What do we do with people who are uninsurable because they have a pre-existing medical condition?
That is a particularly important question as both McCain and Obama propose reforming American health care by building on the private health insurance system.
One of the solutions being discussed–by McCain among others–is to use state-based risk pools. Under McCain’s plan heavily dependent on an individual platform, people who don’t have employer-based coverage and healthy enough to qualify for individual health insurance could get a private mainstream plan and people who do not qualify for a standard individual plan could buy into a state-run high risk pool for the uninsurable.
There’s some peculiar numerology going in the presidential candidates’ health reform plans.
John McCain proposes that every American receive a $2,500 tax credit ($5,000 for families) to help them afford health insurance bought in the private market.Barack Obama says his health care plan will save the average American family $2,500 per year.I mean, what are the chances?I suspect both campaigns are shrewd enough to know that "a couple hundred bucks a month" [middle-class citizen’s translation of $2,500 per year] is likely to get a voter’s attention. The fact that both campaigns came up with an identical figure is eerie, however. It’s enough to make you wonder whether anti-trust laws should apply to political campaigns.
Several months ago, I mentioned the large sum of money being spent by SEIU on political races throughout the country. Now, an editorial in the Wall Street Journal questions the legality of the manner the SEIU is collecting these funds from its members. (By the way, the sum I mentioned was $75 million. The WSJ raises this to $150 million.)
I am not qualified to make a judgment on the legal issues raised by the Journal’s editorial writer, but I want to raise a related political issue. SEIU concludes one of its publications with the following depiction of the future:
SEIU’s health care profile — and power — will only continue to grow. After we help elect a pro-worker president and stronger pro-worker majorities in Congress, we will take all our energy, idea, organizing strength, grassroots lobbying and political muscle and make it happen. Next year, 2009, we — all of us — will make history. We will achieve quality affordable health care for every man, woman, and child in America.
Barack Obama’s health care plan follows the Democratic template—an emphasis on dramatically and quickly increasing the number of people who have health insurance by spending significant money upfront.
The Obama campaign estimates his health care reform plan will cost between $50 and $65 billion a year when fully phased in. He assumes that it will be paid from savings in the system and from discontinuing the Bush tax cuts for those making more than $250,000 per year.
That the Obama health care reform plan would cost between $50 and $65 billion a year is highly doubtful. Obama claimed his plan was nearly identical to Hillary Clinton’s and her plan was projected by her to cost more than $100 billion a year.
John McCain is now the presumptive Republican nominee for president. As a result, what he thinks about health care policy will be out front in the presidential campaign this fall.
McCain’s thinking couldn’t be more different from Democrat Barack Obama.McCain very rightly points to health care costs as the biggest health care issue. "We are approaching a ‘perfect storm’ of problems that if not addressed by the next president will cause our health care system to implode," he has said.
Therefore, his focus is on the health care costs that make health insurance so expensive that many individuals can’t afford it for themselves, employers can’t afford to provide it to their employees, and government can’t afford a wider safety net for the poor and long-term solvency for senior benefits.
He also reminds us that costs can’t be improved without dealing with quality in tandem.
One of the fun parlor games of Election ’08 is to look at Internet data and figure out what they mean.
The answer may be "nothing," of course.
But let’s play along and look at the latest Hitwise data on popular search terms. HitWise, a company that tracks Internet traffic, counted the search words that sent people to John McCain or Barack Obama’s websites. [Here’s a press release about the findings on the candidates’ top Internet search terms.]
"Health care" didn’t make Obama’s top 5 search terms in the first quarter of 2008. In the second quarter, health care took the number 4 slot. [Q1’s top term was "gay marriage," Q2’s "abortion."]
Meantime, "health care" took the tops spots for John McCain in both Q1 and Q2.
So: Does this mean people think they already know Obama’s healthcare plan and don’t need to search about it on the Internet? Or, don’t they have much interest in the issue?
As for McCain, do the searches mean his plan is little-known and people want information on it? Or do those interested in McCain care more about healthcare than Obama’s voters?
“It seems that John McCain may have stolen some of the fire that Democrats traditionally wield on health issues by making cost control his top priority, rather than universal coverage.”-Rob Cunningham, “Health Affairs” May/June 2008
Last week, the bold proposal for health care reform that Dr. Ezekiel Emanuel outlines in Healthcare, Guaranteed drew high praise from the American Prospect’s Ezra Klein. As Klein described it:
Emanuel’s Guaranteed Health Care Access Plan maps out “a total transformation of the system. It does not build on the inefficiencies of the current structure, preserving them in amber for the next generation.”
Rather than expanding on the dysfunctional system that we have today, Emanuel, who is the director of bioethics at NIH (and brother to politician Rahm Emanuel), is calling for structural reform. This is what makes his proposal both brave and fresh.
But Emanuel’s plan isn’t just exciting; it’s practical. As usual, Klein cuts to the heart of the matter: “The big deal, he explains is cost control. In health care, cost control is everything.”
Leading up to the November election, the health reform proposals of presumptive presidential candidates John McCain and Barack Obama will be analyzed, compared and critiqued until absolutely nothing original is left to say about them.
The team of strategists corralled to draft the proposals are now defending and promoting them. Both sides have put Harvard professors and U.S. Representatives to work, but the similarities end there.
Here’s a brief look each candidates’ health wonk roster:
In an Obama administration, we’ll lower premiums
by up to $2,500 for a typical family per year. And we’ll do it by
….covering every single American and making sure that they can take
their health care with them if they lose their job…..We’ll do it by
the end of my first term as President of the United States……
Hal Holman is a professor of Medicine at Stanford University, and Diana Dutton is a research fellow at the London School of Economics and a former director of health services research at Stanford. The married couple supports Obama.
Many people think Hillary Clinton has a better health plan than Barack Obama. She repeatedly tells voters her plan will cover everybody, while Obama’s will leave out 15 million people. Newly emerging data tell a different story.
Since 2006, Massachusetts has been running what amounts to a pilot test of Clinton’s universal mandate plan, requiring all uninsured residents to buy private insurance or be penalized. The state regulates participating insurers and subsidizes costs for lower-income people. Yet after two years, nearly half of the uninsured still aren’t covered, despite strenuous outreach. To boost enrollment, Massachusetts has stiffened fines – up to several thousand dollars. Nevertheless, many people remain uninsured, citing more pressing needs. Clinton insists her mandate wouldn’t force people to buy insurance they can’t afford, but that’s exactly what’s happening in Massachusetts. The state has had to exempt 20 percent of the uninsured because they couldn’t afford even subsidized premiums.
Clinton’s plan would also likely fall far short of universal coverage. She hasn’t said how her mandate would be enforced, but has mentioned the possibility of garnishing wages. Without affordable insurance, a universal mandate means little.