Who Do the Voters Prefer on Health Care Reform?

The big question -- when not discussing the economy -- is who will win the U.S. presidential race this year. It is an historic ticket of each side of the aisle combined with a colorful, and at times shocking, stage show before the media. Discussion of which way things will go is far beyond propriety for this blog to address.

What we can address and investigate is the positions of these two fine men on health care's future course. Today, thanks to a poll recently released, we can take a quick pulse on the American public and see how they feel about the proposals put forth by the White House hopefuls via News-Medical.net:

According to a report released today by the University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health, the majority of likely voters polled selected Obama as their top presidential pick to handle the country's biggest health care issues, including the high cost of health insurance, and the millions of U.S. adults and children without insurance.

One deviation from that was found amongst voters over the age of 65 who felt McCain has a better grasp of the prescription drug cost issue. Other than that, those polled generally show a marked leaning towards Obama's proposed handling of the health care crisis. Here are some of the numbers from the report broken out by health care issue:

• Health insurance is too expensive for families. The vote: McCain (38 percent) / Obama (62 percent)
• Many people can't afford prescription drugs. The vote: McCain (43 percent) / Obama (57 percent)
• Millions of children are uninsured. The vote: McCain (35 percent) / Obama (65 percent)
• Millions of adults are uninsured. The vote: McCain (35 percent) / Obama (65 percent)
• Some people get lower quality of health care than others. The vote: McCain (38 percent) / Obama (62 percent)

On this subject, it would seem that the Democratic Party is much more in line with the will of the (polled) people. Only time will tell how much influence that will have on the final election outcome. I would suspect that a lot of it will ride on the news about the economy. After all, it was the meltdown on Wall Street that bumped health care down the priority list of the American public. Extreme good or bad news on the economy will profoundly affect how much impact this data ends up having.

For the complete report and a podcast about its results, go visit C.S. Mott Children's Hospital National Poll on Children's Health.

SOURCE: "Voters pick Obama to tackle nation's health care problems" 10/13/08
photo courtesy of Torley, used under its Creative Commons license

Union vs. McCain: Round Two

My last post on this blog talked about the recently launched ad campaign levied against Sen. McCain by the American Federation of Government Employees (AFGE). In that post we looked at an example of the YouTube ad and I offered ruminations on the way that the union is leveraging old and new media to get the word out.

Today lets take a look at what the Annenberg Political Fact Check has to say about the content of those ads. (I really hope these guys pay a lot of attention to health care during the upcoming six months. Their objective analysis of the facts behind the spin is usually indispensable.) Here is one small excerpt from their extensively documented breakdown:

The AFL-CIO, in documentation it provided to FactCheck.org, cites four specific votes as support for this allegation. Three of them were against Democratic amendments to the annual budget bill in 2004, 2005 and 2006. And all of them failed along party lines in a Republican-controlled Senate. But in each case, McCain later supported different amendments to increase veterans' health benefits, either on the same day or the following day.

Specifically, in 2004 McCain voted against an increase of $1.8 billion, but an increase of $1.2 billion passed by unanimous consent. In 2005 he voted against an increase of $2.8 billion, then voted for a $410 million increase. And in 2006, he voted against a $1.5 billion increase, then voted for an $823 million increase.

In the increasingly complex flurry of opinion, fact, spin, and rhetoric that surrounds this issue it is more vital than ever to dig down to the roots of any claims made. This is true for both the views you support and the ones that you disagree with.

Think of it like electronic medical records vs. the current system. In the current system the details of a patients health issues can be fragmented across several different hard copy filing systems, each offering only an incomplete picture of the case. The confusion and possibility for mis-diagnosis is high, just as it is when bombarded by the (often ad hominem) arguments and spin surrounding the debate. Just as electronic medical records, once implemented, will allow reconciliation of data from disparate sources and act as a preventative against mistaken assessment of the situation, use of fact checking resources like the Annenberg Political Fact Check can help you reconcile the claims with the realities as the national discussion continues.

SOURCE: "AFL-CIO Falsely Attacks McCain" 07/10/08
photo courtesy of World Economic Forum, used under its Creative Commons license

Union Says McCain Approach to Health Care is Wrong

Market Watch ran an interesting press release last Wednesday concerning Senator McCain's proposed idea of distributing health vouchers to American military veterans at private, for profit providers. This is a move viewed by many as the beginning of a dismantling process for the Veterans Health Administration (VHA).

