Bush Mischaracterizes Kerry's Health Plan

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Bush Mischaracterizes Kerry's Health Plan

Bush claims Kerry's plan puts "bureaucrats in control" of medical decisons, "not you, not your doctor." But experts don't agree with that.

10.04.2004

Summary

A Bush ad claims Kerry’s healthcare proposals would put "big government in charge" of medical decisions. In fact, Kerry's plan would leave 97% with the insurance they have now -- while up to 27 million who aren't insured would gain coverage.

Bush's claim turns out to be based on opinions from two conservative advocates whose predictions aren't supported by neutral experts.

Analysis

Bush launched this misleading attack on Kerry's plan in an ad made public Sept. 13, and has been repeating the same idea in nearly every campaign speech since.

Bush-Cheney '04 Ad

"Healthcare: Practical vs. Big Government"

Announcer: On healthcare, President Bush and our leaders in Congress have a practical plan:

Allow small businesses to join together to get lower insurance rates big companies get. Stop frivolous lawsuits against doctors. Health coverage you can take with you.

The Liberals in Congress and Kerry's plan:

Washington bureaucrats in control. A government-run healthcare plan. 1.5 trillion dollar price tag.

Big government in charge. Not you. Not your doctor.

"Bureaucrats in Control?"

The ad claims Kerry's health care plan puts "Washington bureaucrats in control. . . Big government in charge. Not you. Not your doctor."

That's grossly misleading. In fact, 97% of Americans who now have health insurance will simply keep the plan they have now, according to projections by the independent, politically neutral health-care research firm The Lewin Group .

And The Lewin Group's vice president, John Sheils, disputes the Bush ad's claim:

Sheils: I don’t see how, in Kerry’s plan, decisions on medical procedures would be made in Washington under any circumstances, under any proposal.

Another health-care financing expert, economist Jeff Lemieux of Centrists.org , calls the claims in the Bush ad "way out of bounds."

Lemieux: There is an increased government involvement in providing health insurance through the expansion of Medicaid. But interfering between doctors and patients? There is nothing in (Kerry's) reforms that would come close to making that happen - It is just way out of bounds.

In an earlier assessment of the Kerry plan, the nonpartisan Centrists.org found Kerry’s health proposal to be "similar in many ways to a blueprint offered in July by Senate Republican leader Bill Frist," and concluded that Kerry’s proposal tries to achieve "liberal goals" mostly through "conservative means."

And in fact, a conservative health-care expert, Robert E. Moffit of the Heritage Foundation, calls the claim in the Bush ad oversimplified "bumper-sticker health policy." Moffitt notes that Kerry's plan would expand existing government programs, mainly Medicaid, to cover more children and low-income workers than at present. He said, "In those government programs, as with private managed care programs, your doctor will be under the same restrictions he is under today. In that respect, Kerry is making no changes in the doctor-patient relationship." He added:

Moffitt: The Kerry plan amounts to an expansion of existing public and private third party payment system; it is not so much a change in policy direction, as a dramatically more expensive version of the status quo; and with its cost, it's the status quo on steroids. In other words, it's weirdly "conservative," in the worst sense of that word.

Moffitt did predict that Kerry's plan would lead to "much higher levels of federal regulation," but chiefly on employers and insurance providers rather than doctors or patients. Kerry's plan envisions reducing the cost to workers of existing private health coverage by having the federal government pick up 75% of the cost of "catastrophic" medical bills exceeding $30,000 per year. That would require federal oversight to audit claims and define what medical procedures can be counted toward that $30,000 threshold, Moffitt said. But that's not the same thing as putting "big government in charge" of decisions now made by doctors and patients, as the Bush ad claims.

We also went to Kenneth Thorpe for his assessment. Thorpe was Deputy Assistant Secretary for Health Policy during the Clinton administration, and is now a professor at Emory University in Atlanta, where he has studied both the Kerry and Bush health plans. He says Bush is just making up the claim in the ad:

Thorpe: This is just a fabrication.. . . . Kerry’s plan simply builds on what people are enrolling in today. The (Bush) big-government claims are just the same old scare tactics.

