Politics as usual: Gore and Bush on health care

Online Feature: View the full-text transcript of the interview.

As Jay Leno cracks more one-liners about Al Gore's personality and on-campus "Bush-isms" fliers update us on our dear alum's recent botchings of the English language, it's difficult to remember that the race for the presidency still pretends to be based on real issues. One of them will eventually go home to Washington and preside over our national government. What will happen then? The Herald finds out, issue by issue, asking some of the many experts on campus.

This week, we talked to Mark Schlesinger, a professor at Yale's School of Public Health and Health Policy, about the candidates' health care proposals. Schlesinger calls himself "a conventional Democrat," but having worked with both parties in consulting roles, has "a feel for what's good about their respective positions."

COURTESY SCHOOL OF PUBLIC HEALTH Professor of Public Health Mark Schlesinger compared Bush and Gore's health plans for the Herald.

Yale Herald: What are the pressing issues in the country's health care system?

Mark Schlesinger: We've got about 45 million people who don't have insurance. For some, it's transitory—they're between jobs—but three-quarters have been uninsured for two years or more. That's a substantial chunk of the population. And since the early '80s, the number of uninsured has gone up by one million yearly.

YH: Why has it happened?

MS: Healthcare has gotten more expensive over time. Most people get insurance through work, but now, employers—particularly small employers—often think they can't afford it. There's one additional trend that kicked in around 1994—welfare reform. All of a sudden, you couldn't get welfare for more than two years of your life—and because people used to sign up for Medicaid at the welfare offices, the Medicaid rolls just dropped.

YH: What do Gore and Bush, DC '68, have to say about this problem?

MS: It's a big political hot potato. Bush says, "Al Gore, your administration enacted welfare reform. You failed to enforce provisions which would keep people on Medicaid." Gore's position is, "George Bush, Texas has the worst record in any state of administering Medicaid. You have the most poor kids who don't have health insurance. You're the problem."

YH: Are either of their claims true?

MS: They both have plenty of ammunition to blame the other, because Medicaid is a joint federal-state program. Admittedly, the Vice President doesn't have much influence on Medicaid policy, so blaming Gore is a little weak. On the other hand, the governor in Texas doesn't have too much power, so blaming Bush is also a little weak.

YH: What are Gore and Bush's stances on Medicare?

MS: One issue in Medicare is HMO's—whether to insert private managed care into a government program. George W. Bush views HMO's [as ensuring that] "people get to choose what plan they want to go into— they don't have to stick with the government plan." Al Gore says, "sure they get to choose their plan, but their plan can drop them. That's just insecurity. They can get more benefits, but they can also get mistreated."

YH: What about prescription drugs? Does Gore have a proposal to cover them?

MS: People in Gore's campaign say that we ought to add it to the conventional Medicare program. It would be just one insurance package for everyone, like Medicare, with bulk purchasing by the government. From the Gore perspective, this is great, because you can cut a good deal with drug companies. Everyone gets treated the same and prices get kept low because you're a big central purchaser.

YH: George W. Bush says...?

MS: He says, gosh no. That's big government. What Bush would prefer to do is to have the federal government subsidize people purchasing private insurance, as opposed to just going into one plan. He says that then they'll have the incentive to choose the cheap ones, and that's the way the market should work. That's true. On the other hand, what if people choose badly? There's always more insecurity in a market-based system.

YH: How much is all this talk worth? Do policies they propose have a chance of going into effect?

MS: What you can count on is that they'll try to do it. Because we're in an era of government surpluses, the conditions are right for us to be able to do these things. Most of the things that are proposed are plausible.

YH:What's your opinion, based on their differences?

MS: I think it's one thing to let people make choices when they're 20 or 25. It's another thing to let the elderly make a choice about their retirement health care. It's not a time of life when people want to take a lot of chances. I can see perfectly acceptable arguments for injecting the market in lots of realms of life, but not in a realm of life where security is the paramount concern. That seems to me what's strikingly wrong about the Bush social security and Medicare proposals. There's a mismatch to what people care about at that age.

YH: So it's a pretty conventional Democrat-Republican disagreement?

MS: Both candidates will confuse you with sound-bite nuggets, but it's really a conventional split between market arrangements and government arrangements.

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