Via Market Watch:

This week, the American Federation of Government Employees (AFGE) launched a nationwide radio ad campaign raising serious concerns about Senator McCain's commitment to veterans' health care. In addition to the radio ads, AFGE, which represents employees in the Department of Veterans Affairs, launched a Web site, www.fundtheva.com, and a series of YouTube ads featuring union veterans voicing their concerns about McCain's controversial veterans health care platform.

The AFGE is not being bashful about their views. Not only that, but they are also being quite strategic in how they express them. Radio has a phenomenal reach, not having to concern itself with the digital divide it extends into houses, work sites, and the autos of commuters across the nation. YouTube also boasts an incredible reach, as has been proved repeatedly in the early months of campaigning this year. Between the two, the AFGE will be able to spread their message far and wide.

Here is an example of one of the YouTube ads:


Over the next several months we will be seeing an amazing array of reports, studies, propaganda, and spin concerning health care as the competition for President heats up prior to election day. Here on Health Care Reform Now! we will try to keep you abreast of developments as they happen.

SOURCE: "Union Representing VA Workers Launch Nationwide Radio Campaign, Web Site and Viral Videos for Full VA Funding" 07/09/08
photo courtesy of DOD Via PingNews, used under its Creative Commons license

Examining McCain's Proposed Health Care Tax Credits

Jonathan Cohn has a very interesting article up on CBS News. In it, he examines a recently released paper from the Center for American Progress which dissects Sen. McCain's proposed tax credits -- tax credits that are supposed to fix our broken health care system.

Under our current system, group health premiums (e.g., insurance you get through your job) are exempt from both income tax and payroll tax. Sen. McCain has suggested doing away with that exemption and replacing it with a tax credit ($2,500 for individuals, $5,000 for families) tied to the purchase of individual insurance.

Via Mr. Cohn's article:

McCain's advisers say that the credit would grow at the rate of inflation -- that is, it'd get more expensive at approximately the rate of other goods (or, at least, how the government measures the price increases of other goods). Health care expenses, of course, keep going up faster than other expenses, mostly because of medical technology and the (largely unrestrained) demand for it. So if people kept paying for the same level of insurance, the tax credit would quickly fall behind: They'd end up paying more in taxes. According to the report, "In 2009, the credit will cover 36 percent of an average employer-provided family policy (based upon CBO projections). By 2018, however, the credit will cover only 24 percent of the cost of the same policy."

(This is all in addition to the fact that, for many families, the credit will not be enough to buy a policy — even now — because health care for families costs a lot more than $5,000 a year.)

Now, to its proponents, this feature of the tax credit — the fact that it increases so slowly — is a feature, not a bug. It's designed to encourage people to be more thrifty in their purchase of insurance. Ideally, they'll go for less generous policies — ones that don't subsidize so much wasteful care.

Mr. Cohn points out the crude nature of this approach to cost control, noting that it puts the entire weight of the problem on the backs of consumers while providing no guarantee that adequate health care will be forthcoming. No guarantee of available coverage, much less for pre-existing conditions. No limits on the amount of cost out-of-pocket for consumers.

One reason I enjoy Mr. Cohn's work is that he does embrace transparency in his writing. In the beginning of the article he notes that he has not yet had the opportunity to vet the report in full and that these are initial conclusions only. He closes with a reminder:

OK, and now to that caveat I promised at the beginning. Unlike Barack Obama, McCain hasn't been clear about exactly how he proposes to change the tax treatment of health insurance. And there are rumors around that they might not get rid of the existing deduction entirely, preserving it at least for payroll taxes. It's not clear how that'd affect the paper's conclusions, since the paper assumes the entire deduction goes away. But, of course, if McCain keeps some of the existing tax break, then either his plan won't have as dramatic effect period — or it will run up a higher deficit.

All in all, well worth reading, if for no other reason than to remind yourself that in the convoluted discourse on American health care it pays to dig below the surface on all claims and proposals.