Thorpe says Kerry's plan includes providing private health insurance for small businesses and their workers through a program modeled on the Federal Employees Benefits Health Plan, the program that currently provides a wide choice of coverage for federal workers and members of Congress. "You can choose whatever you want," Thorpe says. "It’s the consumer’s choice."

Bush's Backup

When asked to back up their ad, Bush campaign officials point to two editorial articles written by conservative advocates for Medical Savings Accounts, the approach Bush favors.

One article is by John C. Goodman of the National Center for Policy Analysis, which describes itself as an organization developed to "promote private alternatives to government regulation and control." Goodman's article states that under Kerry's plan, "Most people would be forced from the private health plans they have today," a statement that is contradicted by the politically neutral Lewin Group's study we cited earlier.

Lewin's vice president John Sheils told FactCheck.org that his computer model projects that only 8.2 million (of the 243 million who currently have private or government health insurance) would change their insurance plans under Kerry's plan. And even those who would change would be covered either by Medicaid, in which 70% still have fee-for-service coverage that leaves them free to choose their own doctor, or subsidized private insurance coverage.

We asked Goodman to explain how he could predict that "most" would change insurance when the Lewin computer projection showed that 97% wouldn't change. "Well you know, I haven’t carefully read the Lewin study," Goodman said. "I’m surprised that they said that."

The second article cited by the Bush campaign is by David Gratzer of the conservative Manhattan Institute , but his article mainly urges Republicans to make the political argument that Kerry's plan involves more government control:

Gratzer: Kerry's proposal would nationalize catastrophic coverage. Couple this with his endorsement of drug reimportation, and it becomes clear that a Kerry administration would end up running and setting the price of much of American health care.

Republicans, thus, are presented with a short-term opportunity. Kerry has painted a trillion dollar target on his back. . . . If Washington is in the business of covering catastrophic health expenses, how long before it manages all expenses?

That's not a fact, of course, it's Gratzer's opinion. And it's not shared by the experts we quoted earlier.

A 1.5 trillion price tag?

The Bush ad gives Kerry's plan a "1.5 trillion dollar price tag" and the figure is shown twice on screen during the ad. What the ad doesn't say is that the figure covers a full 10 years, and that it's the highest of three independent estimates issued so far. The figure comes from a study by the American Enterprise Institute, a conservative, pro-business think tank in Washington.

But as we've previously reported, the Bush campaign originally quoted a study by Ken Thorpe of Emory University, who estimates the total cost of Kerry's plan to be $653 billion over 10 years. A third study released later by The Lewin Group concluded that Kerry's plan would cost about $1.25 trillion over 10 years.

The estimates all agree that Kerry's ambitious and expensive plan would provide health coverage for a large portion of the 45 million who currently lack it. The American Enterprise Institute put the figure of those who would gain insurance at 24 million, the Lewin Group put it at 25 million and Thorpe is estimating 27 million.


Sources

John C. Goodman, "Kerrycare ," The Wall Street Journal, 26 August 2004; A12.
John C. Goodman & Devon M. Herrick, "The Case against John Kerry’s Health Plan," National Center for Policy Analysis, 10 Sep 2004.
David Gratzer, "HillaryCare to KerryCare ; Plus ça change," The Weekly Standard, 24 May 2004.
"Bush and Kerry Healthcare Proposal's: Cost and Coverage Compared," The Lewin Group , 21 September 2004.
Kenneth E. Thorpe, "The Impact of Sen. John Kerry's Healthcare Proposal On Healthcare Costs," 22 June 2004.
John Sheils, The Lewin Group, personal interview, 28 September 2004.
Robert E. Moffitt, Heritage Foundation, personal interview, 27 August 2004.
Kenneth E. Thorpe, Emory University, personal interview, 28 September 2004.
David Gratzer, Manhattan Institute, personal interview, 29 September 2004.
John C. Goodman, National Center for Policy Analysis, personal interview, 29 September 2004.
Jeff Lemieux, Centrists.org, personal interview, 23 September 2004.
Jeff Lemieux, "Senator Kerry's Health Proposal - Prospects for Bipartisanship," Centrists.org, 25 August 2004.
Joseph Antos, American Enterprise Institute, personal interview, 28 September 2004.
"Analyzing the Bush and Kerry Health Proposals," American Enterprise Institute , 13 September 2004.