent on domestic concerns like education and health care. He was speaking at the forum, part of a series of forums with the presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

Although he sometimes connects health care policy with other topics, the fifth-term congressman and former mayor of Cleveland is very direct when it comes to universal health care coverage for Americans: He is the only candidate who supports a single-payer system financed by the government.

“Is health care a right or a privilege? If it's a right, then it's appropriate for the government to have a role” in providing it, he said. “If it's a privilege, and it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck. And you know what—47 million [uninsured] Americans are now out of luck.”

He noted that studies show health care debt is responsible for half of bankruptcies in the United States. “The median income is $48,000 per year, and some families are paying $12,000 a year for health insurance; that's a quarter of their gross. I'm talking about breaking the shackles insurance companies have on American families.”

Under Rep. Kucinich's proposal, which has been introduced in Congress as H.R. 676, all for-profit health care entities would be converted to nonprofit entities, with shareholders being compensated by the government. That compensation would be financed through Treasury bonds, he said. Physicians would continue to have private practices, but they, along with hospitals and other providers, would be paid by the federal government, which would disseminate federal funds through a series of regional budgets. There would also be separate budgets for capital expenditures and for medical education.

Coverage under Rep. Kucinich's plan would include inpatient and outpatient services as well as dental care, vision care, mental health care, and long-term care. There would be no deductibles or cost sharing.

When a reporter pointed out that other countries with government-financed health care ended up seeing a private system develop alongside the public one for those who could afford it, Rep. Kucinich said that was no surprise. “Privatizers are at work in every country,” he said. “But the minute you have a for-profit system, you're going to have people cut out of it.”

Another government-run system that people are trying to privatize is Medicare, Rep. Kucinich said. “Right now, Medicare is discouraging doctors by cutting their fees. There's a strategy to privatize Medicare by getting doctors to walk away from [it].”

The passage of the Medicare prescription drug benefit was another part of that plan, he added.

A for-profit system puts the wrong type of pressure on physicians, Rep. Kucinich said in an interview after the forum. “Doctors are under pressure from private insurance not to provide health care,” he said. And when that collides with efforts such as Medicare's pay-for-performance initiative, “there's built-in inertia. Of course we want to encourage doctors to improve their performance, but under a for-profit system, doctors have cost pressures. That's sure not to encourage the results you want.”

During the forum, Rep. Kucinich contrasted his proposal with those offered by two other Democratic candidates, Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.). Under their proposals, Americans would be required to purchase health insurance; they could choose from a variety of private health care plans as well as a public plan modeled after Medicare. “If you can't afford it under the current system, how are you going to afford it under [their] system?” he said. “I'm talking about a plan where everyone's covered, [and it] covers everything. And the fact is, we're already paying for it—we're just not getting it.”

'The minute you have a for-profit system, you're going to have people cut out of it.' REP. KUCINICH

WASHINGTON — Anyone who asks Rep. Dennis Kucinich (D-Ohio) about health care policy should be prepared for the conversation to evolve into other areas—like the Iraq war.

“Health care spending does not occur in a vacuum,” Rep. Kucinich said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “You cannot separate this from war.”

Rep. Kucinich, who is seeking the Democratic nomination for president, noted that money spent on the war in Iraq—an estimated $1.5 trillion, according to a report he cited from the Congressional Budget Office—is money not being spent on domestic concerns like education and health care. He was speaking at the forum, part of a series of forums with the presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

Although he sometimes connects health care policy with other topics, the fifth-term congressman and former mayor of Cleveland is very direct when it comes to universal health care coverage for Americans: He is the only candidate who supports a single-payer system financed by the government.

“Is health care a right or a privilege? If it's a right, then it's appropriate for the government to have a role” in providing it, he said. “If it's a privilege, and it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck. And you know what—47 million [uninsured] Americans are now out of luck.”

He noted that studies show health care debt is responsible for half of bankruptcies in the United States. “The median income is $48,000 per year, and some families are paying $12,000 a year for health insurance; that's a quarter of their gross. I'm talking about breaking the shackles insurance companies have on American families.”

