Security for Older Americans
For most of us, retirement holds both promise and problems. Today’s elderly have far more economic security than earlier generations; and opportunities for learning, teaching, and leading are greater than ever. Public policy must encourage, not inhibit, this. To that end, for half a century, the Republican Party fought to repeal the Democrats’ earnings limitation on Social Security recipients, which took away a dollar for every three they earned. That fight has finally been won, and we salute congressional Republicans for leading it. We likewise note with pride the Republican legislation that has simplified pension law and made it easier for more businesses, especially small ones, to offer pension plans.
We call for full repeal of the death tax, as proposed in Governor Bush’s program, Prosperity with a Purpose, and as recently passed by congressional Republicans. Hard-working Americans should not live with the fear that the fruits of their lifetime of labor will fall into the hands of government instead of their children.
The growing need for long-term care calls for long-term planning both by individuals and by government. We encourage, at all levels of government, regulatory flexibility and sensitivity to human needs in nursing homes and related facilities. In this area, as in so many other unheralded corners of American lives, heroic sacrifices are being made by millions of families to care for their mothers and fathers as their parents cared for them. We support Governor Bush’s call for a 100 percent above-the-line tax deduction for premiums for long-term care insurance, recognizing and rewarding individual responsibility, and we welcome his proposal to allow an additional exemption for each elderly spouse, parent, or relative a family tends to in their own residence.
Preserving and Improving Medicare
“Our nation must reform Medicare — and in doing so, ensure that prescription drugs are affordable and available for every senior who needs them. Seniors deserve a wider scope of coverage, and they deserve to have more choices among health plans. Over the last few years, both Republicans and Democrats have embraced these goals, yet the Clinton-Gore administration has blocked bipartisan Medicare reform. When I am president, I will lead Republicans and Democrats to reform and strengthen Medicare and set it on firm financial ground.” — George W. Bush
Medicare, at age 35, needs a new lease on life. It’s time to bring this program, so critical for 39 million seniors and individuals with disabilities, into the Twenty-First Century. It’s time to modernize the benefit package to match current medical science, improve the program’s financial stability, and cut back the bureaucratic jungle that is smothering it. It’s time to give older Americans access to the same health insurance plan the Congress has created for itself, so that seniors will have the same choices and security as Members of Congress, including elimination of all current limitations and restrictions that prevent the establishment of medical savings accounts. To do that, we need to build on the strengths of the free market system, offer seniors real choices in coverage, give participants flexibility, and make sure there are incentives for the private sector to develop new and inexpensive drugs.
No one in their right mind would choose a physician who limited her practice to the treatments and procedures of the 1960s. By the same token, no one should be content with a Medicare program based on benefit packages and delivery models of that same era. For example, it denies coverage for necessary preventive services, like cholesterol screenings, and limits access to new life-saving technologies. This must change. Every Medicare beneficiary should have a choice of health care options. We want them to have access to the health plan that best fits their medical needs. In short: no more governmental one-size-fits-all.
Medicare also needs new measures of solvency that look at total program expenses and provide an honest reading of how we can guarantee benefits for decades to come. At the same time, we must dramatically reduce the program’s administrative complexities symbolized both by its 130,000 pages of regulations and by its $13.5 billion in improper payments in 1999 alone. Some of that is due to fraud, waste, and abuse, but most of it comes from the sad fact that Medicare is a creaking, bureaucratic, and oppressive dinosaur in the age of MRIs. This frustrates health care providers, hospitals, and patients alike. Let us be clear: We support vigorous enforcement of anti-fraud laws in cases where there is intent to commit fraud, but it is unfair to blame honest health care providers who must seek reimbursement within a minefield of confusing Medicare regulations.
For Medicare to survive — and more important, to succeed — it must become a common enterprise of government, health professionals, and hospitals alike. Rather than continue the practice of recurrent and unpredictable cuts in provider payments, a reformed Medicare program will allow health care providers, particularly those helping rural and underserved populations, to adapt to changing conditions in health care by providing reimbursement at levels that will permit health care providers to continue to care for these patients. Republican leadership will reopen and broaden the door to health care by fulfilling the promise of medical research and innovation, by offering choice and protecting consumer rights, and by modernizing antiquated systems to deliver affordable care for all its beneficiaries.
Quality Health Care: A Commitment to All Americans
Americans enjoy the best health care in the world. Their system, the envy of all mankind, is the center of debate and controversy. This contradiction arises from the dynamism that is changing every aspect of American medicine. Change is seldom easy, and when it relates to the health of those we love, it can be downright scary. Still, the outcome of all this change is a world of unimagined promise in health. We must embrace that change, and master it as well.
