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Weighing the Presidential Healthcare Plans
How Would Things Change With John McCain or Barack Obama?
by Dr. Rick Morris
Here's the problem: Americans spend nearly twice as much per person on healthcare as do citizens of any other country, but by some measures have poorer health (72nd out of 191 countries, according to the World Health Organization). Even worse, 47 million Americans are uninsured (that's one in six) and many more are underinsured.
The uninsured are not merely irresponsible - it is estimated that 80% of them are in working families. In fact, according to a report in the journal Health Affairs, many people are one illness away from financial failure, as more than half of all personal bankruptcies are caused by illness. The situation and the nation's frustration has finally brought it to the political forefront.
Both the Democratic and Republican presidential candidates purport to understand the situation. Tapping into something of crucial importance to voters, they have plans that promise similar reforms. Their measures include five key points:
1. Guaranteed insurability.
2. Affordable coverage.
3. Increased competition and lower pharmaceutical costs.
4. Improved insurance and medical transparency revealing costs, outcomes and quality of care.
5. Updating old paper records to digital, thereby decreasing mistakes and the duplication of unnecessary tests.
They may agree on these goals, but not on the way to get there.
Republican candidate and Ariz. Sen. John McCain would essentially give the healthcare system a slight nudge, leaving the workings of the free marketplace and individual states to fix many of the problems. The Democratic nominee, Ill. Sen. Barack Obama, believes our healthcare system needs a hefty push and mandates change and oversights.
John McCain's Plan
The centerpiece of McCain's program is a tax credit of $2,500 for an individual and $5,000 for a family. He's hoping insurance premiums would decrease and coverage improve with increased competition since individuals would own their own policies and could buy insurance from carriers out of state.
However, according to Health Policy and Strategy Associates (HPSA), a nonpartisan consulting firm based in Alexandria, Va., many people would remain uninsured. This is especially true since the average cost for family health insurance is $12,000 per year.
McCain dislikes mandating insurance policy, leaving individual states to decide such factors as guaranteed insurability, required health services (e.g. mammography, childbirth and cancer screenings) and whether to treat preexisting conditions. Insurance premiums may still be determined by age and health, leaving seniors and those who are ill paying the highest premiums.
It is unclear whether McCain would establish a federal health program to compete with the private insurers. But if he doesn't, there may be little incentive for the insurance companies to change their present practices.
McCain's plan would improve the portability issue, moving many away from employers' and toward individual plans since people would be taxed on employer health benefits. However, purchasing group insurance through clubs and churches may prove easier.
McCain did not explain how he would increase insurance and medical transparency, nor how he would bring medical records up to digital standards. Rand Corporation, a leading think tank, reported that going digital would produce a savings of $77 billion a year due to reduced hospital stays, avoidance of duplicative and unnecessary testing and appropriate drug utilization.
Barack Obama's Plan
Obama's policy is far more ambitious and envisions a larger federal role. The program's centerpiece would be establishing a healthcare plan - the National Health Insurance Exchange, or NHIE - similar to that provided to members of congress. It would require basics such as preventative care, maternity, mammography, cancer screening and treatment for serious mental disorders.
The NHIE would also act as a watchdog over the insurance industry, as insurance plans would be evaluated and would be required to meet the basic standards of care. Premiums would have to be "fair and stable" and not dependent on the insured's "health status," and no citizen could be denied coverage. Differences of each policy would be made public and clear. Hospitals and providers would be required to make public quality-of-care details as well as the percentage of premiums used for patient care.
Employers would be required to make a "meaningful contribution" for their workers. Small businesses would be exempt, but would be encouraged to participate by receiving a tax credit of up to 50% of their costs. Since catastrophic illnesses in a small company could make premiums prohibitive, Obama's plan would reimburse the health insurers for such events.
Medicaid and SCHIP (state healthcare for the poor) would be expanded to cover more low-income people. A federal subsidy would assist those who need help qualifying. In essence, all Americans could be covered, while coverage for children would be mandated.
Obama estimates his plan would cost between $50 billion and $65 billion per year. He believes that under the program, the typical family's health bill would actually drop up to $2,500 a year. The HPSA disagrees, believing the costs would be closer to $100 billion and would require stricter cost-cutting measures.
In Obama's plan, paper medical records would be transferred to digital technology, costing $10 billion a year over five years.
Both candidates would allow Americans to buy drugs from other developed countries and prohibit drug manufacturers from "paying off" competing companies to keep their cheaper generics off the market. Obama would go a step further and cancel the new Medicare drug law that prohibits the U.S. from negotiating cheaper prices with the drug companies and costs the U.S. billions of dollars.
Weighing the Costs
McCain suggests his program is fairly revenue neutral, taxing employees on their employer health benefits to help cover the tax credit he'd give them. But it is hard to see how the new taxes would cover the credit, and if he covered those who still could not afford insurance, the costs could be significant.
Additionally, McCain hopes to increase competition by making our healthcare portable and available outside individual states, and letting the market heal itself. Yet, while more people would be covered, the poor and sick may not. Each state, as occurs today, would set its own rules.
