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...to Wall Street Journal/NBC news poll in November, healthcare is the most important concern for 34% of all adults, ahead of jobs/economy, illegal immigration and terrorism. The big difference this year is that rising healthcare costs are hurting U.S., industry and eroding jobs. Corporate leaders say that costly health benefits undermine global competitiveness, and middle-class consumers fear that job loss will cast them into the growing ranks of the uninsured.
As a result, Democratic and Republican candidates are rolling out health reform platforms that promise to cover the uninsured while also retaining choice. There is much talk of "shared responsibility" between the government, industry and consumers for expanding access to care, and little enthusiasm for abandoning the employer-based insurance system in favor of a single-payer, government-run plan.
Democrats
Health reform is most important for Democratic voters, prompting candidates to propose broader government programs and mandates that employers "play or pay." Funding would come from eliminating tax breaks for the rich and forcing insurance companies to toe the line.
SEN. BARACK OBAMA of Illinois promised that his plan will help "break the stranglehold the drug and insurance companies have on the healthcare market." At a September forum sponsored by Families USA and the Federation of American Hospitals, SEN. HILLARY CLINTON of New York complained that insurers "now spend $50 billion a year on how not to cover people," and declared that "insurance companies will have to do their part" to make coverage more affordable.
Republicans
Health reform is a lower priority issue for Republican voters, who are wary of big government programs and higher taxes. Instead of expanding federal services, Republicans look to boost coverage by offering tax credits and deductions that make it easier for individuals to purchase insurance.
Even former Massachusetts Governor MITT ROMNEY, who helped engineer that state's health reform initiative, shies away from talk of expanding federal programs and mandating coverage.
Most candidates hope to finance the more than $100 billion price tag for broader government programs and subsidies through spending cuts and improvements in delivery systems. But that's a lot of wishful thinking, according to health policy experts on both sides of the aisle. Expanding access to care will require hard decisions about reducing spending and tax increases that most people won't like at all.
Insurers
For insurers and health plans, broader healthcare coverage could expand the health insurance market. Subsidies and tax incentives, as well as coverage mandates, promise to increase the number of covered lives and to give patients more resources to pay their bills. Democratic plans "could be very good for insurers because we would see more people covered," explains Sandy Lutz, managing director of PricewaterhouseCoopers' Health Research Institute.
At the same time, proposals from both parties for expanding the individual insurance market could accelerate a shift to a larger retail market. Lutz believes that insurers can adjust to such a change, as they already have experience with consumer-directed healthcare and Medicare Part D plans, which involve...
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