Home » Library » Features » Comparison: Presidential Candidates on Major Healthcare Issues
Today, over 47 million U.S. citizens are without medical insurance, and approximately 18,000 of those uninsured individuals die per year. Despite these numbers, the U.S. spends more per patient than any country in the world. The healthcare system in this country is upside down, as exemplified by Michael Moore's movie Sicko. Although this movie has stirred more controversy than any other documentary this year, it has brought the healthcare issue to the forefront, just in time for the presidential elections.
Americans have lost patience with a failing healthcare system in our divided government, but some answers - such as a universal healthcare system - meet resistance in some quarters. The dissatisfaction is so palpable that other countries have picked up on the raw statistics to use as comparisons to their systems. This article addresses prominent healthcare problems and how each Republican and Democratic presidential candidate stands on those issues.
On The Issues defines many healthcare issues and we've expanded on those topics based on candidates' stances. The links in the list below will take you to sites that explain each issue further. We tried to find the most unbiased links for this information, but please take into account the sources when you gain access to any information about healthcare issues and the upcoming election.
The candidates are listed below in alphabetical order by surname, and their party affiliation is noted by (D) for Democrat or (R) for Republican following their names. While we strived to discover how each candidate felt about each issue listed above, all candidates were silent on the teacher testing issue, and many candidates avoided some issues altogether. However, some voting and action records are noted to show a discrepancy between past support and current thought, or a continuation of their belief systems, or to illustrate how they might respond to the issues if asked.
Hillary Clinton offers her perspective on "Providing Affordable and Accessible Healthcare" at her presidential campaign site and you can learn more about her initiatives at her Senate site. But neither sites reference her long-term focus on national healthcare, which began in 1994 with a 600-person committee that created a plan for comprehensive national health care reform that died in Congress. This defeat hasn't dampened her enthusiasm for national healthcare coverage. In her first address from the Senate floor, Hillary Clinton offered an agenda of health care initiatives, casting herself as a moderate on the very issue that resulted in one of her most embarrassing defeats as first lady. From the Issues site:
I do have the experience of having put forth a plan, with many of the features that [my opponents have] mentioned. And people were enthusiastic about it initially, but then after the insurance companies and the pharmaceutical companies got finished working on it, everybody got nervous and so politically we were not successful. Well, I'm ready to try again, and there's three things we've got to do. We've got to control and decrease costs for everyone. This is not just about the uninsured. Yes, we have nearly 47 million uninsured, but we've got many millions more who have an insurance policy that they can barely afford and that they can't get the treatments they need under it. We have to cover everybody but we've got to improve quality. We can save money within the existing system. I am not ready to put new money into a system that doesn't work until we've tried to figure out how to get the best outcomes from the money we already have.
Clinton also is supportive of children's health, obesity solutions, tobacco regulation (especially for youth), and medical research funding. She is also a proponent for keeping abortion "safe, legal and rare" (1999), and she wants to "lift [the] ban on stem cell research to cure devastating diseases" (2007). She voted a liberal line on partial birth and harm to fetus (Oct 2005), and she was rated rated 100% by NARAL Pro-Choice America, indicating a pro-choice voting record. (Dec 2003).
Clinton also focuses on the elderly with her voting record with Medicare Part D. Her record shows that she's an advocate for lowering prescription costs for the elderly, for allowing importation of Rx drugs from Canada (2002), and for allowing states to bulk-buy prescriptions to lower costs (2003). She was one of six 6 Senators who signed a letter directed to directors of television networks, where the directors were warned that the government had issues commercials about Medicare that may have been determined as illegal "covert propaganda." Those VNRs (Video News Releases), which were produced by the U.S. Department of Health and Human Services (HHS) and distributed through a public relations firm, contained pre-scripted news story packages and B-Roll designed to influence local news station to run stories complimentary of the new Medicare law recently signed by President Bush. However, the VNRs did not identify that they are produced by the government (2004).