Obama's plan is ambitious and puts the government front and center. It creates a national plan and sets standards others must attain and, in fact, virtually everyone could be covered.
Obama expects to fund his plan by discontinuing the Bush tax cut for those making more than $250,000 a year and enacting his cost containment measures (e.g. digitizing medical records), making care universal (thus limiting uncompensated costs), mandating prevention and tackling public health problems that lead to severe and expensive illness.
Ultimately, the debate may be more emotional than factual. Some view healthcare as a right, while others see it as an individual responsibility. To many, "socialized medicine" conjures images of Karl Marx and Joseph Stalin.
Presently we have a socialized health plan for those over 65 called Medicare that, according to the Healthcare Financing Administration, runs far more efficiently then does private insurance (Medicare operates at 2% operating costs, while private insurance carriers' operating expenses reach up to 30%). Even so, this feels like a government intrusion to many.
This year the rhetoric of the candidates is similar, but their approaches quite different. The effect on our nation is yet to be seen.
Dr. Rick Morris is a chiropractor specializing in disc herniations and spinal stenosis. He has been a doctor for UCLA, the Los Angeles Clippers and the U.S. Olympic Team and can be contacted at wevegotyourback.org. He lives in Downtown Los Angeles.
page 14, 9/1/2008
© Los Angeles Downtown News. Reprinting items retrieved from the archives are for personal use only. They may not be reproduced or retransmitted without permission of the Los Angeles Downtown News. If you would like to re-distribute anything from the Los Angeles Downtown News Archives, please call our permissions department at (213) 481-1448.
by Dr. Rick Morris
Here's the problem: Americans spend nearly twice as much per person on healthcare as do citizens of any other country, but by some measures have poorer health (72nd out of 191 countries, according to the World Health Organization). Even worse, 47 million Americans are uninsured (that's one in six) and many more are underinsured.
The uninsured are not merely irresponsible - it is estimated that 80% of them are in working families. In fact, according to a report in the journal Health Affairs, many people are one illness away from financial failure, as more than half of all personal bankruptcies are caused by illness. The situation and the nation's frustration has finally brought it to the political forefront.
Both the Democratic and Republican presidential candidates purport to understand the situation. Tapping into something of crucial importance to voters, they have plans that promise similar reforms. Their measures include five key points:
1. Guaranteed insurability.
2. Affordable coverage.
3. Increased competition and lower pharmaceutical costs.
4. Improved insurance and medical transparency revealing costs, outcomes and quality of care.
5. Updating old paper records to digital, thereby decreasing mistakes and the duplication of unnecessary tests.
They may agree on these goals, but not on the way to get there.
Republican candidate and Ariz. Sen. John McCain would essentially give the healthcare system a slight nudge, leaving the workings of the free marketplace and individual states to fix many of the problems. The Democratic nominee, Ill. Sen. Barack Obama, believes our healthcare system needs a hefty push and mandates change and oversights.
The centerpiece of McCain's program is a tax credit of $2,500 for an individual and $5,000 for a family. He's hoping insurance premiums would decrease and coverage improve with increased competition since individuals would own their own policies and could buy insurance from carriers out of state.
However, according to Health Policy and Strategy Associates (HPSA), a nonpartisan consulting firm based in Alexandria, Va., many people would remain uninsured. This is especially true since the average cost for family health insurance is $12,000 per year.
McCain dislikes mandating insurance policy, leaving individual states to decide such factors as guaranteed insurability, required health services (e.g. mammography, childbirth and cancer screenings) and whether to treat preexisting conditions. Insurance premiums may still be determined by age and health, leaving seniors and those who are ill paying the highest premiums.
It is unclear whether McCain would establish a federal health program to compete with the private insurers. But if he doesn't, there may be little incentive for the insurance companies to change their present practices.
McCain's plan would improve the portability issue, moving many away from employers' and toward individual plans since people would be taxed on employer health benefits. However, purchasing group insurance through clubs and churches may prove easier.
McCain did not explain how he would increase insurance and medical transparency, nor how he would bring medical records up to digital standards. Rand Corporation, a leading think tank, reported that going digital would produce a savings of $77 billion a year due to reduced hospital stays, avoidance of duplicative and unnecessary testing and appropriate drug utilization.
Obama's policy is far more ambitious and envisions a larger federal role. The program's centerpiece would be establishing a healthcare plan - the National Health Insurance Exchange, or NHIE - similar to that provided to members of congress. It would require basics such as preventative care, maternity, mammography, cancer screening and treatment for serious mental disorders.
The NHIE would also act as a watchdog over the insurance industry, as insurance plans would be evaluated and would be required to meet the basic standards of care. Premiums would have to be "fair and stable" and not dependent on the insured's "health status," and no citizen could be denied coverage. Differences of each policy would be made public and clear. Hospitals and providers would be required to make public quality-of-care details as well as the percentage of premiums used for patient care.
Employers would be required to make a "meaningful contribution" for their workers. Small businesses would be exempt, but would be encouraged to participate by receiving a tax credit of up to 50% of their costs. Since catastrophic illnesses in a small company could make premiums prohibitive, Obama's plan would reimburse the health insurers for such events.
