Health Care Reform Revisited: Brown Defeats Coakley

In yesterday's Senate race Scott Brown (Rep) soundly defeated Martha Coakley (Dem) by 5 percentage points, according to today's headlines in the Boston Globe. While Coakley proved she is knowledgeable and articulate during the debates it seems that voters' took issue with health care reform and probably a number of other issues related to the economy, taxes, and national security.

What I think this election came down to was Massachusetts' voters deciding to mark their ballot for the candidate that best represented their own interests. A likely case for voters in every region of America.

But when it comes to heath care reform, MA is in an interesting predicament.

Candidates Health Plans: Revisted

The NY Times just ran a series of letters to the editor that critiqued the candidates' so-called "solutions" to our health care woes. Below is one that sums up many of the readers' positions quite well. 

Most letters are written by physicians and lawyers -- I hope that public health professionals continue to be an active voice in the debate. We bring the perspective that access to health care is only a part of the solution -- prevention of poor health and improving peoples' built and social environment is essential to improving our nation's health.

NY Times: Letter to the Editor published November 1, 2008

“The Candidates’ Health Plans” (editorial, Oct. 28) reveals the critical flaw in both candidates’ proposals. Both merely redistribute the cost of health care; neither actually lowers the cost. Their common flaw: continued dependence on insurance companies.

Here’s a better plan: a single national nongovernment not-for-profit health insurance company financed by a payroll tax. By eliminating the profit margin and cost of marketing, we can reduce the cost of health insurance, and thus health care, dramatically.

Glenn Alan Cheney
Hanover, Conn., Oct. 28, 2008

The Looming Health Care Crisis

An Op-Ed submission by three Harvard School of Public Health students: Alana Wooley, Katelyn Mack and Jamie Zwiebel. For your reading pleasure. Comments welcome!

As our government leaders grapple with the current economic crisis, another crisis is gaining momentum. We can no longer ignore its symptoms: rising rates of preventable, chronic illnesses; Americans facing trade-offs between doctor visits, prescription drugs, mortgage payments, gas or food; financial concerns determining patient treatment for catastrophic illnesses; and an inability to obtain insurance with a pre-existing illness, among others.  In 2007, 45 million Americans were uninsured.  These numbers will no doubt continue to climb as families and employers alike increasingly feel the direct impact of rising unemployment and inflation.  If we do not address the looming health care crisis, we will undeniably face yet another bailout, this time for health insurance companies and the health care community.

In the most recent presidential debate, Senator Barack Obama (D) told the nation he believed health care is a right and Senator John McCain (R) believed health care is a responsibility.  Whether it is a right or a responsibility, both candidates believe that access to and affordability of health care are important.  While we may disagree about solutions to and responsibility for the health care crisis, 51% of Republicans and 79% of Democrats believe that our nation’s broken health care system is in need of repair (Blendon et al. 2008). While the Presidential candidates agree that something needs to be done, their health care proposals are in vast opposition to one another. 

Senator McCain offers a short-term solution to this imminent crisis.  His health care plan proposes a $2500 and $5000 tax-credit for individuals and families, respectively, to help absorb the rising costs of health insurance.  However, not only is this credit, which is payable only to the insurance companies, considered taxable income, it does not address rising premium costs and treatment expenses.  While this tax credit may be beneficial for young, healthy adults, it would exacerbate the financial burden of health insurance for families and adults living with chronic or catastrophic illnesses. Simply offering a tax-credit to help deflect expenses for an already expensive health care system is not a sustainable solution and one that will be ineffective in reducing the rising numbers of uninsured Americans. 

Senator Obama offers a more comprehensive, long-term solution to the health care crisis. He proposes allowing individuals and families to keep their current employer-offered health care, or opt into a public insurance or obtain private insurance coverage through an insurance clearinghouse. The public insurance would offer coverage similar to that which Senator Obama and Senator McCain have as government officials. Contrary to rumors of socialized health care and fines for not obtaining insurance, this proposal only mandates health insurance coverage for children.  Senator Obama offers a more comprehensive plan that would extend insurance access to those whom the current system does not capture.  While this plan would reduce the number of uninsured Americans and improve coverage for children and families, Senator Obama’s plan would not cover everyone.

