The Body: The Complete HIV/AIDS Resource Follow Us Follow Us on Facebook Follow Us on Twitter Download Our App 
Professionals >> Visit The Body PROThe Body en Espanol

Peer Counseling Perspectives

Health Care Reform 101

September/October 2004

Mary Lynn Hemphill, L.M.S.W.

Elections will soon be upon us, bringing health care reform again to the forefront of public discussion. The American public rates access to health care as a major concern, but evaluating different proposals put forth by the candidates and others can be difficult for those of us who are not policy experts.

What Is Health Care Reform?

Health care reform is a term that describes comprehensive plans that will change the way a population is able to obtain medical care. Some health care reform plans build on the current system by making changes in the tax code, adding benefits or broadening enrollment in existing programs such as Medicare, Medicaid or other plans. Other proposals, such as those that promote single-payer health care, would result in a full-scale change in the way Americans receive health care.

Why Is Health Care Reform an Issue in the United States?

In 2002, 44 million Americans lacked health insurance. That was four million more than in 2000. When people who are uninsured for at least part of the year are also included, a 2003 study found that the number of uninsured is closer to 62 million people.

Several factors have brought the issue of health care reform back into the public eye in the last decade. According to a 2003 study, "the most important factor behind the rise in the number of uninsured over 2000-2002 was the decline in employer-sponsored health insurance coverage." Health insurance premium costs and medical expenses have increased while a weakened job market has left previously insured workers without coverage or with inadequate coverage. These elements strain public systems (including Medicare, Medicaid, the Veterans Administration and the Ryan White system, among others), as well as the private health sector.

In the United States, access to private health insurance is usually tied to employment. Many employers have responded to recent economic constraints and higher insurance costs with a reduction in worker health benefits. This crunch has particularly been felt by the middle class, who now bear a heavier weight from increased contributions to premiums, higher deductibles and co-pays and a more limited selection of medical providers. The bill for uncompensated care (care received by uninsured people without the means to pay their medical bills) in the U.S. is about $35 billion a year.

People without stable medical coverage have a shorter life expectancy and a worse health status. In addition to the toll of human suffering, there is an enormous financial cost to the country from reduced earnings and lower educational attainment. We can clearly see this in the HIV/AIDS community, where many people who are on disability are reluctant to go back to work if it means risking losing current medical benefits.

U.S. public spending per person for health care is greater than in other countries, yet the U.S. ranks lower than Germany, France, the United Kingdom, Canada, Italy and Sweden in life expectancy. Americans are seeing health care provision change, but not in a way that they desire. Tantalizing medications and procedures offer a longer and higher quality of life at a price that is increasingly out of reach for many. Medical care is in crisis and voters are looking to government for solutions.

How Do I Learn About a Candidate's View on Health Care Reform?

Each presidential candidate (and usually local candidates) address health care reform on their web sites, in policy papers and in speeches. Web sites for presidential candidates can be found below. The Commonwealth Fund report, published in March 2004, analyzes the forces behind health care reform and reviews the plans proposed by George W. Bush, John Kerry and Dennis Kucinich. It is an excellent guide to understanding three major perspectives on health care reform. It also provides guidance for assessing each proposal. Although Kucinich has now withdrawn from the presidential race, it is useful to read about his proposal as he, like Ralph Nader, advocates a single-payer health plan. The report can be downloaded at no charge from the Fund's web site at or a copy can be obtained by calling their toll-free publications line at 1 (888) 777-2744.

The plans offered by the presidential candidates differ significantly in the percentage of people who would gain coverage (ranging from 10% to 100%), the cost of each plan (from $70 billion to $6 trillion over ten years) and the time it would take to put the plans into action. To summarize, the Bush plan focuses on tax credits and changes in malpractice awards, the Kerry plan mixes public and private elements with flexibility to move in stages toward universal coverage, while Kucinich's and Nader's plans call for a single-payer system with universal coverage. (Universal coverage means that everyone is covered in a plan, regardless of preexisting condition, marital status, employment status or age.)

Many states are considering or have implemented health care reform, including Maine, where the state is moving on a plan toward universal coverage, and California, where employers are required by law to provide insurance for workers or pay into a state fund that provides coverage. The current Canadian system of single-payer health care started in one province, then grew into a national system. It is likely that states will continue to pursue their own health care reforms rather than wait for an all-encompassing federal response.

In June 2004, a study was released by Georgians for a Common Sense Health Plan that evaluated the administration and funding of a particular universal coverage health proposal for Georgia. A full copy of the report on this proposal, called Georgia Secure Care, can be obtained through Laurie Iscaro at (404) 687-9891 or on the Internet at

What Are Some Questions to Ask Candidates About Health Care Reform Plans?

The Commonwealth Fund recommends considering the following questions as candidates present their plans:

  1. How many uninsured people does the plan cover?

  2. How much will the plan cost the federal government and the health system as a whole, and how might it be financed?

  3. Does the plan improve coverage for people who currently have inadequate health coverage, e.g., high costs or limited benefits?

  4. Does the plan increase stability of insurance coverage, i.e., make it less likely that people will experience gaps in coverage?

  5. Is it likely to improve access to care, the quality of care or health outcomes?

  6. Does it include provisions to reduce costs and improve efficiency in the administration of insurance or delivery of care?

  7. Is it easy to administer or does it require a new and untried administrative structure?

  8. Could the plan be phased in over time?

"The American health care system is confronting a crisis. The health care delivery system is incapable of meeting the present, let along the future, needs of the American public."

-- National Academy of Sciences, November 19, 2002.

Presidential Candidates' Web Sites Regarding Health Care Policy

Mary Lynn Hemphill, L.M.S.W., can be reached at

This article was provided by AIDS Survival Project. It is a part of the publication Survival News.
See Also
More on U.S. HIV Treatment Policy