Presidential Health

Bush, Gore Campaigns Jockey for Position on Health Issues  

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Legislative Affairs Feature -- September 2000  

By  Ken Ortolon
Associate Editor

When Americans go to the polls in November to elect a new president, they will choose a leader who will preside over arguably the most important health care debate our nation has faced since Congress enacted Medicare in the 1960s.

At press time, Congress was locked in a bitter partisan battle over patients' rights legislation, which was stalled in a House-Senate conference committee. Medicare is in serious need of reform to shore up its shaky financial status before the baby boom generation begins retiring early in this century. And the Clinton administration has added a wrinkle by wanting to tack a potentially costly prescription drug benefit onto the program.

Despite a booming national economy, the number of uninsured people has outpaced the nation's prosperity, prompting a potential crisis in the US health care delivery system.

Advances in technology and medical research are driving up the cost of new pharmaceuticals and treatment methods. And, numerous issues -- including the emergence of the Internet and the use and misuse of confidential medical records -- are threatening patient privacy.

All of these issues will confront the new president and the new Congress in 2001. While political observers in both Austin and Washington disagree on whether these issues can make or break the candidacies of Democratic Vice President Al Gore and Texas' Republican Gov George W. Bush, there is little doubt they will figure prominently in the race for the White House. Democratic and Republican politicos say their candidates must stake out territory they can defend and hold as the health care policy debate heats up this fall.

Health issues traditionally have played a key role in national political campaigns. "If you ask the public what issues are important to them, health issues usually are in the top three, but they're always in the top six," said Nancy W. Dickey, MD, acting dean of the Texas A&M University System Health Science Center College of Medicine and past president of the American Medical Association.

A number of recent national polls support Dr Dickey on that point. In late June, Newsweek magazine asked 750 Americans to rank the issues that should be the "highest priority for government in Washington" over the next year. Reforming the health care system and fixing Medicare ranked among the top five issues. A Harris Poll conducted 2 weeks earlier asked 1,015 Americans to name "the two most important issues for the government to address." Health care ranked No. 1.

Staking out a claim  

With health care high on the public radar screen, the question is, Which candidate can exploit the issue with voters this fall? Not surprisingly, both camps think they can gain the upper hand in the health care debate.

"There are a number of health care issues that Americans are concerned about -- long-term care, affordability of prescription drugs, making sure that kids have access to health insurance," said Gore spokesperson Jano Cabrera. "On each of these fronts, if you compare what the two candidates have proposed side by side, we're confident that our guy will come out on top."

Bush supporters disagree. "Issues that traditionally have been Democratic issues in the past, such as Medicare and health care, aren't necessarily to be taken for granted as issues that Gore will be able to champion," said Republican political consultant Bryan Eppstein, of Fort Worth. He says recent polling indicates Governor Bush is doing well on traditional Democratic issues such as Social Security, education, Medicare, and health care in general.

Meanwhile, the war of words and political spin on health care has begun. The vice president's campaign Web site includes a lengthy laundry list of health care priorities, including strengthening Medicare and Medicaid, expanding access to health care, holding down costs, investing in medical research, improving quality, enacting a patients' bill of rights, and protecting children from tobacco.

Governor Bush's site ( ) focuses more on education, Social Security, and taxes, but also includes proposals to help the working uninsured afford health coverage through $2,000 tax credits. He also pays considerable attention to bailing Medicare out of its impending fiscal crisis, while providing a prescription drug benefit for seniors through the private marketplace.

Governor Bush also has spent a significant amount of time on the campaign trail and space on his Web site touting Texas' leadership in the area of managed care reform, all of which was enacted under his watch, if not initially with his enthusiastic support.

Spinning the issues  

Meanwhile Vice President Gore has spent considerable time recently criticizing Texas and Governor Bush for being stingy with spending on health care for the poor and leading the nation in the number of people who lack health insurance.

"The record speaks for itself," Mr Cabrera said. "[Governor Bush] had the opportunity to expand the Children's Health Insurance Program. Once it was passed, he took credit for it, but he initially fought efforts to expand coverage for children in Texas."

Democrats also think Governor Bush is vulnerable on the issue of patients' rights. Some congressional Republicans, such as US Rep Charles Norwood, of Georgia, support and have even sponsored the Patients' Bill of Rights legislation pending in Congress. However, the Republican leadership in Congress has taken the blame for blocking any meaningful patients' rights legislation. And, Vice President Gore has gone so far as to slam Governor Bush for failing to use his influence with those Republican leaders to move the legislation forward.

"Bush can use his influence here," Mr Cabrera said. "These are the people who are supporting his campaign."

