Health returns as hot issue in '08 race

MANCHESTER, N.H. -- Healthcare, a major theme in the 1992 presidential campaign, has returned as a critical issue in the 2008 contest. But this time, contenders in both parties are placing new focus on preventive care as a way of improving public health and ultimately reducing the skyrocketing cost of medical care.

One presidential candidate wants to give earned days off to federal workers who exercise regularly and do not smoke, while another would press schools to ban junk food. Another candidate plans to reward people who undergo regular physicals and engage in healthy lifestyles with discounts in their health insurance premiums.

Mike Huckabee, former Republican governor from Arkansas, has led the charge for giving financial incentives -- including tax breaks and paid days off -- as rewards for healthy behavior.

Democrats Bill Richardson, governor of New Mexico, and John Edwards, former US senator from North Carolina, are proposing similar ideas. Other presidential contenders have raised the issue on the campaign trail in New Hampshire.

While specialists say spending money on preventive care -- such as lowering childhood obesity rates through healthy school lunches and offering incentives to quit smoking -- may not make much of a dent in overall healthcare costs, the candidates say that preventative efforts can reduce painful, expensive-to-treat illnesses such as lung cancer and diabetes.

"Everything about the whole system is upside down," Huckabee said in a recent interview. "Doctors are rewarded for treating sick people, not keeping them well."

Candidates say they are committed to tackling the biggest health crisis: finding coverage for the 47 million Americans who do not have health insurance, a widening gap that the candidates say increases health costs for everyone.

Edwards, the only major party candidate so far to offer a detailed healthcare plan, wants to make health insurance mandatory nationwide, as Massachusetts has done for its residents.

But unlike in previous campaigns when candidates have focused almost entirely on the uninsured, the early presidential candidates are talking about promoting wellness as a way to avoid the high costs of treating cancers, heart disease, and other ailments.

"I think you're going to see a prevention component of virtually every candidate's healthcare reform" plan, said Drew Altman , president of the Kaiser Family Foundation, a healthcare advocacy group. But he said the idea could not take the place of expanding health insurance coverage and controlling costs on a large scale.

"Nobody can pretend we can cover 47 million uninsured people without a huge outlay of money to do it," Altman said.

Among Democrats, Senator Barack Obama of Illinois and Senator Hillary Rodham Clinton of New York, who tried and failed to pass a universal healthcare plan when she was first lady in the 1990s, have discussed preventive care in their early campaign appearances in New Hampshire. Neither has issued a detailed plan, although Obama said he would unveil his in the coming weeks.

The issue is personal to Huckabee, who as Arkansas governor dramatically changed his eating habits and began exercising after a doctor diagnosed him with Type 2 diabetes in 2003.

Huckabee shed 110 pounds, competed four marathons, and instituted a Healthy Arkansas Initiative to encourage state residents to stop smoking, lose weight, and exercise more. Arkansas state employees now receive discounts on their health insurance premiums in exchange for practicing good health habits.

Richardson, who recently announced his candidacy for the Democratic presidential nomination, has already banned junk food in New Mexico schools, installed school-based clinics that provide mental health services as well as medical tests, and reinstituted physical fitness classes in schools where it had been eliminated.

As president, Richardson said in an interview, he would give tax breaks to businesses that grant company time and on-site gym equipment to employees who want to exercise, and he would reward schools that eliminated foods such as chips, soda, and candy from their cafeterias.

"I believe we've got to focus more on preventive care, especially with kids," Richardson said. "In the long range, you get better health for all Americans."

While no lawmaker can force someone to lose weight or stop smoking, Huckabee said, governments can provide incentives that lead to behavioral changes. If elected president , Huckabee said, he would also give tax incentives to businesses that promote healthy habits, and he would allow federal workers to earn time off for good health behavior, the positive alternative to sick days.

Although elementary and secondary schools are largely under local control, Richardson asserts that the federal government has some control over school nutrition guidelines and funds some of it, giving the government leverage when it comes to school menus .

Edwards's healthcare plan is meant to cover all Americans by 2012 either through their employers or through a series of new "health markets," nonprofit plans run by states or groups of states. The health markets, offered to individuals and businesses that do not provide their own health coverage plans, would include lower health insurance premiums to individuals who take advantage of free checkups and enroll in "healthy living programs," an Edwards campaign spokeswoman said.

Healthcare specialists welcomed the candidates' ideas on preventive care but said the concept would not help slow the escalating cost of overall healthcare.

"I think they all feel the need to say something about [healthcare] costs. And who can argue against the logic of prevention?" said John McDonough , executive director of the Massachusetts-based Health Care for All. "The problem is, how do you do it in a way that makes a difference?"

Conducting numerous medical tests, for example, may catch some ailments early, he said, but on a mass scale the price of the tests may drive healthcare costs even higher.

Alan Sager , a Boston University health policy and management professor, said he worried the candidates "are talking about costs in ways that are politically safe and largely irrelevant financially."

Fast-growing healthcare costs will not be contained, he said, until lawmakers grapple with the more politically difficult issues of hospital payments, drug prices, and doctors' fees.

Huckabee said wellness programs would not only lower medical costs, but also increase Americans' productivity at work.

"This isn't just a feel-better" plan," Huckabee said. "It has real economic advantages. And it's something I've not only talked about; I've lived it."

(Correction: Because of an editing error, a Page One story yesterday about healthcare being a hot topic among candidates in the 2008 presidential campaign incorrectly identified the home state of John Edwards. He is a former US senator from North Carolina.)