In the latest news, Clinton said that she would require everyone to have health coverage, funded partly by revoking President George W. Bush's income tax cuts for those earning more than $250,000 a year. Her plan could cost $110 billion per year. Clinton said her plan would not require small businesses to take part, but will offer tax credits to encourage them to do so.
Clinton also sponsored the Nurse Reinvestment Act (2001), and she was rated 100% by APHA (American Public Health Association), indicating a pro-public health record (2003).
A visit to John Edwards presidential committee site shows that this former North Carolina Senator "has a bold plan to transform America's health care system and provide universal health care for every man, woman and child in America." Once Edwards has reached the goals of full insurance through employers, by "creating new tax credits, expanding Medicaid and SCHIP, reforming insurance laws, and taking innovative steps to contain health care costs," and by creating "Health Markets" that provide affordable insurance, Edwards plans to make insurance mandatory for every citizen. Part of how he would pay for this plan is quoted from Issues:
Senator Obama came out with a plan, which I don't believe is completely universal, but it deserves to be credited because he laid out what the cost is and exactly how he was going to pay for it. But my plan calls for $90 billion to $120 billion a year. I'd pay for it by getting rid of Bush's tax cuts for people who make $200,000 a year. And I believe you cannot cover everybody in America, create a more efficient health care system, cover the cracks -- you know, getting rid of things like pre-existing conditions and making sure that mental health is treated the same as physical health -- I don't think you can do all those things for nothing. That's not the truth. And I think people have been so sick of listening to politicians who come and say, we're going to give you universal health care, we're going to change the way we use energy in America, we're going to strengthen the middle class, have middle-class tax cuts, and in the process, we're going to eliminate the federal deficit.
Edwards also supports healthcare rights for same-sex couples (2007), allowing prescription drugs into the US from Canada (2004), and an increase taxes to pay for universal insurance (2007). Edwards believes that the right to abortion is constitutionally protected (2004), and he voted against maintaining a ban on military base abortions in 2000. He was rated 100% by NARAL, indicating a pro-choice voting record. (2003). Like Clinton, Edwards wants to expand embryonic stem cell research (2004).
Edwards' voting records shows that he's supportive of health insurance for children (2003), for the importation of Rx drugs from Canada (2002), and for states to make bulk prescription purchases (2003). He was one of seven Senators who signed the letter to end the government propaganda on the Medicare bill (see Clinton). Edwards is rated 100% by APHA, indicating a pro-public health record (2003).
On the same day that Clinton revealed her health care plan (17 September 2007), Edwards blasted her contribution by stating that Clinton failed fourteen years ago with her health care plan, and that she is responsible for the growing numbers of individuals who aren't receiving health care now. "We didn't get universal health care, but we got [the North American Free Trade Agreement]," he said. "We need universal health care. We didn't need NAFTA."
A visit to Rudy Giuliani's presidential committee Web site reveals that he doesn't address healthcare under his "issues." But, he does address abortion:
Rudy Giuliani supports reasonable restrictions on abortion such as parental notification with a judicial bypass and a ban on partial birth abortion—except when the life of the mother is at stake. He’s proud that adoptions increased 66% while abortions decreased over 16% in New York City when he was Mayor. But Rudy understands that this is a deeply personal moral dilemma, and people of good conscience can disagree respectfully.
Giuliani believes that allowing choice keeps government out of people's lives (2007), but he is a strong proponent for adoption over abortion (although he overstated adoption facts in 2007). Issues shows that Giuliani supports embryonic stem cell research "if limited properly" (2007).
Giuliani has not addresses a universal health care system, but in 2007 he advocated a $15,000 tax credit for HSAs (health savings accounts) and a $15,000 family tax deduction for owning individual health insurance. This candidate is opposed to "socialized medicine," and he would prefer to give vouchers to the poor (2007). He stated in 2007 that:
I would change the whole model that we have for health insurance in this country. The problem with our health insurance is it's government- and employer-dominated. People don't make individual choices. It's your health; you should own your health insurance. We need 100 million Americans making different decisions that will bring down the cost of health insurance; it will bring down the cost of prescription medicines. Free-market principles are the only things that reduce cost and improve quality.
