Proposed Health Care Plans

Large issues, such as health care, should get separate debates so they can't breeze past the issue, as Biden did (Palin didn't respond).  Biden was quick to point out the problems with McCain's plan (plenty, I agree) but didn't give their plan much of an introduction.  Obama's plan is far more detailed--check his website--than McCain's but his won't work either.  Unless you have universal, mandated health care, preferably single payer we will just reconfigure the problem.

Neither Hillary nor Edwards had a single payer system, but both had mandates, which is the first step towards a serious resolution to this problem.  We may see a number of posts calling singe player socialism--yeah, so what!  So is Social Security, Medicare, our public school system, and most of the really good stuff in this country.  And let me not forget the bailout for Wall Street, called socialism for millionaires (or perhaps billionaires).

from today's Times:

"In a poll in August by the Pew Resarch Center, 63 percent of Americans said they favored government-guranteed health insurance, even at the cost of higher taxes, while only 34 percent opposed it."

So what are we waiting for? 

So after reading the above post, does anyone wonder why I'm socialist, except of course the wives of the above CEO's if by chance any of them read these threads.

The people you cite above are not going to take a voluntary paycut.  In a single payer government run health care system there are caps on what administrators, doctors, and all health care professionals can earn--and this doesn't mean they live in poverty.  As someone pointed out, on this thread or the bailout thread, French doctors make on average $55,000 per year, and American doctors on average three or four times that amount.  I'm just as sure those who administer the French system don't make more or much more than the doctors.   More important, the French medical system has been rated number one by the World Health Organization and other organizations that review national health and health care systems for as many years as I can remember, and the U.S. is somewhere in the 30's.  Also, with everyone insured in France, it costs the French (which has one of the more expensive single payer health care systems) approximately half of what it costs in the U.S. for health care. As you pointed out, the costs to pay the middle men is what's eating up these huge sums of money.

Everyone knows that we have extraordinary problems in our health care system, yet there is this huge resistance to looking at other countries and imitating here what works there.  All of the following were once considered "socialism" in this country and all have worked out very well for our citizens: 

Social Security (and how many of you, honestly, are willing to forego this benefit)

Unemployment insurance

Medicare

FDIC bank insurance 

I am sure there are many others that I can't think of at the moment. We need a single payer health care system, and hopefully we don't have to go through a second great depression and the second coming of FDR to get it.  We won't change our system so long as lobbyists and self interest are in charge. 

BB--thanks for link.  I read up to page 18 and then stopped.  It's certainly a plan and I believe the AMA realized that with over 15% of our population not insured they needed to do something to stop being part of the problem (they were against Hillary's plan and helped to stop it, along with the insurance companies and pharmaceuticals).  After reading most of the plan, I believe that, like most of the other plans (McCain, Obama, even Hillary), they're trying to shore up free market health insurance rather than accepting reality, which is that free market plans for basic needs such as health and schooling don't work, or least don't work fairly.  So the AMA plan is a hodge podge of tax credits to avoid going where we will eventually wind up, single payer government health insurance.  The AMA has a  vested interest in keeping  professional fees high, but they also concede indirectly through this plan that they undermine the high respect accorded doctors by keeping some Americans unhealthy to keep their fees high.  I believe that we will see changes, lots of reconfiguration of the tax code over the next few years, but that the problem will continue, and that in ten to fifteen years time we will have a single payer system like most other industrialized nations.  But the wait for those without insurance, in my strongly held view, is a national disgrace.

There have been many misunderstandings about the differences between McCain's and Obama's health plans, and I confess openly that I am one of those who helped the misunderstandings along.  Apologies for that!  I didn't like either plan but preferred Obama's, which I realize now I didn't fully understand.  Nor did I understand McCain's.

One reason for my misunderstanding of McCain's plan is because I trusted Biden's description of it during the VP debate--Biden's description would have led most listeners to assume that under McCain's plan employers and employees would lose tax benefits, and this is not the case.  Only the employee would lose the tax benefit but in its place, he or she would get a tax credit, which in most cases, except for the most expensive employee plans, would be greater than the lost benefit.  Employers would still keep their tax benefit and thus would have no incentive to drop health insurance beyond the usual incentive: to increase company profitability. (I can only hope that Biden was laboring under an equal misunderstanding and that his description of McCain's plan was not intended to deliverately mislead the listener.)

