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Close but No Health Care

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Posted on May 28, 2008

By Marie Cocco

    WASHINGTON—More than halfway through a political season in which public concern about America’s porous, confusing and costly health insurance system has consistently emerged as one of the chief worries of a squeezed electorate, this is what we can expect when the new president takes office next year: not so much. 

    Neither presumptive Republican nominee John McCain nor Democrat Barack Obama, the likely nominee of his party, has pledged to cover all of the 47 million uninsured Americans who are falling through the cracks of a system that already is at a breaking point. Neither has proposed a health-insurance plan that would make health care more fair and equitable by putting everyone in a pool in which risks are shared among those who are healthy (but might one day get sick) and those who are not. This is how insurance—whether it be government insurance, such as Social Security, or private insurance, such as the policies we buy for automobiles—works. With everyone in the same system, everyone shares the burden of paying as well as the benefit of coverage when it is needed.

    Because of the crucial failure of both candidates to acknowledge this elemental truth, the nation is likely to stay on the crooked path down which it has staggered since the employer-based system of care began to unravel at least two decades ago.

    But don’t both McCain and Obama say they want to fix the system, covering more people and lowering costs for everyone? Sure. But talk is cheap—much cheaper, apparently, than the political costs of more comprehensive action that would either anger ideological supporters on the right (if you’re McCain) or raise that old chestnut about “socialized medicine” (if you’re Obama).

    McCain’s plan, because it seeks to placate a right wing for which any hint of government intervention is apostasy, would effectively dismantle the current employer-based system by eliminating the tax deduction that businesses now get when they pay the health premiums for their employees. Most experts say this would quicken the pace at which employers are dropping coverage.

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    McCain would provide tax credits for individuals to purchase insurance, but he relies on the unproved theory that if full costs and responsibility for insurance were shifted back to individuals and families, prices would drop. “This is a ‘back to the future’ plan, returning us all to the period before the creation of employer-based group insurance in the 1930s, when individuals and families were ‘on their own’ to find ways of paying for their health care,” concludes an issue brief by Rekindling Reform, a New York-based group of social welfare agencies, unions and religious, academic and public health organizations. 

    Obama’s plan is a lost opportunity.

    Yes, it would curtail some of the more egregious insurance industry practices and seeks some cost containment. But it still fails to recognize that without some kind of mandate to bring everyone into the system—either an individual mandate, like his Democratic rivals Hillary Clinton and John Edwards proposed, or a nationwide requirement, such as a Medicare-for-all type of system—insurance companies still would be able to cherry-pick among those they want to insure and those they don’t.

    “Where his [Obama’s] falls down is that it’s not universal,” says Aaron E. Carroll, director of the Center for Health Policy and Professionalism Research at Indiana University School of Medicine. “He’s still trying to build this on a patchwork system.”

    Though Obama proposes a mandate that all children be covered, he has no clear way to enforce this beyond what many states already do for the current State Children’s Health Insurance Program (SCHIP). That is, he would do outreach at schools, day-care centers and hospitals to try to get parents to sign their kids up. “Mandates like this are incredibly inefficient,” Carroll says, and would be unlikely to enroll many more children than the state and federal governments already have.

    The good news, I suppose, is that if McCain wins the White House, Democrats probably will continue to control Capitol Hill. They would be unlikely to enact anything so radical as the McCain proposal. The bad news is that if Obama wins, his party will have squandered the best opportunity in more than a decade—since the Bill Clinton era—to take a bold leap toward the universal coverage Democrats have promised since the presidency of Harry Truman.
   
    Marie Cocco’s e-mail address is mariecocco(at)washpost.com.
   
    © 2008, Washington Post Writers Group


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By Frank Cajon, May 30, 2008 at 7:12 pm Link to this comment

Too bad this remains a rhetoric dream. McCain is going to need health care: the strident clean bill of health he received a few weeks ago is a smoke screen. This man has had three recurrences of malignant melanoma. Being a cancer survivor myself, I sympathize with those who have had the thief and rebuild their lives, but it is gut check time. This guy wants to be what before W was the leader of the free world. He has fifty times the chance of a cancer recurrance and spread as a person with only one recurrence and astronomically higher chances than a healthy person. This is a disease that is often systemic and seeds in the brain, liver, and lungs, often insidiously. He also has some signs of mental lapses that should give us pause as he keeps forgetting who is who in the MidEast, and could be signs of either early onset senile dementia or the Alzheimer’s Disease that Reagan had all eight years in office at a younger age. The day has come (with a madman in office) when we need to make sure that we elect a healthy human being to the office of president. We cannot afford another Reagan and by no means another Bush.