NARAL and AHSA provide no ratings for Giuliani.
You won't find healthcare listed on the "issues" tab at John McCain's official campaign site, but you will find his perspectives on abortion under "Human Dignity and the Sanctity of Life":
John McCain believes Roe v. Wade is a flawed decision that must be overturned, and as president he will nominate judges who understand that courts should not be in the business of legislating from the bench. Constitutional balance would be restored by the reversal of Roe v. Wade, returning the abortion question to the individual states. The difficult issue of abortion should not be decided by judicial fiat.
He furthers this statement with a promotion of adoption over abortion. If you want to discover more about how McCain plans to address healthcare, you can visit his Senate site, where you'll discover that he does support a framework for federal support of stem cell research under "strict guidelines and ethical criteria." If you don't want to read through this long list, you can visit Issues to learn more about McCain's stands on various healthcare issues.
McCain does not support a mandated universal healthcare system nor mandated insurance coverage (2006); however, he does support expanded health insurance to 11 million uninsured children (1999). McCain's voting record shows that he voted for allowing importation of Rx drugs from Canada (2002), but that he voted against including prescription drugs under Medicare (2000). But, he voted for increasing Medicaid rebate for generic drug production. In 2002, McCain supported tax credits for those without employee health insurance, and tax deductions for long-term care insurance. He is rated at 25% by APHA, indicating an anti-public health voting record (2003).
Barack Obama lists his stands on healthcare under "Fighting Poverty" at his official campaign site. In this section, it states that "Barack Obama is committed to signing universal health legislation that ensures all Americans have high-quality, affordable health care coverage by the end of his first term in office." Obama also cosponsored the Minority Health Improvement and Health Disparity Elimination Act to better understand the root causes of health disparities and to start addressing them. Finally, he introduced the Healthy Places Act to help local governments assess the health impact of new policies and projects, like highways or shopping centers. This latter act addresses how communities are structured to allow more fitness access for walkers, bikers, etc.
If you want to know more about how Obama stands on healthcare, visit this topic at his Senate site. Here, you'll discover that he supports the same issues as Clinton, but that he also addresses genomics research (how a person's genetic makeup affects propensity for disease and response to treatment) and disability.
Fifty million, or one in seven, individuals in our country suffer from a disability. With proper support, many, if not most, people with disabilities are strong contributors to society. All Americans, regardless of disability, deserve a dignified life, and there are many government programs that are essential to this commitment. In addition to enforcement and funding of the Americans With Disabilities Act, we must also defend and strengthen Medicare, Medicaid, and Social Security.
You also can track Obama's voting record and more stands on healthcare at the Issues site. Obama supports stem cell research (2007) and advocates protecting a woman's right to choose on abortion (2004). He wants to allow prescription drug re-importation (2004), to increase Medicaid rebate for producing generics (2005), to negotiate bulk purchases for Medicare prescription drug (2005), and voted to require negotiated Rx prices for Medicare part D (2007).
NARAL and AHSA provide no ratings for Obama, as he wasn't in office during their rating years (2003).
Ron Paul focuses on "Health Freedom" at his official campaign site, a stand that fits with his adamant "no government involvement" and constitutional stance:
As a member of the U.S. House of Representatives, Dr. Paul tirelessly works for limited constitutional government, low taxes, free markets, and a return to sound monetary policies. He is known among his congressional colleagues and his constituents for his consistent voting record. Dr. Paul never votes for legislation unless the proposed measure is expressly authorized by the Constitution.
From this perspective, Paul believes that embryonic stem cell programs not constitutionally authorized (2007), and he voted that same year against expanding research to more embryonic stem cell lines - a sentiment that echoed his vote against allowing human embryonic stem cell research in 2005. While Paul voted for banning partial-birth abortion except to save mother’s life in 2003, NARAL rated him at 0%, indicating a pro-life voting record. This rating is, perhaps, based upon Paul's vote to ban Family Planning funding in US aid abroad (2001).