So in amends, I went looking for an unbiased description of their plans, which is not an easy task, and I found the following (pasted below). I believe it describes both plans fairly, the pros and cons, but without excessive detail.  My own initial conclusion hasn't changed, which is that neither plan solves the huge health insurance problem in this country and that only a single payer government-run plan will work.  Nonetheless, if I were still working, whether as an employee for a company that provides health insurance or as the owner of my own company, I believe that in self interest I would prefer McCain's plan over Obama's.  On a personal level, McCain's plan would have better served my pocketbook.  On a philosophical level, I prefer any plan that serves the entire community, even if I get a bit less in the end. Neither plan achieves that.

Again, sorry Rosemary for posting incorrect information on the Republican thread. 

McCain, Obama offer vastly different health care plans

WASHINGTON - Susana Espinoza of San Diego is a poster child for what's wrong with American health care.

The 45-year-old mother of two earns about $39,000 a year, but can't afford employer-based health coverage for herself and her sons. And she earns too much for her children to get coverage under Medicaid or California's state children's health-insurance program.

So in an unfortunate compromise that leaves her feeling guilty, Espinoza covers only herself through her job-based plan; her children go uninsured.

When her older son broke his arm playing flag football several years ago, Espinoza borrowed money from friends and took out costly payday loans to cover the $1,800 medical bill. More than three years later, "I'm still paying off the loans," she said.

Presidential hopefuls Barack Obama and John McCain think they have solutions to Espinoza's problem.

McCain, a Republican, would provide Espinoza with a $5,000 tax credit, which would help her buy coverage in the private market. Obama, a Democrat, would expand eligibility in government insurance programs for children and the poor and provide income-based subsidies to help her afford coverage.

Like most people, Espinoza knew little of either candidate's disparate plans to overhaul the nation's dysfunctional health-care system.

But that's likely to change in the coming months as the presidential race sharpens its focus on the policy differences that define and separate Obama and McCain.

Nowhere are those differences more striking than in health care.

Obama's proposed universal health-care plan embodies the long-held Democratic Party goal of covering the 47 million Americans who lack health insurance. Employers, insurers, individuals and the government all would have greater roles in assuring coverage through a number of proposals designed to close gaps in the system.

"It builds on the existing system and recognizes that we're not starting from scratch," said M. Gregg Bloche, health care adviser for Obama. "One can't impose sudden radical change on the system from the top down. There are real limitations to what can be accomplished centrally with respect to health care."

McCain's plan takes a different approach. It follows Republican orthodoxy of trying to make the private-insurance marketplace more affordable and competitive by radically altering the tax treatment of health-care benefits.

For years employers have been able to exclude the cost of health benefits from their employees' taxable incomes, but self-employed workers and those who buy private coverage don't have the same tax benefit. To level the playing field, McCain no longer would exempt employees' health benefits from income taxes. Instead, he'd provide refundable tax credits of $2,500 for individuals and $5,000 for families to help purchase private insurance.

"If you put $5,000 per family in America on the table, insurance companies ought to be able to figure out a product they can buy. That's something that happens in every other part of the economy. It ought to be able to happen in insurance too," Douglas Holtz-Eakin, chief policy adviser for McCain.

Money left over from insurance that costs less than the tax credit could be deposited into health savings accounts. To improve competition and choice, McCain also would allow insurance to be sold across state lines. His tax measure would generate about $3.6 trillion over 10 years, which would pay for the tax credits, making the entire proposal budget-neutral, Holtz-Eakin said. Some 20 million uninsured Americans would get coverage under the plan, Holtz-Eakin estimated.

Kenneth Thorpe, a noted health economist, put the figure at 5 million to 7 million people, because two-thirds of uninsured Americans would require higher tax credits to pay for family coverage, he said, which averages $12,000 a year - $4,500 for individuals.

At those prices, the credits likely could pay only for catastrophic coverage, said Mark Pauly, a health-care management professor at the Wharton School of the University of Pennsylvania.

Holtz-Eakin said insurers would have to provide coverage that met certain standards, but no such standards have been worked out.