Under Rep. Kucinich's proposal, which has been introduced in Congress as H.R. 676, all for-profit health care entities would be converted to nonprofit entities, with shareholders being compensated by the government. That compensation would be financed through Treasury bonds, he said. Physicians would continue to have private practices, but they, along with hospitals and other providers, would be paid by the federal government, which would disseminate federal funds through a series of regional budgets. There would also be separate budgets for capital expenditures and for medical education.

Coverage under Rep. Kucinich's plan would include inpatient and outpatient services as well as dental care, vision care, mental health care, and long-term care. There would be no deductibles or cost sharing.

When a reporter pointed out that other countries with government-financed health care ended up seeing a private system develop alongside the public one for those who could afford it, Rep. Kucinich said that was no surprise. “Privatizers are at work in every country,” he said. “But the minute you have a for-profit system, you're going to have people cut out of it.”

Another government-run system that people are trying to privatize is Medicare, Rep. Kucinich said. “Right now, Medicare is discouraging doctors by cutting their fees. There's a strategy to privatize Medicare by getting doctors to walk away from [it].”

The passage of the Medicare prescription drug benefit was another part of that plan, he added.

A for-profit system puts the wrong type of pressure on physicians, Rep. Kucinich said in an interview after the forum. “Doctors are under pressure from private insurance not to provide health care,” he said. And when that collides with efforts such as Medicare's pay-for-performance initiative, “there's built-in inertia. Of course we want to encourage doctors to improve their performance, but under a for-profit system, doctors have cost pressures. That's sure not to encourage the results you want.”

During the forum, Rep. Kucinich contrasted his proposal with those offered by two other Democratic candidates, Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.). Under their proposals, Americans would be required to purchase health insurance; they could choose from a variety of private health care plans as well as a public plan modeled after Medicare. “If you can't afford it under the current system, how are you going to afford it under [their] system?” he said. “I'm talking about a plan where everyone's covered, [and it] covers everything. And the fact is, we're already paying for it—we're just not getting it.”

'The minute you have a for-profit system, you're going to have people cut out of it.' REP. KUCINICH

For Sen. John McCain (R-Ariz.), having health insurance is desirable but not mandatory.

“I don't think there should be a mandate for every American to have health insurance,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

“I think one of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans,” he said.

As Sen. McCain sees it, health insurance is something many people decide they don't want. “The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

He added, however, that some people with chronic illnesses and other preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them, including additional trust funds for Medicaid payments [for people] who need this kind of coverage.”

Instead of mandating that people have health insurance, Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “I'm not going to force Americans to do it; I don't think that's the role of government,” he said.

“But if we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [health insurance]. The panacea isn't all just health care costs, but unless you address health care costs, you're never going to solve the other aspects of the health care crisis.”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure–the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results.

“That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

To expand access to health insurance, Sen. McCain is proposing a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance policies.

To pay for the tax credits–which would cost the government an estimated $3.5 trillion over 10 years–he proposes abolishing the tax deduction that employees currently take when they pay premiums on their employer-sponsored health plans. He would, however, leave intact the deduction that employers currently take on their portion of the premiums as an incentive for employers to continue offering coverage.

“The important thing about the … refundable tax credit for employees is for them to go out and make choices,” Sen. McCain said during the forum.

“When it's their money and their decision, I think they make much wiser decisions than when it's provided by somebody else.” And because the tax credit is refundable, low-income Americans who currently pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost of a family health insurance policy is more than $12,000 per year–far higher than the amount of the proposed family tax credit–Sen. McCain said the credit still would be beneficial.

“One thing it does is if someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said.

“Another thing it does that I think is very important is that for low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted that the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher.

“But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.”

The senator said he did not have an estimate of how many uninsured people would be able to buy health insurance coverage because of the tax credit.

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does and that would be obviously something that I would not approve of.”

Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents.

“I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

Sen. McCain also said he hoped the tax credit plan would encourage more people to open health savings accounts (HSAs).

“I think they are a good idea,” he said. But he does not think that health savings accounts have received as much attention as they should get.

“Rightly or wrongly, HSAs are viewed by most Americans as something for rich people. But if you can only use that refundable tax credit for purchasing health insurance or HSAs, I think you may see a stimulus in that; at least, I believe that's a strong possibility.”

On another front, the senator said in an interview that he favors reforms to the malpractice system.

“I would like to see that any medical provider or doctor who stayed within medical guidelines would then not be sued. Right now, it's a lottery for trial lawyers.”