According to the Issues site, Paul voted for allowing importation of prescription drugs (2003) and on establishing tax-exempt Medical Savings Accounts (1999). He also voted against limited prescription drug benefit for Medicare recipients (2003) and denying non-emergency treatment for lack of Medicare co-pay (2006). However, in 2000, Paul wanted to abolish federal Medicare entitlement, leaving this issue to the states. Paul is rated 56% by APHA, indicating a mixed record on public health issues (2003).
Democratic New Mexican Senator Bill Richardson wants all Americans to have health coverage, but with no new bureaucracies and with no new taxes. The following quote is from his official campaign site under the "healthcare" tab in "Issues."
Under my plan, all Americans will have personal responsibility for obtaining coverage. To ensure that this happens, employers will be required to do their fair share to contribute to a healthy and covered work force, a sliding-scale tax credit will be available for Americans who need help affording coverage, and American families will get immediate relief from high interest rates for medical debt placed on credit cards.
Richardson would also like to cut health administrative costs and use those savings to invest in preventative care. To the right on this healthcare page, Richardson has provided PDF files that details his health plans, and his commitments to doctors, nurses, veterans, soldiers, seniors, and persons with disabilities. At the time of this writing, the PDF files were unavailable for download. You can find more information about how Richardson views healthcare with this news story, where Richardson states, "As with auto insurance, all Americans will be required to have health coverage and employers will pay their fair share of employee health-care costs." Additionally, he states that, "We will allow Americans 55 to 64 to buy in to Medicare."
Richardson's ideas on healthcare - like Clinton's - could cost up to $110 billion a year, whereas Obama's healthcare plan would cost approximately $65 billion per year after unspecified savings from making system more efficient. Richardson would seek savings in medical care by expanding spending on preventive care.
At the Issues site, you'll learn that Richardson is supportive of stem cell research as part of preventive healthcare (2007) and that he will resist any effort to weaken a woman's right to choose on abortion (2002). While Richardson doesn't maintain a solid voting record on healthcare issues, several points from his quotes at Issues are important. Richardson would prefer to shift Medicaid costs back from states to federal level (2005), he would secure lower prescription drug costs for seniors (2004), and he would fund fight on HIV/AIDS both nationally and internationally (2007).
NARAL and AHSA provide no ratings for Richardson.
Former Massachusetts Governor Mitt Romney's official campaign site covers healthcare under his "Issues Watch" tab, where it's stated that, "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." You'll find two other quotes on this page, but nothing else that would define how Romney stands on any healthcare issues. However, as governor, Romney signed health care law aimed at ensuring universal coverage through a mix of subsidies, sliding scale premiums and penalties for those who do not get insurance.
At the time of this writing, a link to a story that was originally run in the Wall Street Journal was linked to the front page of this site. According to this article (written by two advisors to the Romney campaign), Romney wants to promote individual rather than employer health care plans. And, he would allow individuals to deduct out of pocket medical expenses in a "significant advance in this 30-year progression to a level tax playing field between out-of-pocket expenses and insurance."
We estimate that making out-of-pocket expenses tax deductible, combined with Mr. Romney's other proposals, will reduce the average premium of employer-provided family health plans by around $2,300 per year. Workers' wages will rise by this amount on average. To be sure, higher out-of-pocket expenses will offset part of this increase – $1,000 of it. But workers will still experience a net increase of $1,300 in (taxable) income. Mainly because of this economic effect, we estimate that the U.S. Treasury's revenue loss will be modest – about $10 billion per year.