Critics say that McCain's plan will hasten the decline of the employer-based health system by steering younger, healthy people into the private market. Health economists applaud the proposal, however, because it would make the tax code more progressive by removing an exclusion that disproportionately benefits higher-income workers with more generous health plans. In fact, some higher income people with generous plans would end up with higher tax bills under McCain's proposal.

Under Obama's plan, children - but not adults - would be required to have health insurance. His plan to expand state children's health insurance programs and Medicaid probably would help Espinoza's children get coverage. Covering them through her employer's plan would cost another $300 a month, Espinoza said.

Obama's proposal also allows people who don't have insurance through their jobs and don't qualify for Medicaid or SCHIP to buy into plans that now are available for some federal employees.

Self-employed workers and small businesses that can't afford coverage for their employees also could join the plans. Premiums and co-pays would be charged, but federal subsidies would help low-income people.

To help make the search for affordable coverage easier, Obama calls for a national health-insurance exchange that would set coverage standards for participating insurers.

Instead of mandating coverage, Obama's plan bars any insurer in the exchange from denying coverage to anyone because of illness or pre-existing conditions. Applicants to the expanded federal programs also couldn't be denied coverage. Employers that don't offer coverage and don't help workers pay for their health care would have to contribute to the cost of covering the uninsured.

Bloche said Obama's proposal would cost $50 billion to $65 billion a year and would be financed by eliminating President Bush's tax cuts for people who earn more than $250,000, savings on Iraq war spending and a number of cost-saving health-care proposals.

Pauly of the Wharton school said Obama's plan probably would cost twice its projected amount because it assumed cost savings that "nobody's been able to demonstrate they can produce."

Obama's proposal is based loosely on the health plan adopted by Massachusetts and is similar to Hillary Clinton's plan. But unlike Clinton's proposal, Obama's has no mandate for adults to be covered.

That's problematic, because many people would wait until they're sick to seek coverage, which would drive premiums higher so that insurers wouldn't lose money, said Paul Ginsburg, the president of the Center for the Study of Health System Change.

Bloche said Obama hadn't closed the door on requiring adult coverage. But he said other options were available, such as automatically enrolling people in plans and giving them the option to withdraw. "Congress will ultimately decide," Bloche said.

Critics of McCain plan's worry that older, sicker Americans won't be able to get coverage in the private market. For these people, McCain proposes a guaranteed-access coverage plan that also would provide subsidies for low-income participants. While specifics of the plan haven't been worked out, Holtz-Eakin said the measure could require up to $10 billion a year in federal money.

What many health experts find most attractive about McCain's plan is the potential for containing health-care spending.

"I consider it the most important of his cost-containment ideas," Ginsburg said.

Much of the rise in health-care spending isn't due to increasing costs, but rather more use of services, tests and procedures stemming from more aggressive treatment.

"If that tax exclusion is no longer allowed and all I get is a tax credit for $5,000, well, maybe I'll decide a (cheaper) policy is all I need or all I can afford. I'll get less health insurance, which means I'm going to be paying more of the cost of care, and that is a cost-containment" mechanism," Ginsburg said.

Perhaps the biggest hurdle McCain's plan faces is its radical nature and the uncertainty that it creates.

"People fear losing the insurance they've got until they know what they can get is better," said Chris Jennings, Hillary Clinton's health-policy adviser. "I would suggest to you that this is going to be the problem with Senator McCain's policy."

A footnote: After hearing details of the Obama and McCain plans, Espinosa preferred the $5,000 tax credit that McCain offers.

Grace--since my husband is Latino I do think about it. I see discrimination all the time, for 30 years now. When we purchased our first house in rural New York, it was particularly evident, and ugly. He couldn't get an appointment with the town's dentist, for example, after he gave his name to the nurse over the telephone--he also has a heavy accent.  When I called ten minutes later, without accent and with an Irish name, I got an appointment immediately.  I complained to the State board and got no satisfaction whatsoever. Fortunately, he's very easy going and lets it roll off his back--I get angry.  But I don't see what that has to do with either candidate's health plans, other than that African Americans and Latinos are less likely to have health insurance than other Americans.  