He is in favor of damage caps, “but more importantly, I've opposed punitive damages. … Punitive damages are something that I have not supported in anything.”

Sen. McCain also noted that although he is against abortion, “after a lot of agonizing thought and consultation, I believe in stem cell research. I think stem cell research holds great promise in addressing some of these terrible afflictions that face our nation and the world, such as Alzheimer's and Parkinson's.”

A large portion of the 47 million Americans who are without health insurance choose not to sign up. SEN. MCCAIN

Editor's Note

This look at the health care proposals of Sen. John McCain (R-Ariz.) is the first in an occasional series highlighting the health policy views of those seeking to be our next president. Each article is based on a 1-hour health policy forum with an individual candidate held at the Kaiser Family Foundation in Washington, and sponsored by Families USA and the Federation of American Hospitals.

For Sen. John McCain (R-Ariz.), having health insurance is desirable but not mandatory.

“I don't think there should be a mandate for every American to have health insurance,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

“I think one of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans,” he said.

As Sen. McCain sees it, health insurance is something many people decide they don't want. “The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

He added, however, that some people with chronic illnesses and other preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them, including additional trust funds for Medicaid payments [for people] who need this kind of coverage.”

Instead of mandating that people have health insurance, Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “I'm not going to force Americans to do it; I don't think that's the role of government,” he said.

“But if we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [health insurance]. The panacea isn't all just health care costs, but unless you address health care costs, you're never going to solve the other aspects of the health care crisis.”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure–the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results.

“That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

To expand access to health insurance, Sen. McCain is proposing a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance policies.

To pay for the tax credits–which would cost the government an estimated $3.5 trillion over 10 years–he proposes abolishing the tax deduction that employees currently take when they pay premiums on their employer-sponsored health plans. He would, however, leave intact the deduction that employers currently take on their portion of the premiums as an incentive for employers to continue offering coverage.

“The important thing about the … refundable tax credit for employees is for them to go out and make choices,” Sen. McCain said during the forum.

“When it's their money and their decision, I think they make much wiser decisions than when it's provided by somebody else.” And because the tax credit is refundable, low-income Americans who currently pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost of a family health insurance policy is more than $12,000 per year–far higher than the amount of the proposed family tax credit–Sen. McCain said the credit still would be beneficial.

“One thing it does is if someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said.

“Another thing it does that I think is very important is that for low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted that the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher.

“But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.”

The senator said he did not have an estimate of how many uninsured people would be able to buy health insurance coverage because of the tax credit.

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does and that would be obviously something that I would not approve of.”

Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents.

“I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

Sen. McCain also said he hoped the tax credit plan would encourage more people to open health savings accounts (HSAs).

“I think they are a good idea,” he said. But he does not think that health savings accounts have received as much attention as they should get.

“Rightly or wrongly, HSAs are viewed by most Americans as something for rich people. But if you can only use that refundable tax credit for purchasing health insurance or HSAs, I think you may see a stimulus in that; at least, I believe that's a strong possibility.”

On another front, the senator said in an interview that he favors reforms to the malpractice system.

“I would like to see that any medical provider or doctor who stayed within medical guidelines would then not be sued. Right now, it's a lottery for trial lawyers.”

He is in favor of damage caps, “but more importantly, I've opposed punitive damages. … Punitive damages are something that I have not supported in anything.”

Sen. McCain also noted that although he is against abortion, “after a lot of agonizing thought and consultation, I believe in stem cell research. I think stem cell research holds great promise in addressing some of these terrible afflictions that face our nation and the world, such as Alzheimer's and Parkinson's.”

A large portion of the 47 million Americans who are without health insurance choose not to sign up. SEN. MCCAIN

Editor's Note

This look at the health care proposals of Sen. John McCain (R-Ariz.) is the first in an occasional series highlighting the health policy views of those seeking to be our next president. Each article is based on a 1-hour health policy forum with an individual candidate held at the Kaiser Family Foundation in Washington, and sponsored by Families USA and the Federation of American Hospitals.

For Sen. John McCain (R-Ariz.), having health insurance is desirable but not mandatory.

“I don't think there should be a mandate for every American to have health insurance,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

“I think one of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans,” he said.