Romney's attitude about abortion and stem cell research is clear at the Issues site. He is "tired of holier-than-thou attitude about becoming pro-life (2007)," and he wants to immediately overturn Roe vs. Wade; "then change hearts & minds about his decision" (2007). These statements were made despite the fact that he was pro-choice as governor (2002). This former pro-choice stance came a relative's death from an illegal abortion. So, Romney has either forgotten that banning legal abortions usually increases illegal abortions, or he's pandering with right-wing rhetoric. At Issues, however, it states that he changed his stance based upon cloning. Romney supports nuclear transfer instead of embryonic stem cell research (2007), however, nuclear cell transfer is the first step in reproductive cloning.
Basically, Romney's health plan is identical to Obama's healthcare plan (2007):
Romney tried to distance his state's universal health insurance plan from the proposals of the Democratic presidential candidates. Romney said, "Every Democrat up there's talking about a form of socialized medicine, government takeover, massive tax increase. I'm the guy who actually tackled this issue. We get all of our citizens insured. We get people that were uninsured with private health insurance. We have to stand up and say the market works. Personal responsibility works."
There are two problems with Romney's characterization: One, Ohio Rep. Dennis Kucinich is the only Democratic candidate to propose a single-payer, wholly government-funded health care plan. And two, Romney's Massachusetts universal insurance system bears a striking resemblance to the health care proposals of the Democratic front-runners. For example, the Obama and Romney plans are virtually identical. But in our view, the term "government takeover" could only be applied to Rep. Kucinich's proposal.
NARAL and AHSA provide no ratings for Romney.
Fred Thompson's official "I'm With Fred" site has changed recently to reflect Thompson's recent bid for presidency. Therefore, the fact that Thompson has little to say about healthcare could be because he's had little time to address the matter. However, he is forthright about what little he does have to say when he states that, "Those who propose a one-size-fits-all Washington-controlled program ignore the cost, inefficiency, and inadequate care that such a system offers." He believes that "affordable, portable health care" can be made available without new mandates or taxes. It will be up to Thompson to outline that health plan in the future.
As far as his current stance on abortion, Thompson asserts that Roe v. Wade was bad law and bad science (2007), and he states that he's never been pro-choice. The Issues page doesn't offer any clues as to how Thompson stands on stem cell research, but he states on his site that he desires a healthcare system that "promotes and speeds medical research and life-sciences innovation." He has a voting record, where he stands out as the only candidate who voted against importation of Rx drugs from Canada (2002). He also voted against increasing tobacco restrictions (1998), the inclusion of prescription drugs under Medicare (1999), and on medical savings accounts (1996). He did support funding the GOP version of Medicare prescription drug benefit (2001), and on limiting self-employment health deduction (1999).
NARAL and AHSA provide no ratings for Giuliani.
Out of all the healthcare issues listed at the beginning of this article, euthanasia seems of little to no concern for any candidate. With that said, any U.S. citizen who wants to see drastic reforms in the current healthcare system must look to the Democratic candidates to see any possibility for changes.
The Democrats, fueled by the 1994 failure of Hillary Clinton's proposed health care plan, are keen to put their perspectives about healthcare on the table; however, since Clinton's healthcare plan was considered "socialist" by the Republicans, these latter candidates are a bit more circumspect about laying out specific plans. Additionally, competing Democrats are avid about refuting Clinton's ability to lead this country into a more viable health care system.
Republicans might heed a recent poll by the nonprofit Kaiser Family Foundation, where 30% of respondents said health care is one of the top two issues they want to hear Presidential candidates talk about. Only Iraq ranked higher. Republicans Giuliani and Thompson prefer to relegate healthcare issues to "market-based solutions," rather than come up with a healthcare plan. However, Giuliani leans more to middle ground with his arbitrary stands on abortion and stem cell research. Mitt Romney is the only Republican who has addressed this issue in any depth, and his plan is - ironically - identical to Democrat Obama's plan. With that said, Romney currently is against pro-choice and stem cell research, whereas Obama is supportive of those two issues.
But, the campaign still has some time to go before the elections in 2008. Some candidates have come into the race recently, like Fred Thompson. Others may drop out and still others may join the race at a later date. Plenty of time remains for voters to question the candidates and to fully understand how each one stands on healthcare in America today.
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