Sunday, May 4, 2008

Health Care

The culture, it is a-changin':
WASHINGTON -- Some people marry for love, some for companionship, and others for status or money. Now comes another reason to get hitched: health insurance.

In a poll released today, 7% of Americans said they or someone in their household decided to marry in the last year so they could get healthcare benefits via their spouse.

Ricardo Alonso-Zaldivar, Getting married for health insurance, L.A. TIMES, April 29, 2008, http://www.latimes.com/news/printedition/asection/la-na-health29apr29,1,1912378.story

The idea may strike some older Americans as odd, or even sacrilege — but not my generation. I know at least two couples for whom health insurance has dictated the timing, though probably not the ultimate decision, to get married.
Of course, these types of decisions are mere symptoms of the health care crisis in this country, a frequently debated topic in this year's presidential election. In fact, it's one of the most important issues that will continue to draw attention in the six months between now and Tuesday, November 4. Still, as important as this debate will be, much confusion and misinformation abound. Part of this is the media's fault, because they think we're more interested in bowling scores and shots of whiskey, as Elizabeth Edwards pointed out so brilliantly in this op-ed last month. (It's poignantly titled, "Bowling 1, Health Care 0.") But mostly, if we don't know what the debate is about, it's because we haven't taken the time to educate ourselves. The info's all there; we just need to know where to look.

First, some facts. Some of these may be well known, but they bear repeating. (Primary source: the non-partisan National Coalition on Health Care, co-chaired by former Iowa Gov. Robert Ray.)

  • Of the nearly 300 million people in the U.S., 47 million do not have health insurance — about 16 percent of the population.
  • Of those 47 million uninsured, 80 percent are native or naturalized citizens. (We're not just talking about illegal immigrants here.)
  • Since 2000, the number of uninsured has increased by nearly 9 million.
  • While our system is primarily employer-based, about 15 percent of workers did not have health insurance available to them through work in 2005.
  • In 2006, there were 8.7 million American children without health insurance.
  • Nearly 40 percent of the 47 million uninsured Americans have household incomes of $50,000 or more.
  • Employee spending on health insurance premiums has increased 143% since 2000.
  • Only 7% of unemployed Americans can afford COBRA, the continuation health insurance offered by employers when people lose their jobs.
  • The U.S. government pays nearly $100 billion to provide uninsured residents with health care each year.
  • American hospitals provide $34 billion in uncompensated health care annually.
  • Of those Americans who do have health insurance, 29% are under-insured, meaning that they delay medical treatment due to high co-pays or co-insurance. (Here's an eye-opening article about rising health care costs.)
  • Other countries have cheaper, more efficient systems of providing health care than we do, and they don't necessarily sacrifice quality to do it. See, e.g., Japan and France. Canada and the U.K. have single-payer (government-run) systems, while France is employer-based, like the U.S.
For a look at the myriad problems with the health care system, see this list of under-treated conditions, duplications and wildly disparate care depending on the illness. Two examples: nearly 10,000 deaths from pneumonia could be prevented each year through vaccination, and nearly 70,000 more people die from poor control of high blood pressure, another preventable condition.

So, what to do about this mess? Well, if it's up to our presidential candidates, there are three different options. None of them is advocating a single-payer system, like Canada or the U.K. (or Dennis Kucinich). John McCain has attacked the Democrats' plans as an attempt to socialize the American health care system, a suggestion the New York Times debunks quite resoundingly here.

Both Democrats are pushing for versions of universal health insurance. Both plans would expand the employer-based system, giving more tax incentives to small businesses that offer insurance. Both plans allow all Americans the option to keep their current insurance, if they like it, but also create an option to buy insurance from the government, the way House and Senate members do. Both plans focus on reducing premiums and reducing health care costs. Barack Obama's plan mandates health insurance for all children, but does not penalize those who can't afford to buy insurance. Hillary Clinton's plan would mandate insurance for all. Essentially, both Democrats believe that the health insurance market is broken, that government must intervene or the system will continue to spiral out of control. Both Obama's and Clinton's plans are amazingly detailed. Check out the links — whatever your question (e.g., how will they pay for all this?), the websites have the answer.

The Henry J. Kaiser Family Foundation has a tremendous side-by-side analysis of all three candidates' plans.

The differences between Clinton's plan and Obama's plan are minimal, especially when contrasted with John McCain's plan. Strangely, it is McCain — not the Democrats — who would eviscerate the employer-based system. McCain would cancel the tax incentive for employers to provide health insurance, then provide tax credits of $2,500 to individuals and $5,000 to families to essentially find their own health insurance, because employers likely won't be doing it anymore. Moreover, McCain would make it more difficult for states to get Medicaid reimbursements. In other words, McCain places his faith in the market to fix the health care crisis. Poor people, in particular, would be on their own.

On this issue, I can't put it much better than Elizabeth Edwards, who has had her fair share of experience with the health care system: "Basically John McCain's health care program works very well if you happen to be rich and healthy and not very well if those are not descriptions of you."

1 comment:

Genevieve said...

you should take Tortorice's Health Law class next semester... he also has his own interesting idea of what type of plan should be implemented--looks somewhat like Obama's... but definitely worth discussion.