The Campaign Trail: Health care plank builds presidential platforms

Welcome to the Campaign Trail, a new ACP Internist column covering health care issues in the 2008 presidential campaign.

Over the next 10 months, I will try to update you on what the candidates have been saying about health care, suggest good resources for additional information on their positions, and, through a series of ACP InternistWeekly online polls, provide insight into your colleagues' thoughts about the election.

According to the results of our first poll, readers are most interested in the candidates' plans to expand health care access. Access resoundingly defeated cost, quality and the ever-popular “other” categories in our unscientific online survey (see graph “Readers decide: health care access”).

So are the candidates responding to physicians' concern about expanding Americans' access to health care? To find out, I decided to check out the campaign Web sites of six top candidates (the three Democrats and three Republicans who were polling highest as of press time).

If you evaluate the candidates solely on who puts the most emphasis on health care, the Democrats as a group are leading the Republicans, and underdog John Edwards takes top honors. Health care is the top item on the “issues” page of his Web site. Hillary Clinton's site ranks it second after strengthening the middle class, and Barack Obama lists health care third, just after overseas issues and Iraq.

On the Republican side, Fred Thompson has health care in the fourth spot on his list of issues, behind national security, the federal budget and taxes. Mitt Romney lists it at 11 out of 12, and Rudy Giuliani makes no mention of health care on his issues site, which covers his 12 commitments to America.

What does Web site content and placement say about the presidential contenders? Does it accurately represent their perception of their supporters' interests or just the preferences of their Web developers? I don't know. What I do know is that clicking through on the links doesn't offer much more information to differentiate the candidates on the issue of health care access.

The leading Democratic candidates have remarkably similar plans intended to provide “universal, affordable, quality” health coverage for all. Senators Clinton and Obama even explain their programs in the same way—providing all Americans with the same health insurance options that members of Congress receive. And Mr. Edwards has noted repeatedly how similar Sen. Clinton's plan is to his own.

Likewise, Republican candidates are unified in their desire to keep health care in the private sector and use free-market strategies to expand access to insurance. Even their critiques of the Democratic plans sound the same—Mr. Romney presents his plan as an alternative to “a one-size-fits-all, government-run system,” while Sen. Thompson opposes “a one-size-fits-all Washington-controlled program.”

So how does a health-care-concerned primary voter choose the candidate who best reflects his or her views? You can get behind one of the long-shot but more activist candidates. (At the Democratic debate in Philadelphia, Dennis Kucinich explained his sponsorship of legislation establishing Medicare for all: “There is no one else on this stage who is ready to take on the insurance companies directly,” he said.)

Or you can check out ACP's new candidate comparison Web tool, which enables you to compare the details of all the candidates' plans with the official positions of the College. The web tool draws on recommendations for health care reform that were outlined in the College's recent position paper, Achieving a High Performance Health Care System with Universal Access, published in the Jan. 1 issue of Annals of Internal Medicine. The tool looks at six different issues raised in the paper and evaluates where the candidates stand on each of them. The tool will be updated continually throughout the 2008 election cycle.