With health care a top issue for both Democratic and Republican voters in this year's presidential campaigns, candidates from both parties have unveiled plans for curbing health costs and boosting insurance coverage. But voters might be surprised by which party's plans would actually change the health system more.
The Democratic candidates have mostly emphasized covering the 47 million Americans who don't have health insurance.
"The single, most important element ... is does it cover everybody?" said former North Carolina Sen. John Edwards at a health care forum last fall. "Because if it doesn't cover everybody, then I think whoever the candidate is should be made to explain what American they believe is not worthy of health care coverage."
Republicans, on the other hand, tend to stress ways to bring down health care costs. Here's how former Tennessee Sen. Fred Thompson put it at the GOP debate just before last week's New Hampshire primary: "We've got the best health care in the world. It costs more than it should. We can either go one of two ways. We can let the government take it over, and that'll lower costs — like they do in other countries. We will also sacrifice care, which nobody wants to do. We're not going to do that in this country. Or we can make the markets work more efficiently."
It's true, said Drew Altman, president of the nonpartisan Kaiser Family Foundation, that the Democrats want to rely more on government programs and the Republicans more on the free market to fix what's wrong with the nation's health care system. It's also true that Democrats are proposing to spend more money on their plans, he said, "but it's actually the Republicans who are proposing the bigger transformation of the health insurance system and indeed the more radical change, and that's been completely lost and misunderstood."
That's because most of the Democrats — still smarting from the failure of the last health reform effort in the 1990s — want to build on the existing system, in which most people get their health insurance on the job. Their plans would have government fill in around the edges and offer subsidies to make coverage more affordable.
Republicans, on the other hand, want to go in an entirely different direction — using the tax system to encourage people to purchase their own individual coverage.
"Only 17 million Americans right now buy their own health insurance," said New York Mayor Rudy Giuliani at a New Hampshire debate.
"If 50 million Americans were buying their own health insurance — because it would be just as tax-advantageous to do it that way — and we had a health savings account, people — economists believe there'd be a 30 (percent) to 50 percent reduction in the cost of health insurance and quality would come up."
That last contention is debatable. But what isn't, said Altman, is how the average consumer would be affected by the Republicans' proposals.
"Because they see a world in which we move away from the current employment-based system, and to some extent our existing public programs, and many more Americans purchase their health insurance themselves," he said. "That's a much bigger change."
But other health analysts aren't convinced the GOP plans are really all that radical. Joe Antos of the conservative American Enterprise Institute said he thinks the Republican changes would likely be more gradual.
"I think what the main Republican candidates are really talking about is the idea that we want to level the playing field on taxes, but I don't think they seriously imagine the employer-sponsored health system is going to dry up and blow away — in fact it won't," he said.
That's mainly because big employers, at least, still use health insurance as an important tool to recruit and retain workers. And besides, he said, when it comes to changing health care in this country — nothing ever happens fast. That's something Democrats and Republicans do agree on.