Where They Stand: Health Care

Sept. 16, 2004 -- 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.