The health of our nation is central to the health of our workforce, the strength of our families and communities, and our national security. This election is an opportunity to ensure that the housing and credit woes we now face do not similarly beset the fragile US health care system.  As voters, we must elect someone with sound judgment and visionary thinking.  We can no longer afford short-term solutions.  Our next President must offer long-term, sustainable solutions to the long-standing dysfunction and discord of the US health care system. Let us enter the polls with the economy, health care, and education on our minds, all of which are inextricably linked together. Now is the time.  It is our responsibility to avoid another bailout blunder by electing the candidate with the best solution to improving the health and well being of all Americans.

Health Care: A Right?

In the second Presidential debate of the season, the two Presidential candidates were asked whether they believe that health care is a privilege, a right, or a responsibility. 

Senator McCain responded:

"I think it's a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. And with the plan that...I have, that will do that. But government mandates I -- I'm always a little nervous about. But it is certainly my responsibility. It is certainly small-business people and others, and they understand that responsibility. American citizens understand that. Employers understand that."

I had trouble figuring out what McCain meant by saying health care is a responsibility since he followed that up with "we should have available and affordable health care to every American citizen." After going through his health care proposal I have come to understand his response as: it would be his responsibility as President to encourage the market (employers and insurance companies) to provide health care for American workers. He does not believe that increases in health care accessibility and affordability should result from increases in government spending on health care. But what about the people who cannot afford to work enough hours to be eligible for employer-based insurance (due to economic turmoil, layoffs, or family responsibilities)? What about the elderly? The disabled? What about the hard-working Americans who are working double-duty shifts and yet still earn less than half the median income-- not enough to pay $5-8,000 out-of-pocket for quality health care coverage for their family? Whose responsibility is it then? If it is the government's responsibility to provide access in these cases, the government is not doing enough.

On the other hand, here is Senator Obama's response:

"Well, I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can't pay their medical bills -- for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they're saying that this may be a pre-existing condition and they don't have to pay her treatment, there's something fundamentally wrong about that."

That health care is a human right is widespread belief. The preamble to the World Health Organization Constitution declares "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." Recently, the Office of the United Nations High Commissioner for Human Rights and the World Health Organization released "The Right to Health," a fact sheet that seeks to outline the basic understanding of what "the right to health" is and "its implications for specific individuals and groups." 

While no country has a perfect health care system, some certainly have achieved more equity and better health outcomes than what we observe in the US. Ours is a system driven by capitalist principles for all but the most impoverished families (who are eligible for Medicaid and SCHIP). While I have heard it argued that no one can be turned away from medical services for immediate life-threatening illness or injury, we all know that chronic health conditions are increasingly placing a burden on our system in terms of human and financial resources. Plenty of studies (including an upcoming publication in Journal of Women's Health -- woohoo!) support the notion that men and women without health insurance are less likely to access and receive preventive health services. This results in later disease complications and even (preventable) death. I will readily acknowledge, however, that providing health insurance to everyone is not a magic bullet solution to the current state of (ill-) health  in our country.

What are your thoughts on health care as a right or a responsibility? Do you think health care rights include social conditions such as safe drinking water, adequate nutrition, proper housing, and gender equality? What about access to essential medications, preventive health services (screening, education, vaccinations), reproductive health services? Why?

Finally, will the country's looming health care crisis factor into your vote on November 4th? 

Comment! I know you want to.

Update: America's Health Insurance Plans investigated the average cost of health insurance. While premiums for families varied widely depending on the State in which you live, the average cost was $5799. In Massachusetts, the average cost was over $13,000. Obviously, there are huge differences as well in what you get for $6000 family insurance in terms of deductibles, preventive care, and copayments. 

Debate Politics: Taxes

Friday, September 26 9pmEST

MCCAIN:

"Now, that's a fundamental difference between myself and Senator Obama. I want to cut spending. I want to keep taxes low. The worst thing we could do in this economic climate is to raise people's taxes."

response

OBAMA:

"What I do is I close corporate loopholes, stop providing tax cuts to corporations that are shipping jobs overseas so that we're giving tax breaks to companies that are investing here in the United States. I make sure that we have a health care system that allows for everyone to have basic coverage. I think those are pretty important priorities. And I pay for every dime of it."

