WASHINGTON -- Offering new access to health care for some, restricted medical services to others, a business boom to insurers, and the prospect of extra work -- and income -- to doctors, the Bush health care reforms would produce plenty of winners and losers.
It faces an uncertain future in Congress, where an assortment of other proposals, ranging from a Canadian-style nationalized health system to a mixed private and public scheme, are under consideration.
But the presidential plan will shape the national debate on health care reform. Among the winners in the Bush proposal would be:
Lisa Shorter, 25, the mother of 11-month-old twins and a 2-year-old, Upper Marlboro.
She has medical coverage for herself through her $20,000-a-year job as a secretary with the Salvation Army, but she cannot afford the extra $400 a month she estimates it would cost for her children's medical insurance.
"Fortunately, they have not been sick yet. That's not to say something might not happen. Everybody needs to be covered in some way."
The Bush plan would offer her a $3,750 tax credit for health insurance, adjusted for her employer's medical insurance contribution.
"For myself and a lot of others, we would benefit from the proposal. I don't know how serious he is, or how it's going to take place. We don't know whether George Bush is doing this just because he wants to be elected."
Bob DeCoursey, insurance agent, Philadelphia.
Under the Bush plan, the poor and uninsured would be issued vouchers or tax credits worth $1,250 for the individual, $2,500 for a couple, and $3,750 for a family of three or more. The vouchers could be spent only on medical insurance.
"In a sense it's a made market for us. There are going to be a lot of people out there who can now afford to buy insurance and will have the money for no other purpose than insurance. That's the pretty side from the agent's side."
Less attractive is the proposal that the insurance-for-the-needy package will be standardized in each state. This could minimize the margin of profit. It would almost certainly make it less profitable for an agent in a high-cost city like Baltimore to issue the policy than an agent in a lower-cost town like Hagerstown.
He expects his individual-policy business to flourish. "It could be a nice opportunity to do some good for poor people who have not had coverage. If they don't pay me, I won't go out and look for them, whereas if there is any reasonable compensation level, going to be found business which every agent ought to welcome."
* William Lowther, 49, author and free-lance journalist, of Columbia.
The Bush plan allows the self-employed to charge 100 percent their medical insurance costs against taxes. Currently, only 25 percent of the cost is deductible.
Mr. Lowther would be able to deduct all of the $466 he pays monthly for medical insurance for himself, his wife, Joanna, and his three college-age children. His insurance premium has been rising by about $50 yearly, and he expects his bills to top $500 monthly as of April.
"These are hard times for everybody, so every little bit of help would count."
His Canadian wife pointed to Canada's nationalized health system and said: "My mother was extremely well taken care of when she was ill. It didn't put them in the poorhouse, because they were covered. I have problems in terms of national anything, but I think the Canadian system works extremely well and, given the cost of medical coverage here, I guess I would be prepared to overcome my strong feelings against national takeovers of anything."
Ricky Moore, 34, unemployed and homeless.
"If I get sick, I just get sick. That's the way I look at it. If I get real ill, I don't know about that. I ain't there yet." He was unaware of the Bush proposal to give the uninsured individual a $1,250 voucher that could be used only for medical insurance.
"I don't have insurance. Does it worry me? Yes, it worries me. I do want to get on it. If I had a steady job I probably would get on it," he said, while receiving free treatment for an injured leg at the infirmary of the Community for Creative Non-Violence Shelter in Washington.
* Dr. Raymond Scarletta, senior partner in the Washington Internal Medicine Group, and clinical professor of medicine at George Washington University.
Though he was unsure how the reforms would affect a doctor's workload, he said physicians could absorb the increase with "efficiencies of practice."
"A lot will depend on other aspects of it. If it's a token-type reimbursement [for doctors] . . . patients will have greater difficulty in gaining access. This is where we will have to know more about the proposal."
"At least President Bush has put something on the table. I am pleased he did not overturn our current system. That would be extraordinarily damaging to the future of medicine because of the loss of initiative and individuals not willing to come into medicine in the future.
"At least those who are uninsured or underinsured will have the opportunity to utilize these vouchers to get into the marketplace and obtain the essential benefit package that will be very helpful in keeping them out of the emergency room and getting them into private physicians' offices or a network office."
* Not everyone will gain from the Bush proposal. Among the losers would be:
Robert and Beverly Hummel, federal retirees, of Bethesda.
Medicare recipients already pay a $31.87 monthly premium, with a 20 percent co-payment for most treatment and deductibles for hospitalization.
The Bush plan indicates that constraints on growth of Medicare would be one way of financing the voucher plan for the needy.
Mr. Hummel, 73, and Mrs. Hummel, 70, are covered through Blue Cross and Blue Shield and Medicare, but would like a universal national health system. They lament the absence of a long-term care provision in the Bush plan.
For the past seven years, they have paid $3,000 a year for nursing home insurance, which will still leave them paying $100 each for the first 100 days of any residence, or $10,000 each.
Their daughter, a secretary, has a medical condition that puts medical insurance beyond her reach, and they help pay her health bills.
"The really bad thing about the Bush proposal is it strengthens the health insurance companies," Mrs. Hummel said. "They are the ones who are making the billions of dollars out of the health care system.
"The system is caffooey. It's the wrong system . . . What you really have to do is throw the whole thing out and get a system that covers everybody and pay for it with an increase in taxes."
* Serena Patrick, 29, between jobs, staying in a women's shelter in Arlington, Va.
For three years, she had medical insurance while working at McDonald's. When she lost her job, she lost the coverage. On Jan. 6, Ms. Patrick signed on for Medicaid as an unemployed mother with a 5-year-old son.
The Bush plan proposes to limit the growth of Medicaid, which provides medical coverage for the needy and which has become one of the costliest provision programs for most states.
For Ms. Patrick, the important thing this week was that her son was able to get a physical with the bill sent to Medicaid. She starts work at $5.25 an hour in a fabric shop next week. She will not be insured.
The $2,500 voucher she would get under the Bush program, she believes, would not buy adequate coverage. She wonders now if she will lose her Medicaid once she is working. Will her son still be covered?
"It's really scary because you never know what might happen. I think a national system would be better because there are too many loopholes."