Campaign 2008: The Candidates Speak

  • My head is spinning from everything I've read about health care issues on the presidential candidates' web sites. In this blog entry, I'll encapsulate the main contenders' platforms, and offer my own commentary. A "fair and balanced" news report is not possible here, as I believe FoxNews owns the copyright on that expression. (I'm being satirical; Al Franken won the lawsuit when he used the words "fair and balanced" in a book title.)


    Coming up in my next blog entries, I'll talk about "Universal Health Care: the Pros and Cons" and then "Preventive Health Care: My Perspective as a Medical and Psychiatric Patient." For now, I'll report and you can decide for yourself about the guy (or gal) you'll pull the flapjack for.

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    John McCain's bullet points are clear, concise and intelligent. To quote this Republican hopeful, he believes, among other things, that "Insurance reforms should increase the variety and affordability of insurance coverage available to American families by fostering competition and innovation."


    Some of his solutions:

    • Reform the tax code to eliminate the bias toward employer-sponsored health insurance, and provide all individuals with a $2,500 tax credit ($5,000 for families) to increase incentives for insurance coverage. Individuals owning innovative multi-year policies that cost less than the full credit can deposit the remainder in expanded health savings accounts.
    • Allow individuals to get insurance through any organization or association that they choose: employers, individual purchases, churches, professional association, and so forth. These policies will be available to small businesses and the self-employed, will be portable across all jobs, and will automatically bridge the time between retirement and Medicare eligibility. These plans would have to meet rigorous standards and certification.


    This guy is the Republican frontrunner in my book. The party would be foolish not to nominate him.


    Mitt Romney, one of his brethren, believes that, "By expanding and deregulating the private health insurance market, we can decrease costs and ensure that more Americans have access to affordable, portable, quality, private health insurance."


    Now, the words "deregulating the private health insurance market" scare me. Already, in the free market, insurers have historically denied coverage or imposed drug formularies. And, my heart beats still, they refused to get wise to mental health parity until individual states legislated this kind of reform.


    He swipes: "Democrats believe that the solution to these problems is a one-size-fits-all, government-run, socialized health care system - a course that threatens medical progress and restricts free markets." Not necessarily so. Hillary Clinton, if you read her 11-page health care proposal, offers a mix of public and private options, like a menu. She and Barack Obama would give us the ability to choose the very same health plan that members of Congress have available.


    "Universal healthcare," unfortunately, has become synonymous with socialized medicine, and that is not the case. Guaranteeing equal and accessible coverage for all Americans can be achieved with a range of options, but to say the "Invisible Hand" of the marketplace will result in insurance carriers' voluntarily policing themselves (the myth of deregulation) is a stretch.


    The problem is, every insurer is out to make a profit, whether it's a non-profit corporation or a for-profit business. They deserve to make money. Fair enough. So here's why universal coverage, that is, making insurance (whether private or public or a mix) available to all Americans, is good business: If a bigger pool of insureds is created, the risk is spread out. It's Insurance 101: the "law of large numbers" states that the greater the numbers of people you have, the easier it is to predict outcomes.


    Another hopeful, Mike Huckabee, shows some promise as regards health care (but you already know my stance on his other position): "We do need to get serious about preventive health care instead of chasing more and more dollars to treat chronic disease, which currently gobbles up 80% of our health care costs, and yet is often avoidable. We have to change a system that happily pays $30,000 for a diabetic to have his foot amputated, but won't pay for the shoes that would save his foot."

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    I'll wrap up my Republican coverage here by saying that their overriding theme of "personality responsibility" isn't just wordplay. Most of us need to take better care of our health. One truth cuts across party lines: getting your husband (or wife, or someone else) to consider going to the doctor, even if treatment is available, is another story. But if the treatment is affordable, hey, maybe the person will go. So in one of my next blog entries I'll talk about why preventive medicine is the key.


    Traditionally, stigma has kept some of us from seeing a psychiatrist. And also, a lot of our psychiatrists seem to have gotten their degrees from a CrackerJack box. True health care reform must do two things for you and me: give us access to "best practices" psychiatry, and allow us to see truly great doctors, regardless of the kind of health plan we buy into.


    Right now, I'll synthesize and interpret the key Democratic candidates' healthcare platforms. Again, to get the full scoop on these and the others, I'll repeat the links to their web sites at the end of this blog entry.


    First, Barack Obama. He's intelligent, articulate and could hold his own in a boxing ring with John McCain. If the two of them advanced to the finals, the outcome wouldn't be guaranteed. Any Republicans reading this, I'll tell you now: McCain is the guy Most Likely to be Elected.


    Here, Obama is a man after my own pocketbook. His plan to cover the uninsured includes:

    • Guaranteed eligibility. No American will be turned away from any insurance plan because of illness or pre-existing conditions.
    • Comprehensive benefits. The benefit package will be similar to the Federal Employees Health Benefits Program (FEHBP), and cover all essential medical services, including preventive, maternity and mental health care.


    According to his web site, "As president, Barack Obama will prioritize these activities to strengthen prevention and public health, as well as fight for the following initiatives," among others:

    • Improve Mental Health Care. Mental illness affects approximately one in five American families. The National Alliance on Mental Illness estimates that untreated mental illnesses cost the U.S. more than $100 billion per year. As president, Obama will support mental health parity so that coverage for serious mental illnesses is provided on the same terms and conditions as other illnesses and diseases.

    He is the only candidate who mentioned this on his web site.


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    Moving on, John Edwards' web site states:


    Chronic diseases account for three-quarters of national health care spending. Helping patients and providers to manage these illnesses and avoid unnecessary hospitalizations can improve health and dramatically reduce health care costs. Additionally, less than 5 percent of total U.S. health care spending goes toward prevention.


    As president, Edwards will cut the cost of and improve treatment for chronic conditions by:

    • Creating Patient-Centered Medical Homes: Ninety percent of Medicare dollars are spent on people with three or more conditions, who usually see multiple specialists. At the same time, the number of new family practitioners has dropped 50 percent, in part because we don't properly value primary care. Starting with Medicare and other public plans, Edwards will help transform how health care is delivered by changing reimbursement rules to emphasize primary care. Primary care physicians will guide care for patients to make sure they are getting proven treatment from a coordinated team.

    This sounds like a winning strategy. In my blog entry about preventive medicine, I'll talk about my experiences with various health plans over the years, and why finding a great primary care doctor made all the difference.


    Hillary Clinton gives a three-pronged approach: If you are happy with your current health care coverage, you can keep it through employer or individual coverage. If you don't have health care or want to change your current coverage, you can choose from the same private health care options that members of congress enjoy, or you can choose a quality public plan option similar to Medicare.


    She offers a number of policies that will make health insurance more affordable, such as: Limiting premium payments to a percentage of income. "This guarantee will be achieved through a premium affordability tax credit that ensures that health premiums never rise above a certain percentage of family income."


    To wrap up, I can say Barack Obama was the only one to specifically mention NAMI and its membership. He and Clinton offer similar plans. The Republican candidates offer plans similar to each other, too. So it could be another deciding factor that tips me towards one candidate over another.


    Here now, I'll re-link you to their web sites:


Published On: December 20, 2007