Medicaid and SCHIP (state healthcare for the poor) would be expanded to cover more low-income people. A federal subsidy would assist those who need help qualifying. In essence, all Americans could be covered, while coverage for children would be mandated.
Obama estimates his plan would cost between $50 billion and $65 billion per year. He believes that under the program, the typical family's health bill would actually drop up to $2,500 a year. The HPSA disagrees, believing the costs would be closer to $100 billion and would require stricter cost-cutting measures.
In Obama's plan, paper medical records would be transferred to digital technology, costing $10 billion a year over five years.
Both candidates would allow Americans to buy drugs from other developed countries and prohibit drug manufacturers from "paying off" competing companies to keep their cheaper generics off the market. Obama would go a step further and cancel the new Medicare drug law that prohibits the U.S. from negotiating cheaper prices with the drug companies and costs the U.S. billions of dollars.
McCain suggests his program is fairly revenue neutral, taxing employees on their employer health benefits to help cover the tax credit he'd give them. But it is hard to see how the new taxes would cover the credit, and if he covered those who still could not afford insurance, the costs could be significant.
Additionally, McCain hopes to increase competition by making our healthcare portable and available outside individual states, and letting the market heal itself. Yet, while more people would be covered, the poor and sick may not. Each state, as occurs today, would set its own rules.
Obama's plan is ambitious and puts the government front and center. It creates a national plan and sets standards others must attain and, in fact, virtually everyone could be covered.
Obama expects to fund his plan by discontinuing the Bush tax cut for those making more than $250,000 a year and enacting his cost containment measures (e.g. digitizing medical records), making care universal (thus limiting uncompensated costs), mandating prevention and tackling public health problems that lead to severe and expensive illness.
Ultimately, the debate may be more emotional than factual. Some view healthcare as a right, while others see it as an individual responsibility. To many, "socialized medicine" conjures images of Karl Marx and Joseph Stalin.
Presently we have a socialized health plan for those over 65 called Medicare that, according to the Healthcare Financing Administration, runs far more efficiently then does private insurance (Medicare operates at 2% operating costs, while private insurance carriers' operating expenses reach up to 30%). Even so, this feels like a government intrusion to many.
This year the rhetoric of the candidates is similar, but their approaches quite different. The effect on our nation is yet to be seen.
Dr. Rick Morris is a chiropractor specializing in disc herniations and spinal stenosis. He has been a doctor for UCLA, the Los Angeles Clippers and the U.S. Olympic Team and can be contacted at wevegotyourback.org. He lives in Downtown Los Angeles.
page 14, 9/1/2008
© Los Angeles Downtown News. Reprinting items retrieved from the archives are for personal use only. They may not be reproduced or retransmitted without permission of the Los Angeles Downtown News. If you would like to re-distribute anything from the Los Angeles Downtown News Archives, please call our permissions department at (213) 481-1448.
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Reader Comments
The following are comments from the readers. In no way do they represent the view of ladowntownnews.com.
dowtown reader wrote on Sep 2, 2008 2:49 PM:
" thanks for this well written and thought out article! It's far more informative than anything I've seen on network or cable news and even the LA Times. This article should be distributed nationally so all can get a clear and fair assessment of how the policies differ. Thanks again! The only thing I wouldve added was to mention we have socialized government institutions all over the place. Eg. Schools, police, postal and even the Military. All socialized institutions. Are they so bad and should they all be 100% privatized? I'm not 100% for obama's plan but it seems more inclusive and comprehensive than McCains "hands off and step back" approach. The insurance companies have run too long without any oversight. "
Bill Cooper wrote on Sep 4, 2008 3:47 PM:
" This is great information to have. I thought it was interesting that there was no mention of Health Care or Education from the GOP party last night, including nothing from Sara Palin's speach. "
Sherri Cannon wrote on Sep 4, 2008 3:48 PM:
" Thank you for providing this in-depth comparison of the campaigns' plans. This will help me participate more effectively in the important conversations that we should be having right now. I'll also share with many.
Excellently done--please continue to publish this kind of thoughtful assessment. "
Excellently done--please continue to publish this kind of thoughtful assessment. "
Lyn wrote on Sep 4, 2008 5:06 PM:
" Thanks for a lively informative article. You have given me much "Food for thought". Kudos for your newspaper tackling such a hot issue. Hopefully, you'll continue this important and similar timely issues - "
Diana Abrashkin wrote on Sep 4, 2008 11:41 PM:
" This piece really helped me to understand the 2 candidates' proposals. Appreciate Dr. Morris' analysis of this tough issue. Thanks! "
George wrote on Sep 8, 2008 8:41 AM:
" Thanks for you article. This page by Healthcare.com provides a side-by-side of the McCain and Obama plans. It also allows users to "vote", and they are keeping a running tally. If you're interested in reading more, take a look. It's as good of a comparative analysis as I've seen:
http://decision.healthcare.com/obama-mccain/ "
http://decision.healthcare.com/obama-mccain/ "
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