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Presidential Health Care Candidates Debate Federal Role in Health Care System

By Reed Cooley, CQ Staff

May 19, 2008 -- A discussion of the kind of role the government should play in the health care system marked the sharpest policy divides among a gathering of presidential health care advisors on Monday.

During the forum hosted by Women in Government Relations, Tom Miller, an economic advisor to Sen. John McCain, R-Ariz., called the rival health care plans of Sens. Hillary Rodham Clinton, D-N.Y., and Barack Obama, D-Ill.,—which he said push for universal coverage without first addressing costs—"presumptive" and "counter-productive." In particular, Miller took issue with Democrats' emphasis on what he described as increasing public funding and amplifying government regulation of the insurance industry.

Any major change to the health care system "has to resonate with our political culture, our history. Our economy is a market-based economy," Miller said.

Katherine Hayes, a health policy advisor in the Clinton camp, highlighted the human aspect of the toll of high health care costs and argued that the government has a duty to ensure coverage for all Americans.

"I look at some of these Republicans and wonder if they've ever had to go in and buy health insurance coverage," she said.

"Certainly we need competition in our health care system, but if you're going to receive federal dollars, you have to play by certain federal rules," Hayes added.

Hayes also pointed out that those Americans without health insurance contributed significantly to the cost of the system, citing a study that found that the cost of care for the country's 48 million uninsured contributes an extra $922 to every family premium.

Miller said such statistics misconstrue the facts. "Covering [the uninsured] isn't going to make a difference in terms of your premiums," he said.

Miller criticized aspects of Democratic proposals that would increase regulations on insurance companies, especially those that would prohibit raising premiums for consumers with pre-existing health conditions. He touted McCain's emphasis on two kinds of personal responsibility—wellness and a commitment to finding the best health coverage for one's own family.

"We weren't misinformed when we pulled up to the McDonald's two times a day," he said.

Both Hayes and Dora Hughes, Obama's health advisor, pointed out that low-cost foods are sometimes the only option for those who can't afford healthier choices.

"What does personal responsibility mean? Does it mean that someone who is obese and has diabetes should be punished?" Hayes asked.

She added that both Democratic health plans would avoid what she considered the chief crime of McCain's proposal: the abandonment of citizens to "the mercy of the market."

However, both parties' representatives appeared to agree on one point: that the health care system and the economy are inextricably linked.

Forum moderator Julie Barnes of the New America Foundation pointed out other major challenges facing the next president, including the Iraq War, the economy, and environmental issues, and asked, "How can we realistically keep health care at the top of the agenda?"

Hughes replied, "Whether we look at it from the lens of economy or separately from the lens of health care, we have the political impetus as well as the political will to address the health care crisis."

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