ELECTION 2004

• Chabot has a nice chat with justice • Health care looms as president's task • Fingerhut knows underdogs • Women for Kerry draws 2,500 • Kerry: Bush has hidden plan • Disagreements mark race • Voting opens today in Fla. • Newspaper: More votes uncounted in black areas • 2004 Presidential endorsements • Election 2004 section

Many people agree that America's health-care system needs fixing. Few agree on how to fix it.

During last week's debate and in a flurry of political ads that will become more intense as the Nov. 2 election approaches, both sides have blitzed voters with health-care statistics and sound bites, charges and countercharges.

But in Cincinnati, like much of the country, it does not appear that voters will be selecting their president based on health care.

"I think health care is an important issue in this election and for many elections to come," says Alan Flaherty, 64, Evendale. "On the other hand, I don't think it's going to have a huge influence on who wins the presidency next month."

Iraq, terrorism and the economy seem to be higher priority issues.

Even so, the next president will deal with health care.

In Cincinnati, an Enquirer poll conducted earlier this year found that nearly 57 percent of area residents believe the health-care system is in a crisis.

At the national level, the consumer group Families USA reviewed what progress, if any, has been made on key health issues.

"The answer to our question - are we better off today? - is a clear 'no,'" states the group's report, issued in September. "The challenge in the next four years will be for our nation's leaders to move from debate to action - making health care a top budget and issue priority."

Problems facing the health-care system include:

PROPOSALS

Candidates' heath care proposals President Bush Affordable health coverage: Would provide tax credits to low-income families to encourage enrollment in health savings accounts. Also would provide a tax credit to small businesses to encourage worker enrollment and would allow small businesses to form pooled coverage plans. Would reduce drug costs by encouraging competition between generic and brand-name drugs. Contends that malpractice reforms also will help reduce costs. Covering the uninsured: Would provide tax credits for the uninsured to purchase private policies. Single adults with incomes up to $30,000 a year would be eligible for credits worth up to $1,000 a year. Families with incomes up to $60,000 a year could get credits worth up to $3,000 per year. Also would launch a two-year, $1 billion Cover the Kids campaign to enroll children who are currently eligible but have not enrolled for Medicaid and the state Children's Health Insurance Program (CHIP). Bush also proposes to add 600 new or expanded health center sites. Malpractice reform: Would impose minimum standards on the medical liability system, including a $250,000 cap on non-economic damages. Prescription drugs: Successfully pushed for passage of a Medicare discount card program that took effect in 2003 and says seniors will benefit even more from the full-blown Medicare prescription drug plan that takes effect in 2006. Stem cell research: Bush signed an executive order allowing for federally funded research on existing embryonic stem cell lines. However, experts say only 22 of the 60 approved stem cell lines still exist. Other reforms: Would make premium payments for long-term-care insurance fully tax-deductible. He also proposes an additional personal tax exemption for people who take time off to care for family members. John Kerry Affordable health coverage: Would encourage people to join a variety of insurance pools, including one that matches the benefits provided to members of Congress. Small-business owners would get tax credits worth up to 50 percent of premium contributions for buying into the new group plans. People ages 55-64, low-income people, and unemployed people also would get various tax credits to buy into the group plans. Private insurers would offer the coverage plans in the system. Covering the uninsured: Uninsured individuals would get tax credits if they spend 6 percent to 12 percent of their income on premiums in the new insurance pool. The federal government would assume costs of all children enrolled in Medicaid if states agree to expand coverage to children in all households with incomes up to 300 percent of poverty, as well as expand coverage to parents and other poor adults. Malpractice reform: Proposes a mediation system before allowing cases to go to trial, a review system to determine if claims are reasonable, sanctioning cases that make improper claims, and limits on when punitive damages can be awarded. Prescription drugs: Would allow importing drugs from Canada and would require that Medicare negotiate lower prices for prescription drugs. Kerry also proposes closing loopholes that keep some generic drugs off the market. Stem cell research: Kerry calls for lifting current restrictions on stem cell research. Other reforms: Calls for Medicare to provide 80 percent coverage for mental health services.

• Soaring premiums for health-care coverage. Workers' payments for health benefits rose nearly three times faster than wages from 2000 to 2004, and many people are getting weaker coverage for their money. Businesses, especially small businesses, are as frustrated as workers about soaring health care costs.

• The number of uninsured people has grown from 39.8 million in 2000 to 45 million in 2003, according to the Census Bureau, creating a financial burden on the health system while aggravating health problems suffered by uninsured people who are more likely to skip checkups and delay treatments.

• Senior citizens have yet to feel relief from soaring prescription drug prices despite a flurry of drug discount cards issued this year and promises that reforms coming in 2006 will make a difference.

• Doctors are deeply frustrated about rising malpractice insurance fees.

• Hospitals, which have enjoyed improved finances in Cincinnati in recent years, still worry that rising budget deficits could hurt them by leading to cuts in payments from Medicare and Medicaid programs.

So who has the better plan?

Kerry blames the Bush administration for people losing their health insurance, for seniors turning to Canada for cheaper medicine, and for workers getting socked by soaring health coverage costs.

He says he would allow imported drugs from Canada and would push Medicare to negotiate lower prices with drug companies. He says a new set of health insurance pools for small businesses, early retirees and the uninsured would make health benefits more affordable.

President Bush says health coverage should be more of an individual responsibility than a government obligation. He dismisses Kerry's proposals as expensive, big government solutions that won't work.

Bush also claims credit for taking more action on Medicare prescription drugs than any other president in years - and accuses Kerry of showing no leadership on health issues as a senator.

Bush would make health care more affordable by promoting health savings accounts; by offering several tax credits for uninsured people, small businesses and others to offset coverage expenses; and by promoting malpractice reform.

Both plans get attacked by special interest groups for being too expensive or too complex, yet not strong enough or comprehensive enough to really change the system.

In Greater Cincinnati, viewpoints on health care are just as divided as the candidates themselves.

Dr. Carl Gilbert, vice president of the Cincinnati Medical Association, says minority health concerns seem overlooked.

"As a matter of fact, the vice president during his debate admitted he was not familiar with the higher number of HIV/AIDS in African-American communities," Gilbert says.

Woody Pack, owner of Pack Pharmacy in O'Bryonville, says he opposes Kerry's proposal to allow imported drugs from Canada.

"Kerry says he's against outsourcing jobs, but he's willing to outsource my job to Canada," Pack says.

Dr. Susan Montauk, a family practice specialist and former member of the Cincinnati Board of Health, says she cannot support either candidate's health proposals.

"In the face of millions of Americans who would continue to receive either no health care or enormous bills that may potentially drive them further into debt ... a few Band-Aids offer little hope," Montauk says.

Then there's the stem cell research debate, a high-tech topic suddenly infused with high-profile personality factors - including the recent deaths of former president Ronald Reagan and actor Christopher Reeve.

Advocates say embyronic stem cell research could lead to cures for Alzheimer's disease, spinal cord injuries and many other conditions. Opponents say the process requires destroying human embryos - which they consider akin to abortion.

Both candidates walk a tightrope on the topic.

Bush has attempted a compromise by allowing federal funds to pay for research based on embryonic stem cell lines that already exist, but not for destroying embryos to create more. Many scientists say the restriction cripples progress in the field.

Kerry, a Catholic, has called for removing the existing restrictions on stem cell research. But that has prompted other Catholics to accuse him of betraying a fundamental tenet of their faith.

---

E-mail tbonfield@enquirer.com