SOURCE: "McCain’s Fuzzy-Math Health Care Plan" 07/05/08
photo courtesy of SoggyDan, used under its Creative Commons license

Credit Cards, Health Care, and McCain's Vision

Robert Gordon of Slate offers a prescription of comparison as a cure for rhetoric. While examining the health care proposals of Senator McCain, he examines a similar situation in recent history: the treatment of the credit industry in the late 1970s.

Let's start with his recap of the way that credit-card business migrated to the states that had the least regulation:

Until the late 1970s, South Dakota and Delaware didn't have an outsized share of the credit-card business. Banks had to obey the interest caps of the states where borrowers lived. So, for example, loans to New York residents were always subject to New York's limits on interest rates. At 12 percent back then, and with high inflation, these laws sharply limited profits on credit cards.

Then in 1978, the Supreme Court said banks should follow the rate cap in their home states. This meant that as long as a credit-card company relocated to a state with a higher interest-rate limit, the company could lend to borrowers anywhere under that higher limit. Following the court's ruling, Citibank chairman Walter Wriston offered Gov. Bill Janklow a deal: If South Dakota lifted its rate cap altogether and formally invited Citibank to the state (as federal law required), the banking giant would move its credit-card operations to South Dakota—along with 400 good jobs.

The bill was introduced and passed in the space of a day. Soon after, Delaware lifted its cap, too. Voilà, South Dakota and Delaware became the hosts of most credit-card companies.

An excellent illustration of the fact that one needs to looks not only at the proposed actions to be taken, but also at the ramifications of those actions. This brings us to the Senator's statements about "allowing families to purchase insurance across state lines." Seemingly sound upon first glance, the actual repercussions bear scrutiny.

McCain argues that different states' regulations "prevent the best companies, with the best plans and lowest prices, from making their product available to any American who wants it." Although he hasn't given details, his supporters say that he favors an approach, endorsed by President Bush and championed by McCain's Arizona colleague John Shadegg, that would allow insurers to choose the state laws under which they are regulated. (I e-mailed the campaign about the specifics of McCain's approach and didn't hear back.) An insurance company that chose to be regulated under Arizona law could sell policies in New York without following New York rules. Arizona, like most states, lets companies charge what they want to people who are sick—or simply deny them coverage altogether. Under Shadegg's bill, insurers wouldn't even need to pick up and move their operations; it would be enough to file some paperwork with a state insurance commissioner and pay that state's relevant taxes.

Now the classic Libertarian argument about credit-cards would probably be that no one forced anyone to get a credit card in the first place. However, that argument is incomplete. It fails to take into account the usurious practices that tend to flourish in an environment where consumer protections and regulation are minimized to this extent.

With the individual market for health care, the libertarian argument fails on its own terms: Sick people can't get coverage they can afford. It's as though the rafts are reserved for people who already have life preservers. Americans with pre-existing conditions—cancer, asthma, diabetes, and the like—would need to pay even more than they do today. Through no fault of their own, more of them would end up without insurance. Meanwhile, insurers would improve their own profits by offering targeted policies to people with the fewest health expenses. As with the history of credit cards, it's Robin Hood in reverse. Apart from the obvious injustice, this approach could add to spiraling health costs. The sickest 10 percent of Americans are already responsible for 70 percent of the nation's health expenses. When more such Americans go uninsured, skip checkups, and land in the emergency room, they end up costing taxpayers more.

It is hardly shocking that once again we come full circle to one of the points in George C. Halvorson's book Health Care Reform Now!. Chronic conditions are the lion's share of health care expenses in the U.S. The looming financial specter of the emergency room casts a very long shadow across the health care crisis. Despite President Bush's famous remarks last July (“The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America. After all, you just go to an emergency room.”) this approach does nothing but drive overall costs upward while overextending the ER's to the point of massively increasing wait times and decreasing quality of care. Besides, when was the last time you know of someone going to the emergency room for chemotherapy?

There are many measures that can be taken to help pull our nation out of its downward spiral, but they all require careful thought and practical implementation. Both regulation and deregulation and powerful things and both have far reaching effects that will ripple across America. We need to be decisive yet act with care, especially those of us who are getting older.

Check out the original article and see what you think.

SOURCE: "Reverse Robin Hood Why is John McCain wrong on health care? Think credit cards." 05/19/08
photo courtesy of SoggyDan, used under its Creative Commons license