As Sen. McCain sees it, health insurance is something many people decide they don't want. “The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

He added, however, that some people with chronic illnesses and other preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them, including additional trust funds for Medicaid payments [for people] who need this kind of coverage.”

Instead of mandating that people have health insurance, Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “I'm not going to force Americans to do it; I don't think that's the role of government,” he said.

“But if we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [health insurance]. The panacea isn't all just health care costs, but unless you address health care costs, you're never going to solve the other aspects of the health care crisis.”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure–the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results.

“That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

To expand access to health insurance, Sen. McCain is proposing a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance policies.

To pay for the tax credits–which would cost the government an estimated $3.5 trillion over 10 years–he proposes abolishing the tax deduction that employees currently take when they pay premiums on their employer-sponsored health plans. He would, however, leave intact the deduction that employers currently take on their portion of the premiums as an incentive for employers to continue offering coverage.

“The important thing about the … refundable tax credit for employees is for them to go out and make choices,” Sen. McCain said during the forum.

“When it's their money and their decision, I think they make much wiser decisions than when it's provided by somebody else.” And because the tax credit is refundable, low-income Americans who currently pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost of a family health insurance policy is more than $12,000 per year–far higher than the amount of the proposed family tax credit–Sen. McCain said the credit still would be beneficial.

“One thing it does is if someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said.

“Another thing it does that I think is very important is that for low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted that the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher.

“But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.”

The senator said he did not have an estimate of how many uninsured people would be able to buy health insurance coverage because of the tax credit.

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does and that would be obviously something that I would not approve of.”

Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents.

“I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

Sen. McCain also said he hoped the tax credit plan would encourage more people to open health savings accounts (HSAs).

“I think they are a good idea,” he said. But he does not think that health savings accounts have received as much attention as they should get.

“Rightly or wrongly, HSAs are viewed by most Americans as something for rich people. But if you can only use that refundable tax credit for purchasing health insurance or HSAs, I think you may see a stimulus in that; at least, I believe that's a strong possibility.”

On another front, the senator said in an interview that he favors reforms to the malpractice system.

“I would like to see that any medical provider or doctor who stayed within medical guidelines would then not be sued. Right now, it's a lottery for trial lawyers.”

He is in favor of damage caps, “but more importantly, I've opposed punitive damages. … Punitive damages are something that I have not supported in anything.”

Sen. McCain also noted that although he is against abortion, “after a lot of agonizing thought and consultation, I believe in stem cell research. I think stem cell research holds great promise in addressing some of these terrible afflictions that face our nation and the world, such as Alzheimer's and Parkinson's.”

A large portion of the 47 million Americans who are without health insurance choose not to sign up. SEN. MCCAIN

Editor's Note

This look at the health care proposals of Sen. John McCain (R-Ariz.) is the first in an occasional series highlighting the health policy views of those seeking to be our next president. Each article is based on a 1-hour health policy forum with an individual candidate held at the Kaiser Family Foundation in Washington, and sponsored by Families USA and the Federation of American Hospitals.

For Sen. John McCain (R-Ariz.), having health insurance is desirable but not mandatory.

“I don't think there should be a mandate for every American to have health insurance,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “I think one of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans,” he said.

As Sen. McCain sees it, health insurance is something many people decide they don't want. “The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. He added, however, that some people with chronic illnesses and other preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them.”

Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “I'm not going to force Americans to do it; I don't think that's the role of government,” he said. “But if we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [health insurance]. The panacea isn't all just health care costs, but unless you address health care costs, you're never going to solve the other aspects of the health care crisis.”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure—the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results. That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

Sen. McCain is proposing a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance policies. To pay for the tax credits—which would cost the government an estimated $3.5 trillion over 10 years—he proposes abolishing the tax deduction that employees currently take when they pay premiums on their employer-sponsored health plans. He would, however, leave intact the deduction that employers currently take on their portion of the premiums as an incentive for employers to continue offering coverage.

The “refundable tax credit for employees [allows] them to go out and make choices,” Sen. McCain said during the forum. “When it's their money and their decision, I think they make much wiser decisions than when it's provided by somebody else.” Low-income Americans who currently pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost for family health insurance is more than $12,000 per year—far higher than the amount of the proposed family tax credit—Sen. McCain said the credit still would be beneficial. “One thing it does is if someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said. “Another thing it does that I think is very important is that for low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted that the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher. But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.” The senator said he did not have an estimate of how many uninsured people would be able to buy health insurance coverage because of the tax credit.

