Where They Stand: Health Care

The promises are made at every campaign stop. President Bush pledges to make health care "more accessible and affordable." Sen. John Kerry promotes his ideas as a "plan for stronger, healthier families and children."

Both presidential candidates are keenly aware of how important health care is as an issue to many voters. The latest ABC News poll shows Americans rank health care No. 4 of the issues they're most concerned about — behind the economy, terrorism and Iraq.

"Nobody can duck health care," said Drew Altman of the nonpartisan Kaiser Family Foundation. "Everybody has to show they care about health and that they have a plan."

But in this election year, Altman said, the two candidates have plans that are quite different. Bush and Kerry offer distinctly different philosophies on how best to lower health care costs and provide coverage for more Americans.

"I think the Bush plan is more radical than Mr. Kerry's," said Henry Aaron of the Brookings Institution, a Washington think tank. "The Bush plan would try to begin to move away from the employment-based system to a system of individually purchased health insurance. Sen. Kerry's plan takes the current system and tries to strengthen it."

Bush’s Plan

The centerpiece of Bush's plan is meant to encourage individuals to take more control of their own health care.

The plan includes tax breaks for individuals and small businesses who contribute to health savings accounts. HSAs are accounts in which people can save money tax-free and use the funds to purchase health care.

"The Bush vision is quite radical. He essentially is dreaming of a world where there is no employer-provided insurance," said Uwe Reinhardt, a health economist at Princeton University. "You buy your own insurance, but you pay the first $2,000 to $4,000 per year out of your own pocket."

The idea makes a lot of sense for healthy Americans who don't expect to have many medical problems. They can buy insurance with a low premium and a high deductible and use the money from their HSAs to pay for minimal expenses they incur.

"People who are now buying very expensive insurance on the individual market are attracted to this, because they are finally getting a tax break, and they are getting an opportunity for their employers or themselves to put some money aside for health eventualities that we all run into," said Joseph Antos of the American Enterprise Institute, another think tank in Washington.

Bush campaign officials say consumers will be more savvy and aware of costs if they're in charge of their own health expenses. That, they argue, will reduce the total bill America pays for health care.

But critics worry the healthiest, wealthiest Americans will be more likely to take advantage of the tax breaks and the system would leave poorer patients behind.

And health savings accounts are a relatively new phenomenon, so it's difficult to measure how much impact they could have. Researchers at the RAND Corp. estimated the use of such accounts by the nonelderly might change health spending overall by 1 percent or 2 percent — not a very big number.

Kerry's Plan

Kerry's health care proposals are less radical in theory. They are more extensive, though still not a total overhaul of the current system.

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