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John Paulson, a Hedge Fund manager, earned 3.7 BILLION dollars in 2007. He paid only about 15% in taxes due to loopholes in the current system. I find this appalling. Our tax system is flawed. He and 5 other hedge fund managers who made over $1,000,000,000 (...look at all those zeros!) were able to keep millions of dollars in capital gains. McCain and most Republicans would have us think that somehow this translates into a stronger economy and more jobs - but how this is so really is beyond my comprehension. Please comment if you know how reducing taxes for those most wealthy (we are talking about millionaires and billionaires) is going to turn around our economy. On the other hand, there is firm evidence that this growing income inequality harms society (poorer overall health, broken community networks, decreased social support, etc), and has the most deleterious effects for the disadvantaged in our country.

Last night during the debate there were 17 "mentions" of the health care system in the United States. However, I was less interested in their discussion of McCain's $5,000 health tax credits (via increased employer based health taxes...) and Obama's spending to cover the uninsured -- all of that will be another post, coming soon-- and I was more interested in listening to them debate their tax reform plans. Most Americans are unhappy with the tax system in our country. I am currently among them.

Many Americans may feel overtaxed, but the truth is that those who are escaping like bandits are the ones who you think would be taxed 30 or 40% and are actually paying proportionally less in taxes than you probably are. I would be intrigued to hear a family with a household income of $500,000 argue that taxes (even slight increases) would prevent them from living very comfortably (for my California friends, I would consider views on variable taxes based on cost of living by State/region -- they do it for government employees already!). Consider that our government expects a family of 4 to be able to survive (how about: thrive?) on $21,200/year. 

Taxes are not a fun topic to discuss -- most Americans are unhappy to be paying taxes at all, despite the extent to which they personally benefit from them with government funded social services (e.g., public education, Medicare, Medicaid, social security, veterans benefits, etc). However, something must be done to tackle the growing income inequality in our country. The pressure that is put on the government to lower taxes reduces public spending for the poor and lower classes that desperately need help. We are still a society that has difficulty taking care of our own and making it possible for all Americans to live out their dreams without having to overcome inordinate and, in some cases, insurmountable obstacles. We need to accept that all is not equal in our great country. Yet, we can move in a direction that reduces such inequity.

The Good Sheet

I hadn't heard of GOOD magazine until walking into Starbucks yesterday. To my surprise, I noticed a small brochure of sorts on newspaper media entitled "Good: Health Care". It is the second in a series of "Good Sheets" aimed at exploring major issues facing Americans during this election season including health care, clean energy, and education. The Good Sheet on Health Care provides an overview of the US health care system and gives some facts on how much the US spends on health care compared to other developed countries, where the money comes from, history of the health care system, and strategies that could help mend the health care mess. If you're stopping by Starbucks in the next couple days, pick one up! Otherwise, you can just follow either of the links above and get the information online. It's easy to read and pretty informative. You can even see where Obama and McCain agree (and of course, disagree) on how to bring about systemic change in the different topic areas.

Presidential Health Care Politics: Part I

I write this as I await the acceptance speech of John McCain for Republican nominee for President of the United States. In the past few weeks I have noticed how issues that were once so important in the primaries (e.g., health care) are now hardly mentioned at all in the candidates discourse. I wonder if now that the candidates are facing off against each other the issues will shift to no longer include a reorganization of the US healthcare "system" and will be replaced with promises about strengthening the economy, improving education, and winning the war in Iraq (all important issues, as well -- and ones that are inextricably linked to the health of our country).

My passion for improving peoples' health and well-being has led me to try and understand which candidate will put into effect policies that will improve the nation's health. The United States (which spends outrageously more on health care than any other country in the world) ranks about 30th in life expectancy! Most estimates compare the United States to other countries in the OECD, where the US life expectancy falls well below the average. While years of healthy life expectancy in other countries has continued to increase, health improvements in the US has stagnated. And that's not all - There is nearly a 20 year gap in life expectancy within the United States! The average life expectancy in the District of Columbia is 72 years, 18 years less than the life expectancy in Hawaii. A recent publication draws attention to the "8 Americas" and I encourage any interested in health inequalities in the United States to take the time to read it.

The variability in health outcomes across our own nation is disturbing. It is an issue that needs to be addressed -- and now is the time. I listen with anticipation to here what the Presidential candidates will say about this critical issue that affects the lives of us all -- whether we realize it or not.