The mapping of the human genome, identifying every gene in the human body, may, over time, translate into new treatments and cures for scourges like cancer, Alzheimer’s, heart disease, and HIV/AIDS, as well as diseases that affect the very young, such as muscular dystrophy and juvenile diabetes. A century ago, the average American life span was 55. Today, it is 78, and children born in this decade have the realistic prospect of living into the Twenty-Second Century. A simple blood test can now screen for prostate cancer at its earliest appearance. Biochemistry is revolutionizing the field of mental health. Millions of operations have been replaced with CAT scans. We want that progress to continue. But translating the promise of medical research into readily available treatments requires more than just money; it needs a whole new prescription for health care. That prescription is what the Republican party offers in the elections of 2000.
Let’s start with the diagnosis. After eight years of pressure from the current administration, the foundations of our health care system are cracking. We can spot the fissures everywhere:
There are currently 44 million uninsured Americans, an increase of one million for each of the past eight years.
The institutions and the people who provide health care are at risk. Hospitals in our poorest urban and rural areas are being callously closed, by the same administration that budgets far less than was originally projected, while calling for greater coverage.
The quality of health care is in jeopardy. Recent reports estimate that almost 100,000 patients die each year from medical errors. This is more than from auto accidents, murders, or AIDS.
Medicare, the bedrock of care for our elderly, is suffocating under more than 130,000 pages of federal rules, three times the size of the entire IRS code. It pays for only 53 percent of seniors’ care, provides no outpatient prescription drugs, and does not cover real long-term care, and it is still headed for bankruptcy in the near future.
The doctor-patient relationship has been eroded, and in some instances replaced, by external decision-making and managed care bureaucracy.
We intend to save this beleaguered system with a vision of health care adapted to the changing demands of a new century. It is as simple, and yet as profound, as this: All Americans should have access to high-quality and affordable health care. They should have a range of options and be able to select what is the best care for their individual and family needs. The integration of access, affordability, quality, and choice into the nation’s health care system is the goal that brings together all of the following proposals. In achieving that goal, we will promote a health care system that supports, not supplants, the private sector; that promotes personal responsibility in health care decision-making; and that ensures the least intrusive role for the federal government.
Affordable, Quality Health Insurance
“We will not nationalize our health care system. We will promote individual choice. We will rely on private insurance. But make no mistake: In my administration, low-income Americans will have access to high-quality health care.”
— George W. Bush
Let’s give credit where due: More than 100 million American workers and their families have sound health insurance through their places of employment. The job-creating dynamism of our free economy has thus done more to advance health care than any government program possibly could. The tie between good jobs and good insurance coverage is the single most important factor in advancing health care for those who need it.
That’s why the Republican party remains determined to change federal law to give small employers the liberty to band together to purchase group insurance for their employees at reduced rates, thus providing them that important security. The tragedy is that this urgent expansion of coverage has this far been blocked by veto threats. With a Republican president, that will change.
Uninsured Americans do not have a single face. Their situations vary tremendously, with changes in family status, age, and income. It makes sense to let them decide what kind of coverage best suits their needs. To give them that power of choice, we propose an unprecedented tax credit that will enable 27 million individuals and families to purchase the private health insurance that’s right for them. We also support full deductibility of health insurance premiums for the self-employed.
Truly positive market forces occur when individuals have the ability to make individual marketplace decisions. We therefore strongly encourage support of the emerging concepts of defined contribution plans and medical savings accounts. Individuals should be free to manage their own health care needs through Flexible Savings Accounts (FSAs) and Medical Savings Accounts (MSAs). These initiatives make a government takeover of health care as anachronistic as surgery without anesthesia. We will make these accounts the vanguard of a new consumer rights movement in health care. Individuals should be able to roll over excess FSA dollars from one year to the next, instead of losing their unspent money at the end of each year. MSAs should be a permanent part of tax law, offered to all workers without restriction, with both employers and employees allowed to contribute.
Still, more needs to be done. A major reason why health insurance is so expensive is that many state legislatures now require all insurance policies to provide benefits and treatments which many families do not want and do not need. It is as if automakers were required by law to sell only fully equipped cars, even to buyers who didn’t want or need all the extras. These mandates, extending far beyond minimum standards, increase costs for everyone, price low-income families out of the insurance market, and advance the interests of specific providers. They have no place in a health care system based on consumer rights and patient choice. One area of health care that is sadly ignored is the role of primary and preventive care. This is particularly important in our inner cities and rural communities, where the emergency room may be the only avenue for assistance. People in rural and underserved areas need access to critical primary care. We will boost funding for community health centers and establish stronger public-private partnerships for safety net providers and hospitals in rural and underserved communities.