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By Leefeller, May 30, 2008 at 7:08 am Link to this comment

cyrena,

As usual I will defer the specific research to you, you are so much better at it.
Still feel the best plan was the one promoted by Dennis Kucinich.  Yes this does seem to be a pro Hillary article.

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By cyrena, May 29, 2008 at 4:51 pm Link to this comment

Your sarcasm is wasted Alex, at least on anybody who’s actually studied both health plans, because they are identical, and NEITHER are without flaws.

But then, you haven’t even bothered to pay attention to that, because for you and Marie, this is only about Hillary v. Obama.

Besides that, at least a portion of this spin from Marie in not new, (about the cherry-picking of insurance companies)and is bogus and misses the point, because she (like you) is trying to use it as a she vs him thing, at the expense of the American public. ALL of us.

And, you’ve done it right here with the “Democrats who oppose him”.

Very sad that people like you and Marie would target something as important as health care to spin into your sick bias that lacks any objective pragmatism.

Shows the typical desperation that Hillary supporters have resorted to.

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By Alex, May 29, 2008 at 4:54 am Link to this comment
(Unregistered commenter)

Geez yeah Marie, get with the program? We all know that it’s impossible for Obama’s healthcare plan to be flawed because that would mean that there are some redeemable aspects to Democrats who oppose him, which is clearly nonsense. Why would you even bring it up?

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By cyrena, May 28, 2008 at 11:58 pm Link to this comment

Marie, This is a total waste of your time as well as ours, because you’re assuming that we haven’t read both of the health plans that both Hillary and Obama brought to their respective campaigns. (McCain never had one, and still doesn’t).

The health plans of Hillary Clinton and Barack Obama are IDENTICAL, with one exception. Hillary claimed that it would be MANDATED that every single person purchase insurance, (even though that was stupid because she admitted herself that she had no way to enforce such a mandate) and Obama’s plan did not involve a mandate other than for children. (and I’m not sure how he would enforce that either, except via the state, since there are already such programs in effect).

That is the ONLY difference in their health plans. BOTH plans still require that we PURCHASE health care insurance, and if one is fortunate enough to be employed, then this will force employers to offer it, though the employee will most likely still have to kick in.

People on Medicare will no doubt CONTINE to pay the feds (as we’ve been doing all along) for part B insurace coverage. (something that I don’t think many journalists are aware of.) Medicare does not MANDATE that it’s recipients purchase part B, but it would be pretty stupid to be without it, so most people DO opt for it. It costs the average recipient just over $1,200. per year, deducted from their SS income. Again, it is NOT mandatory, but since it covers hospitalization, it would be a little stupid to NOT purchase it.

As for insurance companies being able to continue their ‘cherry picking’ that too is a bogus claim, which is the whole point of having the health care plan (imperfect as it is) that both Hillary and Obama came up with. It is to make health insurance affordable (supposedly) to anyone who wants to purchase it, so insurance companies CANNOT deny coverage or pick and choose who they want to cover.

For those who are NOT employed, (and therefore assisted by employer contributions) it will be more of a burden. So, if some 25 year old thinks that they cannot afford to fork out a hundred or more dollars a month for insurance, because they think they can get by cheaper just paying out of their pockets for a once a year physical, then that will be their choice, and they’ll have to hope that they don’t come up on some life threatening illness or accident.

But I’m sick of hearing this bogus claim that the lack of a MANDATE for people to purchase health insurance is somehow leaving them uninsured. If it’s as ‘affordable’ as Hillary and Barack claim it will be, (and let me repeat, aside from this mandate that forces everyone to purchase a plan, the plans are IDENTICAL) then people will obviously buy the insurance.

And Marie…Hillary lost. Get over it. And unless McCain somehow slips in, anybody that wants to purchase health insurance will be able to do that, and the insurance companies will have to insure them. 

Now find another topic Marie, because you’re as stale as your heroine, Hillary. Maybe you could spend the next 4 years coming up with a single payer health insurance program that doesn’t employ anyone from the Insurance industry, and let the feds take responsibility for the whole thing. (the feds can just hire all of those claims processors from the insurance industry)

Then again, maybe not. We see what they’ve done to the prescription drug part of the plan.

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