Parsing GOP, Democratic Health Care Proposals

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The Issues

Where do the GOP and Democratic presidential candidates stand? Read side-by-side comparisons.

Super Tuesday

On Feb. 5, 24 states will hold presidential nominating contests. Find out what's at stake, region by region.

Next week, almost half of the states will vote or caucus to choose a Republican and a Democratic presidential nominee — 24, to be exact. Poll takers say many Americans remain undecided, so we're looking at a handful of the issues in the campaign. Today's subject is health care. It's always an important issue for Democratic voters, but this year, Republicans also are worried about rising costs — so every candidate has a health care plan. NPR health policy correspondent Julie Rovner and Michele Norris help sort through some of them.

Candidates from both parties are proposing fairly far-reaching health plans. But while the Democratic plans would probably cover more of the uninsured, they would change the health care system for most people less than the Republican plans would, and the GOP plans envision a much bigger shift in the way people get their health insurance.

In the end, it's still back to the same old debate of Democrats pushing a bigger role for government and Republicans more of a role for the free market, Rovner says.

The Democrats

Hillary Clinton's plan would require people to have health insurance — it's called an individual mandate. John Edwards, who just dropped out, also had one, and Barack Obama has one, too, at least for children. All three plans were based on the concept of "shared responsibility," where government, individuals and employers all pay something.

The big difference among the Democrats — really the only meaningful difference — is that while Clinton would require everyone to have coverage, Obama wouldn't. He basically says that if you build it, people will come — you don't have to have a mandate to get people to buy insurance.

So, Clinton and Obama would let people keep their existing coverage if they want to, or buy into a government-sponsored plan like Medicare, and the government would subsidize small businesses and the poor.

The Republicans

The GOP plans are more alike than they are different, although not quite as alike as the Democrats' plans. The Republicans — like President Bush — want to rely more on the free market to create more competition to push down the cost of health care, and they want to use the tax code to encourage more individuals to buy their own insurance.

Mike Huckabee has a provision in his plan that would allow people who live "healthy lifestyles" to pay lower health insurance premiums. And John McCain proposes to pay doctors and hospitals based on how well their patients do, and to "reward wellness and fitness."

Former Massachusetts Gov. Mitt Romney has done what none of the other candidates can claim: He signed a major health reform into law. The Massachusetts plan has a mandate attached to it, something Republican primary voters aren't thrilled by, but Romney has said he'd let states basically do what they want. And he'd roll back the federal standards now in place for the Medicaid program for the poor and let states use that money to figure out how to cover the uninsured — which would be a pretty dramatic change.

2008 Election Issues: Candidate Positions

Read side-by-side comparisons of what the Democratic and Republican presidential hopefuls have said on the issues on voters' minds:

Economy

Last fall, as the subprime housing crisis intensified, the economy replaced the war in Iraq as the top concern for Americans. It's quite possible that the economy will remain the top issue until the elections. That's because the bad debts generated by the subprime debacle have caused a credit crunch that, along with record high energy prices, appears to be dragging the U.S. economy into recession. There are even fears of a global downturn.

These concerns have caused wild gyrations in the financial markets, dramatic interest rate cuts by the Federal Reserve and efforts to stimulate the economy by the White House and Congress. The economic situation has compelled the presidential candidates of both parties to hone their economic positions and provide their own ideas about how to avoid a recession. Read a quick summary of their economic views.

Iraq

Few issues divide Republican and Democratic presidential candidates more than Iraq. The Democrats talk about "ending the war" and "bringing the troops home." Republican candidates talk about "success" and "victory" in the region.

But go beyond the bumper sticker quotes and it gets a little muddy.

All the major Democratic candidates say they want to bring the troops home. But they also want to keep some U.S. troops in Iraq to go after al-Qaida, protect diplomats and aid workers. They are vague as to how long those troops would stay. And the Republican candidates talk of success and victory, but with little detail. Read more on where the presidential candidates stand on Iraq.

Health Care

Health care is once again near the top of voters' concerns — a position it has not held since the 1992 presidential race. A December 2007 poll by the Kaiser Family Foundation found that health ranked second among issues voters want policymakers to address — following only the war in Iraq — among Democrats, Republicans and independents.

That may help explain why Democrats and Republicans running for president have offered up comprehensive health care policy proposals during the primary phase of their campaigns. Read a sampling of each candidate's health care proposals.

Immigration

Immigration provides one of the clearest contrasts between the parties. While both Democrats and Republicans advocate various enforcement measures, most of the Republican contenders reject legalizing an estimated 12 million undocumented immigrants now in the U.S.; all the Democratic contenders support it. GOP candidates have highlighted their get-tough approach, while Democrats have generally avoided the topic unless asked.

Read a breakdown of the candidates' votes and positions on some of the main immigration legislation in recent years.

Climate Change

Climate change is moving to the front burner for many of the candidates vying for the Democratic and Republican nominations in 2008. The new awareness results from several factors: A growing consensus among Americans on the left and right that global warming issues must be addressed; concern over imported oil from the Middle East; and the newfound muscle of California's eco-voters, thanks to their state's early primary this year. Read what the presidential candidates have said so far.

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