When Congressional Republicans established the State Children’s Health Insurance Program (S-CHIP) program in 1997, they enabled us to secure health insurance coverage for approximately 8 million youngsters. Republicans want to ensure that children have access to quality health care, and that states have the flexibility to innovate, expand family coverage without interference from the Health Care Financing Administration, and reach out to eligible households that are currently not enrolled in a health insurance program or in Medicaid. In a Republican administration, the first order of business at the Department of Health and Human Services will be to eliminate regulations that are stymieing the effectiveness of S-CHIP program and to stop imposing unwarranted mandates, so states can make sure children who need health care can get it. A streamlined enrollment process and energetic outreach efforts will finally fulfill the promise of S-CHIP. All it takes is caring.
Improving the Quality of Health Care
Protecting Patients’ Rights. The tremendous growth of managed health care was driven by a market response to the fractured system of health care delivery that preceded it. One result of that growth has been a welcomed slowing of the rapid increases in health costs that were a regular occurrence of the 1970s and 1980s. However, this has come at the cost of patient dissatisfaction with the at times impersonal or insufficient health care delivery mechanism. Simply put, patients deserve more protections if we are to achieve a patient-centered system that offers high-quality, affordable care. The parents of a sick child should have access to the nearest emergency care. A patient in need of a heart specialist’s expertise should be allowed to seek that opinion. A woman with breast cancer should be able to participate in a potentially life-saving clinical trial, and patients should have prompt access to independent physicians, or when appropriate, other health care professionals, to override any wrongful denial of treatment.
The traditional patient-doctor relationship must be preserved. Medical decision-making should be in the hands of physicians and their patients. In cases when a health plan denies treatment, a rapid appeals process geared toward ensuring that patients receive the right treatment without delays that might threaten a patient’s health — as opposed to a lengthy trial — must be readily accessible to everyone in all health plans. We believe a quick and fair resolution to treatment disputes without going to court is the best result. However, as a last resort, we also support a patient’s right to adjudicate claims in court to receive necessary medical care. In the interest of fairness to the thousands of businesses that purchase health benefits for their employees and for physicians who care for patients, employers and physicians should not be liable for the actions of the health plan and should be shielded from frivolous and unnecessary lawsuits.
Our overall philosophy is to trust state and local government to know what best suits the needs of their people. We believe the federal government should respect the states’ traditional authority to regulate health insurance, health care professionals, and health practice guidelines through their medical boards.
Medical Errors and Malpractice Reform. Our goal is to reduce the rate of medical errors, especially those that result in a patient’s death. We will support scientific research to provide the public and health care providers with information about why these errors occur and what can be done to prevent them. We should not displace the current, very effective hospital peer review system.
Another key step will be reform of malpractice law. In its current form, it encourages health care providers to conceal even innocent mistakes, lest they be subject to vilifying publicity through the trial lawyers’ system of jackpot justice. That is why a cloak of secrecy envelops operating rooms. We must open up the free flow of information concerning medical errors, both to protect patients and to reduce the cost of modern medicine. Patients who are genuinely injured should be rightly compensated, but the punitive and random aspects of today’s litigation lottery cry out for reform. Just as we hold all health care personnel to the highest standards, so too must public policy respect their ethical conscience. No individual or institution should be compelled to assist in providing any medical service that violates their moral or religious convictions.
Women’s Health. As Republicans, we hold dear the health and vitality of our families. Our efforts to build healthier families must begin with women — our mothers, daughters, grandmothers and grand-daughters. This nation needs far greater focus on the needs of women who have historically been underrepresented in medical research and access to the proper level of medical attention. We are reversing this historic trend.
Across this country, and at all levels of government, Republicans are at the forefront in aggressively developing health care initiatives targeted specifically at the needs of women. The enormous increases in the NIH budget brought about by the Republican Congress will make possible aggressive new research and clinical trials into diseases and health issues that disproportionately affect women as well as into conditions that affect the elderly, the majority of whom are women. And we are leading efforts to reach out to underserved and minority female populations, where disparities persist in life expectancy, infant mortality and death rates from cancer, heart disease, and diabetes.