Speaking of your SIL, I believe under the McCain insurance plan, your SIL would pay about $400-$450 a month instead of the current $800.  It sounds as though the company part of his coverage is quite small, so the additional tax owed by him would be negligible. Under Obama's plan, he would either stick with current coverage (paying $800 a month as now), or opt to buy into the government plan, but that would cost him $12,000 a year (or $1,000 a month).  If he falls into the lower income level defined by the plan (which hasn't yet been spelled out by Obama), he would get some help towards paying the $1,000,but if he doesn't fit into that lower income category, he will pay the full amount. So it appears that he's better off under McCain's plan.

The problem with Obama's plan is that if voters are deciding on their candidate based on their health plans, they can pretty much figure out what they'll get with McCain's plan (other than the high risk people who McCain says he will take care of, but doesn't tell us how; McCain also says he'll offer some type of help to those who can't afford health insurance, but like Obama he doesn't provide details).  Voters actually have no clue what they'll actually get with Obama as none of the details are provided.  Do they fall into the lower-income group?  If so, what are the subsidies? What will the government plan cost an individual, a family?  Will there be minimum coverage requirements--i.e. dental, mammograms, health checkups?  How will he pay for it? Obama says he'll bring down the cost of insurance, but beyond citing a few of Hillary's ideas, he doesn't say how.  Anyone going into this election voting on health care has no idea how Obama's plan will actually impact him or her.  It's like putting your money into a blind trust.  And this is what I find so objectionable about Obama as the Democratic candidate.  He talks around the edges of everything so he can't be pinned down later if he doesn't deliver.  It's his "present" vote in brighter colors. 

I have excellent insurance (Medicare Advantage) but it is soon to change when the Democrats are a majority.  They plan major changes to Medicare, taking away some of the subsidies, and benefits.  The government currently pays these plans 15% more than it does to those on regular Medicare. Unfortunately, there are lots of states that don't have these plans (Maine, for example), so as always someone gets screwed.  (Bush was the one who introduced the Advantage plans and for some of us they work very well.)  I will be disadvantaged when the Democratic changes are introduced, but in truth I think it's fair that everyone get the same (no privileges for the guys who live in the right areas), so I'll find a way to pay the extra money. I won't vote Republican because it's better for me, but is this true for all those on Medicare enrolled in these plans.  Do they even know what coming next year?  On regular Medicare, I would have paid $20-$25,000 for my BC treatment the first year.  On Medicare Advantage, I paid $750.00--a huge difference! I consider myself lucky to have gotten BC right after I qualified for Medicare and very lucky that I could enroll in an Advantage Plan.  Of course, if you think about it, the costs are ridiculous: $50,000 for radiation, for example; $70,000 for Herceptin, etc.  These costs are so much less in Europe.  Obviously, the costs are outrageous here and neither candidate tells us how he plans to get them down--the obvious solution is regulate, regulate, and regulate some more.  My wish is for Medicare to be extended to all Americans, and there have been many papers published that show this would work and that medical costs would be reduced drastically.  But that would be socialized medicine for all instead of the elderly, and how horrible would that be!  Socialism--can you just imagine!  

I'm not sure about the state line issue so what I say is pure guess.  I believe the coverage requirements are different in different states, so that if New York, for example, requires that all insurers cover yearly mammograms, an out-of-state insurer covering a resident of New York  must cover that yearly mammogram.  I'm assuming this would no longer be the case so that if a New York resident were to purchase insurance in New Jersey (which might not have the mammogram requirement) the insurer wouldn't have to pay for the New York resident's yearly mammogram.  In this way, young women who don't think they need yearly mammograms would purchase a cheaper New Jersey plan.  That's my guess anyway.  

As I wrote on the bailout thread, McCain's plan appears to me to be a lot closer to socialized medicine since the government is now getting into the business of paying for health insurance.  Unless I totally misunderstand McCain's plan (which has happened before) everyone gets the credit, no matter whether they pay taxes or not. It's just not large enough to cover the full cost of insurance and the buyer can choose among many plans.  It's the first step towards socialized medicine and I'm all for socialized medicine. 

Here's a link to an excellent article on both candidates' health care plans if you prefer knowing the facts to listening to the candidates' spin.  The conclusion is that both plans are not detailed enough to make any realistic predictions as to cost of either plan or numbers of uninsured that will now have coverage, or what anyone will wind up paying.  As the article states, both candidates distort the other's plan.  I really do dislike politicians.  Didn't their mothers tell them the Cherry Tree story!

http://www.newsweek.com/id/163909