Republicans look to free market, tax cuts in effort to meet healthcare needs

Editor’s Note: This is the second in a two-part look at the 2008 presidential election, the candidates, and, most important, how they stand on health care, including—where applicable—their past voting record on the issues that matter most to retail pharmacy. In the Nov. 12, 2007, issue, Drug Store News examined leading Democrats; this time, the Republicans are under the microscope.

WASHINGTON

“Overall, the Democrats are more trusted than the Republicans to come up with good healthcare policies, but all parties and candidates have seen a decline in the public’s trust since February 2007, suggesting a general concern about politicians’ ability to affect change,” noted a recent report from WSJ.com/Harris Interactive. Among Republicans, the report noted, containing healthcare costs is the top priority. But no matter which party voters adhere to, most appear ready for fundamental change in the health-care system. “Across party lines,” noted the Harris/WSJ report, “there is widely held belief that the U.S. healthcare system works better for the very poor and the wealthy than it does for the middle class. Two-thirds [65 percent] of all U.S. adults believe it is the government’s duty to ensure that all Americans have have adequate health care coverage, and equally large majorities [63 percent] believe that our healthcare system works well if you are healthy, but not if you are sick.”

Among Republican contenders, apparent front-runner Rudolph Giuliani said he’d provide tax deductions to help Americans offset the cost of individual health insurance, in part to lessen the reliance on employer-sponsored coverage. Families could see tax deductions as high as $15,000 under his proposal, and individuals $7,500, to buy coverage. Excess funds could be placed in health savings accounts. Low-income families also could receive tax refunds and subsidies to buy health coverage.

“I believe we can reduce costs and improve the quality of care by increasing competition … through tax cuts,” Giuliani said. “I will give Americans more control over and access to health care with affordable and portable free-market solutions.”

Former Tennessee Sen. Fred Thompson expressed the belief that “every American should be able to get health insurance coverage that is affordable, fully accessible and portable … without imposing new mandates or raising taxes.” Although still short on specifics, Thompson’s plan would provide consumers with more information about “affordable healthcare options,” by encouraging clinical best practices and health IT, and by “shifting to a system that promotes cost-effective prevention, chronic-care management and personal responsibility.”

Arizona Sen. John McCain favors tax deductions to encourage employers to continue providing coverage, as well as tax credits of $2,500 for individuals and $5,000 for families to help them pay for health coverage. McCain opposes mandating coverage, however.

“I’m not going to force Americans to buy insurance,” he said. “But if we bring down the cost, I’m convinced more and more will take advantage of it.”

McCain also wants to overhaul the Medicare reimbursement to encourage prevention and coordination of care, require transparency to allow consumers to compare prices of drugs and doctors’ fees, encourage the use of retail health clinics and eliminate roadblocks to generic drug competition and the approval of biogenerics.

As governor of Massachusetts from 2001 to 2007, Mitt Romney signed legislation creating one of the nation’s most generous prescription drug benefits for the state’s residents. He also proved a friend to pharmacy by vetoing legislation that would have revived the state’s controversial prescription tax after it was struck down in court, and by rejecting efforts the state legislature made to reduce dispensing fees to $2 for both branded and generic prescriptions.

As an aspirant to the White House, Romney has taken a more conservative tack. “The health of our nation can be improved by extending health insurance to all Americans, not through a government program or new taxes, but through market reforms,” he said. “We can’t have as a nation 40 million people—or, in my state, half a million—saying, ‘I don’t have insurance, and if I get sick, I want someone else to pay.’”

“In my state … we had half a million people without insurance,” Romney told Iowa voters recently. “And I said, ‘How do we get everybody insured by supporting a free-market system. And we found a way to do that.

“Getting everybody insured is an important priority,” he added. “If we don’t do it, the Democrats will. And if the Democrats do it, it will be socialized medicine.”

Romney also promotes preventive health, particularly through childhood education and screening programs, as the best way to head off such conditions as diabetes and obesity and lower health costs.