Republicans are dedicated to pursuing comprehensive women's health care initiatives that include access to state-of-the-art medical advances and technology; equality for women in the delivery of health care services; medical research that focuses specifically on women; appropriate representation of women in clinical trials; and direct access to women’s health providers.
The increasing focus upon health problems of the very elderly, the great majority of whom are women, holds the promise of advances concerning osteoporosis and other ailments which should no longer be considered the inevitable price of old age. Because nutrition is intimately related to health, we advocate state flexibility in managing the various federal nutrition programs for low-income families, especially those receiving TANF assistance, most of whom are female-headed households. Their transition to jobs and independence should include nutritional improvement both for mothers and for their children.
The united efforts of Republican leaders at all levels of government and within our communities will make sure that women gain greater access to relevant care, research, and education on health care issues important to them.
Children’s Health. The huge strides we have already made in improving children’s health must be balanced against sobering statistics. Asthma affects nearly five million children, and the incidence is dramatically increasing. Childhood obesity has jumped 100 percent in the last 15 years and can be a forerunner of the most serious illnesses later in life. Diabetes is now the second most common chronic disease in children. Youth drug abuse has more than doubled in the past eight years. Smoking rates for youth have risen alarmingly. Every year, 2,500 babies are born with fetal alcohol syndrome. So much of the suffering caused by childhood diseases can be prevented — by increasing immunization rates; by increasing resources for biomedical research, not by crippling pharmaceutical progress; by sensible strategies against teen smoking rather than the folly of prohibition; by a real war on drugs in place of the white flag policies of recent years. Our commitment is to address the emotional, behavioral, and mental illnesses affecting children. With parental involvement as the critical component, we can help our youth make the healthy and the right choice in avoiding risk behaviors involving alcohol, drugs, premarital sex, tobacco, and violence.
Biomedical Research. Recognizing the critical importance of research, the Republican Congress, rejecting the administration’s lower figures, has already begun to fulfill its pledge to double funding for the National Institutes of Health (NIH). This is one of the few areas in which government investment yields tangible results; and those benefits can be greatest for currently underserved and minority populations, in which disparities persist in life expectancy, infant mortality, as well as death rates from heart disease, diabetes, and cancer. With one out of four Americans contracting cancer, we need to increase not only research but also early detection and prevention efforts. Since Republicans took control of Congress in January 1995, our party has led in setting sound HIV/AIDS policy, including increased research funding and access to health services. We remain committed to, and place a high priority on, finding a cure for HIV/AIDS. With the enormous increase in resources for biomedical research comes accountability for its use, as well as responsibility to maintain the highest ethical standards. We applaud congressional Republicans for the steps they have taken for protection of human embryos and against human cloning, the trafficking in fetal tissue organs, and related abuses.
Academic Medical Centers. Adequate government reimbursement for medical services is critical to our nation’s comprehensive academic medical centers, which serve as the primary health care resource for our poorest citizens, provide cutting-edge medical discovery, and teach and train our next generation of physicians.
Medical Privacy. The revolution in information and medical technology has created concerns about who has access to personal data — and how it might be used. Patients and their families should feel free to share all medical information with their doctor, but they will feel safe in doing so only if that information is protected. A related concern is genetic discrimination, now that genetic testing will become a routine part of medical health care. Well-conceived, thoughtful action is clearly needed, action that will protect and not harm patients. In both Congress and the Executive Branch, Republicans will work with patients, health care providers, researchers, and insurers to establish new rules for dealing with these new challenges.
Safe Clinical Trials. Ensuring the safety of patients who participate in investigational clinical trials is fundamental to the future of medical innovation. The lack of oversight by the current administration in gene therapy trials put patients at risk and undermined critical research. A Republican administration will require the Food and Drug Administration and NIH to make patient protection a priority in clinical trial research.
Emerging Threats and Bioterrorism. The current administration has left our public health system inadequate to respond to the threats of emerging infectious diseases and the possibility of bioterrorism. We pledge to ensure the ability of the public health service to detect, track, and prevent infectious outbreaks, whether natural or provoked by those who hate America.
Wellness. We repeat our statement that America has the finest health care delivery system that is still the envy of the world. We also recognize that an individual’s health is often a reflection of the everyday choices made. While government’s role is to help ensure a quality health care system, only individuals can make healthy choices.
