While living abroad in Norway, I had my second baby. Everyone back in the States thought I was nuts. They even had me a little nervous. I’d always assumed socialized medicine was subpar, but that was not the case. The maternity ward was well equipped and the certified nurse midwives who attend all non-complicated births were awesome. The entire experience was thoroughly impressive. In fact, Scandinavia consistently ranks as the best place in the world to have a baby because of universal access to prenatal and infant medical care. The country has half the infant mortality rate of the U.S.
During our time in that country, where the government truly does run health care, my family never once experienced the long lines or waiting lists bemoaned by pundits and lobbyists who are against regulating our privatized health care system. My son was diagnosed with autism and received progressive and effective therapies. We actually had to convince doctors and nurses to find the necessary paperwork to bill our private insurance.
It was other-worldly. In a good way.
Neither presidential candidate’s health care plan brings us anywhere near a true socialized medicine or single-payer system. But they do both point out the many ways our own health care structure can be improved.
The beginning of an organized medical care in the U.S. began when more than half of the country’s doctors joined the newly formed American Medical Association in 1901. Due to their lobbying efforts, doctors were no longer expected to provide free services to anyone who walked into a hospital. In the 1930s, Blue Cross began providing private coverage for hospital visits, amidst wrangling within the Roosevelt Administration after passage of the Social Security Act, which omitted health insurance.
Both Roosevelt and Truman called for health care to be an “economic right.” Truman then proposed a single-payer health program to cover all Americans. But it was called a “Communist plot” by a House subcommittee after the American Medical Association denounced it.
Wars, sacrifice and more political turmoil distracted the nation from worrying about health care. And by the 1960s, Americans were paying fully double the average cost of health care as compared to a decade earlier. Seven hundred private companies were now offering insurance and President Lyndon Johnson signed Medicaid and Medicare into law to cover seniors over sixty-five. But this subsidized, mostly unregulated coverage caused medical costs (and profits) to run rampant and to rapidly inflate during the ’70s. The Reagan Administration imposed more regulations, creating HMOs, and the 1980s saw private insurance companies integrate themselves into the health care industry. Their profits soared.
In the 1990s, the insurance industry launched attack ads on the Clintons’ plan for health care reform and major news outlets ran stories questioning whether there was really a health care crisis. Congress failed to pass any reform of the industry under pressure from lobbyists and public opinion.
Today, the minimally regulated for-profit industry controlling our medical care has continued to prosper. Insurance premiums have increased 87% in the last six years while at the same time overhead and profit are the fastest-growing factors in health care costs. At this rate, the industry will comprise 20% of our overall economy within the next ten years.
While the worries about our economy grow, the issue of health care becomes even more entangled with our overall economic health. Half of all bankruptcies in this country are due to medical expenses.
In one breath, the presidential candidates lament the economic crisis, yet in the next, both promise to provide relief for all those in need of health care coverage. Sometimes in the midst of all the spin, the facts become unrecognizable.
During last week’s final presidential debate, there was a big disparity in the numbers quoted by Senators Obama and McCain. Just how much does the average family pay for health insurance coverage? Is it $5,800 as John McCain claimed, or $12,000 as Barack Obama asserted?
Fact-checkers found a critical error McCain’s statement, as he expects families to purchase health insurance by being reimbursed with a $5,000 tax credit – the fundamental basis of his plan. Turns out, it actually costs an average family $12,680 to purchase a plan. The candidates do agree that it’s important to use technology for coordinating patient care rather than the boatloads of paper records that now exist. Electronic health records will save up to $77 billion each year by preventing duplicate procedures and testing, among other things.
The candidates also agree that there needs to be more transparency about actual medical treatment costs vs. administration and overhead. They each also want to lower prescription drug costs by creating competition, and to allow patients to import pharmaceuticals from other countries.
And there’s more! The presidential hopefuls also both agree that having consistent access to medical care will prevent emergency room visits by not waiting until the last resort. It will also help prevent chronic illness due to untreated health problems and also work toward protecting public health in general.
But the candidates diverge on how to ensure that all Americans have access to health insurance. Both want there to be no ‘state lines’ as there are now, so families can shop around for the best plan. However, Obama will regulate and require insurance companies to cover patients regardless of pre-existing conditions, and McCain will not. McCain will instead work with Governors on (fifty separate) plans to optimize access to health care within each individual state.
Obama will form a National Health Insurance Exchange (NHIE) to regulate and reform the private insurance market. Americans will choose a NHIE plan or private plan that bests suits them, or remain with their current coverage (if they are not one of the 45 million currently uninsured).
It’s hard to believe how little the question of health care has changed in the last 100 years. Obama’s plan will mandate that large companies provide insurance for their employees or contribute toward a public plan. Small businesses will receive a tax credit to help with the costs of covering their workers. Freelancers and the self-employed can choose from a public or private plan at a reasonable cost, and are guaranteed coverage. When a baby is born, families will register them for a birth certificate and a health insurance plan. If they can’t afford premiums, the child will be covered by an NHIE plan.
Obama’s mandate is a little like auto insurance. We’re all required to have it because it protects our own economic interests and that of others on the road. Not many complain about the government intruding on their rights in this regard, as it’s seen as a practical and protective measure. And if a family can’t afford to pay the premiums for health insurance, under Obama’s plan the government will help.
How does Obama expect to pay for the infrastructure and technology needed to implement such a thorough plan? By letting the Bush tax cuts for the wealthiest one percent of Americans expire. More tax revenue, more money to spend.
McCain’s approach is to keep the choice with families on how to protect themselves. The responsibility remains with families to find a plan that works for them and to pay for it themselves, using the McCain tax credit or their own Health Savings Accounts. There is a serious risk, however, that because McCain’s plan will give out insurance credits, some employers will stop paying for their employees’ health care. A recent study done by researchers from Harvard, Columbia and Purdue projected that as many as twenty million Americans currently covered by employer-based insurance programs could lose that coverage under the McCain plan.
How does McCain intend to pay for his tax credits? The jury is out on that, but his campaign has said it will come partially from major cuts to Medicare and Medicaid programs serving elderly and low-income Americans. But his funding the program may be a moot point if McCain activates an across-the-board spending freeze, as he has promised to do.
It’s hard to believe how little the question of health care has changed in the last 100 years. We’re still asking the same basic question: for-profit or for health? It is too much to hope that the next administration can finally give us an answer?