Health care lobbyist Marc Samuels, a former health policy analyst to both President George Bush and the governor, says the vice president's arguments simply point out his own lack of leadership.

"A sitting president and a sitting vice president -- who also acts as presiding officer of the Senate -- should be able to move these issues," Mr Samuels said. "The administration shouldn't need the Republican presidential nominee to move these issues along for them."

The Texas record  

Meanwhile, other Republican strategists say Governor Bush is well positioned on patients' rights. In fact, in a July 11 press release, the governor's campaign took the vice president to task for his lack of leadership on patients' rights and touted the cutting-edge managed care reforms Texas has enacted during Governor Bush's tenure.

Mr Eppstein says the governor has a real chance to own the patients' rights issue this fall. "If George W. Bush champions loudly the patient protections that have been passed in Texas, he will win this issue strongly. He certainly has the platform to stand on. The question is whether he will get on it and champion it, because to do so he has to butt heads with the Republican leadership in Congress right now," he said.

Governor Bush vetoed the first patient protection bill that landed on his desk in 1995. But his supporters, including some Texas physicians, point out that he had a justifiable reason.

"The governor's argument was that the bill in 1995 exempted two large health plans," said Houston internist Carlos Hamilton, MD, former chair of the Texas Medical Association Political Action Committee (TEXPAC), who is close to Governor Bush. "He asked his insurance commissioner, Elton Bomer, to promulgate rules to reinstate all the aspects of patients' rights that he did support."

The rules then-Commissioner Bomer eventually adopted went even farther than the original bill and formed the basis of the far broader package of patient protection reforms that the Texas Legislature enacted in 1997. Governor Bush signed most of those bills and let a measure creating the first-in-the-nation statute allowing health maintenance organizations to be sued for negligent medical necessity decisions become law without his signature.

"Bush said his reason for not signing the liability reform was that he was skeptical as to whether it would dramatically escalate lawsuits," Mr Eppstein said. "The proof is that it has not. He's always been good at standing up and saying, 'I'm wrong or if the empirical data proves me wrong, I'll correct my position.'"

Kim Ross, TMA's vice president for public policy, agrees with Mr Eppstein. "Any criticism of Governor Bush's veto of 1995 misses the point entirely," he said. "The 1997 legislative package, which he did support despite fierce opposition from the business and insurance interest groups that were among his staunchest supporters when he first ran, was more comprehensive by a factor of 5. In fact, it is the basis of the bipartisan Norwood-Dingell Patients' Bill of Rights.

"Governor Bush overcame stiff internal opposition from his staff, as well as a multimillion-dollar lobbying blitz by some of his core constituencies to cross over and land on the shores of patients' rights," Mr Ross continued. "It is of national significance that the Republican nominee for president of the United States has taken a position that not only defends states' rights and patients' rights but also directly contradicts the position of the Republican congressional leadership."

Meanwhile, Republicans say the vice president has some vulnerability of his own on health care. For one, they say the administration's Medicare prescription drug plan -- staunchly supported by Vice President Gore -- is unrealistic because it would create an uncapped entitlement that puts the government at great financial risk.

Ringing endorsement  

Despite Texas physicians' initial disappointment over the veto of the 1995 patient protection bill, many continue to support the governor. And TEXPAC has endorsed him in his campaign against Vice President Gore.

"During his tenure, Governor Bush has demonstrated a talent for overcoming the more strident elements of his party, as well as his supporters in the business and insurance communities, to support what is demonstrably the most comprehensive patients' rights laws in the country," Mr Ross said.

Ken Ortolon can be reached at (800) 880-1300, ext 1392, or (512) 370-1392; or by email at Ken Ortolon.  


What Americans think

Health care ranked high on Americans' list of priorities in recent polls by Newsweek magazine and the Harris Poll.

In June, Newsweek asked 750 adults: "In your opinion, which ONE of the following should be the highest priority for the government over the next year or so?"

Their responses were:

  1. Improving education -- 32%
  2. Fixing the Social Security system -- 24%
  3. Reforming the health care system -- 23%
  4. Fixing the Medicare system -- 11%
  5. Reforming the campaign finance system -- 4%
  6. Don't know -- 6%

Also in June, the Harris Poll asked 1,015 adults: "What do you think are the two most important issues for the government to address?"

The top responses were:

  1. Health care (excluding Medicare) -- 18%
  2. Education -- 15%
  3. Taxes -- 14%
  4. Crime/violence -- 12%
  5. Social Security -- 12%
  6. The economy -- 9%
  7. Gun control -- 7%

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