American Partners in Conservation and Preservation:
Stewardship of Our Natural Resources
“As an avid outdoorsman, I know all our prosperity as a nation will mean little if we leave future generations a world of polluted air, toxic waste, and vanished wilderness and forests.” — George W. Bush
Today’s Republican party stands in the proud tradition of Teddy Roosevelt, the first president to stress the importance of environmental conservation. We approach both the national and individual stewardship of natural resources in the spirit of his maxim: "The nation behaves well if it treats the natural resources as assets which it must turn over to the next generation increased, and not impaired, in value." Over the past three decades, we have made progress. Air and water are cleaner. Some endangered species have made comebacks. Wetlands are being preserved. Recycling is commonplace in our homes. That progress itself has brought us to the threshold of a new era in environmental policy. The lessons we have learned over the last three decades, along with the steady advance of environmental technology, gives us the opportunity to explore better ways to achieve even higher goals.
Our way is to trust the innate good sense and decency of the American people. We will make them partners with government, rather than adversaries of it. The way current laws have been implemented has often fostered costly litigation and discouraged personal innovation in environmental conservation. We need to get back on a common track, so that both the people and their government can jointly focus on the real problems at hand. As a basis for that cooperation, we propose these principles:
Economic prosperity and environmental protection must advance together. Prosperity gives our society the wherewithal to advance environmental protection, and a thriving natural environment enhances the quality of life that makes prosperity worthwhile.
Scare tactics and scapegoating of legitimate economic interests undermine support for environmental causes and, what is worse, can discredit actual threats to health and safety.
Environmental regulations should be based upon the best science, peer-reviewed, and available for public consideration.
We support the federal, local, state, and tribal responsibilities for environmental protection. We believe the government’s main role should be to provide market-based incentives to innovate and develop the new technologies for Americans to meet — and exceed — environmental standards.
We condemn the current administration’s policy of resorting to confrontation first. Instead we should work cooperatively to ensure that our environmental policy meets the particular needs of geographic regions and localities.
Environmental policy should focus on achieving results — cleaner air, water, and lands — not crafting bureaucratic processes. Where environmental standards are violated, the government should take consistent enforcement.
While the very nature of environmental concerns at times requires federal intervention, the heartening progress made by many of the states and localities demonstrates their unique ability to solve problems at the local level. As the laboratories of innovation, they should be given flexibility, authority, and finality by the federal government. Many states have enacted environmental education and voluntary self-audit laws to encourage people to find and correct pollution; the Congress should remove disincentives for states to achieve these goals. Strong leadership by governors, legislators, and local officials is the key to solving the emerging environmental issues of this new century. For example, the reauthorization of the Safe Drinking Water Act by the Republican Congress enabled states and communities to take stronger action to ensure reliable and safe water supplies. Another example is the way states are handling the problem of brownfields. In 35 states, voluntary programs are cleaning up thousands of brownfield sites faster and more effectively, and with less litigation, than under the federal Superfund program. A case in point is Texas, where, under Governor Bush, the number of brownfield sites restored to productive use climbed from zero to 451, not only improving the environment but restoring more than $200 million in property value to local tax rolls, most of it in poor communities.
We will replicate Governor Bush’s success on the national level. We will use Superfund resources to actually clean up places where people live and labor, rather than waste it on costly litigation. The old approach of mandate, regulate, and litigate has sent potential developers away from brownfield neighborhoods. The result: no new businesses, no new jobs — only dirty and dangerous sites. Governor Bush has pledged to transform this failure into an environmental win for those communities, just as he did in Texas, and we heartily endorse his agenda for doing so.
Wherever it is environmentally responsible to do so, we will promote market-based programs that are voluntary, flexible, comprehensive, and cost-effective. The Endangered Species Act (ESA), for example, is sometimes counter-productive toward its truly important goal of protecting rare species, 75 percent of which are located on private land. Its punitive approach actually encourages landowners to remove habitat to avoid federal intervention. This serves as a disincentive for private landowners to do more to restore habitat and become private stewards of wildlife. The legislation needs incentive-based cooperation among federal, state, local, and tribal governments, and private citizens. The result will be a more effective ESA that better protects wildlife diversity.
As environmental issues become increasingly international, progress will increasingly depend on strong and credible presidential leadership. Complex and contentious issues like global warming call for a far more realistic approach than that of the Kyoto Conference. Its deliberations were not based on the best science; its proposed agreements would be ineffective and unfair inasmuch as they do not apply to the developing world; and the current administration is still trying to implement it, without authority of law. More research is needed to understand both the cause and the impact of global warming. That is why the Kyoto treaty was repudiated in a lopsided, bipartisan Senate vote. A Republican president will work with businesses and with other nations to reduce harmful emissions through new technologies without compromising America’s sovereignty or competitiveness — and without forcing Americans to walk to work.