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does.” Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents. “I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

The senator said in an interview that he favors reforms to the malpractice system. “I would like to see that any medical provider or doctor who stayed within medical guidelines would then not be sued.”

A 'very large portion' of the uninsured 'are healthy young Americans who simply choose not to' sign up for it. SEN. MCCAIN

For Sen. John McCain (R-Ariz.), having health insurance is desirable but not mandatory.

“I don't think there should be a mandate for every American to have health insurance,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “I think one of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans,” he said.

As Sen. McCain sees it, health insurance is something many people decide they don't want. “The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. He added, however, that some people with chronic illnesses and other preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them.”

Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “I'm not going to force Americans to do it; I don't think that's the role of government,” he said. “But if we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [health insurance]. The panacea isn't all just health care costs, but unless you address health care costs, you're never going to solve the other aspects of the health care crisis.”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure—the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results. That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

Sen. McCain is proposing a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance policies. To pay for the tax credits—which would cost the government an estimated $3.5 trillion over 10 years—he proposes abolishing the tax deduction that employees currently take when they pay premiums on their employer-sponsored health plans. He would, however, leave intact the deduction that employers currently take on their portion of the premiums as an incentive for employers to continue offering coverage.

The “refundable tax credit for employees [allows] them to go out and make choices,” Sen. McCain said during the forum. “When it's their money and their decision, I think they make much wiser decisions than when it's provided by somebody else.” Low-income Americans who currently pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost for family health insurance is more than $12,000 per year—far higher than the amount of the proposed family tax credit—Sen. McCain said the credit still would be beneficial. “One thing it does is if someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said. “Another thing it does that I think is very important is that for low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted that the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher. But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.” The senator said he did not have an estimate of how many uninsured people would be able to buy health insurance coverage because of the tax credit.

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does.” Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents. “I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

The senator said in an interview that he favors reforms to the malpractice system. “I would like to see that any medical provider or doctor who stayed within medical guidelines would then not be sued.”

A 'very large portion' of the uninsured 'are healthy young Americans who simply choose not to' sign up for it. SEN. MCCAIN

For Sen. John McCain (R-Ariz.), having health insurance is desirable but not mandatory.

“I don't think there should be a mandate for every American to have health insurance,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “I think one of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans,” he said.

As Sen. McCain sees it, health insurance is something many people decide they don't want. “The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. He added, however, that some people with chronic illnesses and other preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them.”

Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “I'm not going to force Americans to do it; I don't think that's the role of government,” he said. “But if we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [health insurance]. The panacea isn't all just health care costs, but unless you address health care costs, you're never going to solve the other aspects of the health care crisis.”

One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure—the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results. That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”

Sen. McCain is proposing a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance policies. To pay for the tax credits—which would cost the government an estimated $3.5 trillion over 10 years—he proposes abolishing the tax deduction that employees currently take when they pay premiums on their employer-sponsored health plans. He would, however, leave intact the deduction that employers currently take on their portion of the premiums as an incentive for employers to continue offering coverage.

The “refundable tax credit for employees [allows] them to go out and make choices,” Sen. McCain said during the forum. “When it's their money and their decision, I think they make much wiser decisions than when it's provided by somebody else.” Low-income Americans who currently pay no taxes will receive a check for the amount of the credit, he noted.

When a reporter pointed out that the average cost for family health insurance is more than $12,000 per year—far higher than the amount of the proposed family tax credit—Sen. McCain said the credit still would be beneficial. “One thing it does is if someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said. “Another thing it does that I think is very important is that for low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”

Sen. McCain admitted that the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher. But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.” The senator said he did not have an estimate of how many uninsured people would be able to buy health insurance coverage because of the tax credit.

Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does.” Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents. “I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”

The senator said in an interview that he favors reforms to the malpractice system. “I would like to see that any medical provider or doctor who stayed within medical guidelines would then not be sued.”

A 'very large portion' of the uninsured 'are healthy young Americans who simply choose not to' sign up for it. SEN. MCCAIN