By Jan Moller
Senate candidates' ideas differ drastically
Trolling for votes on the campaign trail, Democratic U.S. Sen. Mary Landrieu and her Republican challenger, John Kennedy, each advocate a major reshaping of an American health-care system that often gets low marks for cost, fairness and quality.
With nearly one-sixth of the population uninsured, and health-care costs rising faster than the rate of inflation, there is widespread agreement among experts that the next administration and Congress will need to reshape the health care landscape in fundamental ways.
Landrieu and Kennedy have responded to the challenge with plans that differ markedly from each other and from the ideas offered by their parties' presidential standard-bearers.
Kennedy, the state treasurer making his second run for the Senate, favors shifting more responsibility for obtaining health coverage onto individuals through changes to the federal tax code and by erasing federal barriers that prevent people from buying insurance across state lines.
Landrieu, who is running for a third term in the upper chamber, is pinning her hopes on a bipartisan bill, the Healthy Americans Act, that would dismantle the current system of employer-based health coverage in favor of requiring people to buy health coverage from a pool of state-regulated private plans.
--- Kennedy's plan ---
"I think we can achieve everything we need to achieve (through) the private sector," said Kennedy, whose plan would offer a tax credit of $2,500 for individuals and $5,000 per family that could be used only to buy health coverage. To help individuals find cheaper coverage, Kennedy's plan would let people seek policies in other states rather than be limited to the offerings in their state.
"If I want to buy a policy in Pennsylvania, I should be able to do it," Kennedy said.
Unlike a similar plan offered by GOP presidential nominee John McCain, the Kennedy plan would not seek to offset the new tax credit by eliminating the tax breaks companies receive for offering health benefits to their workers.
Kennedy also would seek to expand market-based health care plans popular with Republicans, such as health-savings accounts and expanding high-risk insurance pools for people who cannot get coverage because of pre-existing conditions.
--- Landrieu's plan ---
Under Landrieu's approach, people would be offered a choice of plans similar to what is now provided to federal workers, with subsidies offered to those who make less than four times the federal poverty level. Most people would pay for their coverage via paycheck withholding.
Businesses would initially be forced to redirect the money they were spending on health benefits into increased salaries for their employees. Businesses that were not offering coverage would be required to pay a new tax that would vary based on the size of the company and its ability to pay. Eventually, all employers would be required to pay the tax.
"It's a very different model than the industrial age model that the country is using now, which in my view stifles entrepreneurship, it stifles mobility and it is, in its present form, extremely wasteful and inefficient," Landrieu said.
It also is an idea that differs starkly from the proposals offered by Democratic presidential nominee Barack Obama, who would seek to build on the current health care system by adding new mandates on insurers and creating a low-cost public plan to compete with private-sector offerings.
--- Pros and cons ---
In a campaign where Kennedy has styled himself as a budget-balancing fiscal conservative and criticized Landrieu for excessive spending, analysts say his plan would likely cost the federal government more money in the long haul than the approach favored by Landrieu or McCain.
"It would cost more, because you're providing a tax credit to people who don't currently receive one now without changing the tax preference for (employer-sponsored) insurance," said Jennifer Tolbert, a principal policy analyst with the Kaiser Family Foundation, a nonpartisan health policy research group.
Kennedy said he does not favor tampering with the employer-sponsored health insurance system, since most people who get health coverage through their job are happy with the status quo.
"I don't think you ought to fix a system that's not broken," Kennedy said.
According to the Congressional Budget Office, which did an analysis of the Healthy Americans Act favored by Landrieu, the plan would be budget neutral in its first full year of operation and would eventually save taxpayers money.
While the bill has attracted a bipartisan cast of Senate co-sponsors, with 10 Republicans, six Democrats and one independent, critics have also materialized on both the left and right. Some labor unions have complained that it would eliminate health care benefits negotiated through collective bargaining with employers; some on the right have said it would put too much control in the hands of government and force people to buy insurance whether they want it or not.
Still others complain that it would eliminate programs such as Medicaid and the State Children's Health Insurance Program, since everyone would be covered by the new private offerings.
Critics of the Kennedy plan, meanwhile, said the elimination of insurance barriers between states would result in healthy, young people who are less expensive to insure seeking coverage in low-cost states, leaving those who are older and sicker in expensive plans offered by states that require insurers to cover pre-existing conditions.
"If you are older or sicker, you're going to have a lot more trouble affording health insurance under McCain," said John Shiels, a senior vice president of the Lewin Group, a health care consulting group that helped develop the Healthy Americans Act.
--- Unchartered territory ---
Tolbert, of the Kaiser Family Foundation, said the easing of insurance barriers could undermine consumer-protection laws, potentially leaving people with no recourse if they have a dispute with an out-of-state health insurer.
"It's not been tried before, so we don't know whether it would be possible to create that kind of national market," Tolbert said.
On health care issues closer to home, the differences between Kennedy and Landrieu are more subtle. Both candidates support efforts to build a new teaching hospital in downtown New Orleans to anchor a burgeoning biosciences district, but Kennedy has been a critic of the process and has urged state officials to also explore alternatives that might be less expensive.
"To me, this issue is about health care," Kennedy said. "It's not about economic development. It's not about turf. It's not about spending money here as opposed to there."
Landrieu said she favors the project, which calls for the state and the U.S. Department of Veterans Affairs to build adjacent hospitals near downtown, and said she would work to unclog the backlog of recovery projects that are still waiting for federal reimbursement.
"I intend for FEMA to pay the state of Louisiana everything the state believes it's owed," Landrieu said. "I've been working on that, project by project by project, with a great deal of success."