The Story Mainstream Press Won't Tell... Obama and McCain's Health Care Plans

Submitted by SadInAmerica on Thu, 09/25/2008 - 2:29pm.

A look at the way each candidate's plan might affect your ability to fill prescriptions, find a competent doctor and pay the bills. (This is a must read article to see how an Obama or McCain presidency will affect your health care. ~ SadInAmerica)

This is a 2 part article...

Part One

How McCain and Obama's Health Plans Would Affect Real People

So far, mainstream media coverage of health care during the campaign has been characterized by stenographic reporting -- simply transcribing what the candidates say, buzz words and all. Blogosphere coverage has trended the opposite direction -- way too much wonk talk, angels dancing on the head of a pin-type stuff. What have been missing are the people stories. Exactly how will all these economic and political calculations and pronouncements affect those who struggle daily to fill their prescriptions, find a competent doctor, or pay their medical bills? These are the people whose stories the media have yet to tell.

Plenty of coverage has depicted the McCain and Obama plans in broad brush strokes: McCain wants to rip up the employer-based health care system, replace it with tax credits for families and individuals, and require workers to pay income taxes on the value of their health insurance benefits from employers. He also wants families to make medical decisions. Obama would let people keep insurance from their bosses but make it easier for those who are uninsured to buy coverage through a public plan like Medicare. Neither would require people to carry health insurance (except Obama requires it for kids). Both candidates promise tax subsidies. How big they will be and who they will help is anyone's guess.

Last month, NPR aired just such a broad-brush plan-comparison story, featuring a health care policy researcher who drew distinctions between the two approaches. The most telling point he made was that "we pretty much have the same solutions that we've always had." Okay, the solutions may be shop worn, but that's no excuse for not showing people how they will be affected by them.

To begin what I hope will be an ongoing narrative about the candidates' plans and where ordinary people fit into them, I went to Helena, Arkansas, a town of 6,300 along the Mississippi River, whose population and importance peaked in the early 1900s during the sharecropper era. It's like many old river ports and tiny towns across America, in that the population vanished when the jobs did. There aren't many opportunities to go out and find employment with good insurance, the standard advice for decades. Helena's median family income in 1999 dollars was $21,500, compared to $50,000 for the U.S. at large.

The people I talked to represent the socio-economic strata of the town -- from the head jailer and the garbage collector to the insurance agent and the soybean farmer who owns 5,000 acres. They all have health issues. Most people do. Twenty-seven percent of the population is disabled, and all will be affected one way or another by the strategies for reform pursued by John McCain and Barack Obama.

What struck me was that even with insurance, which many had, people were still paying large medical bills out of pocket, reflecting the big cost shift from those who traditionally pay the health care tab to patients themselves. They are the underinsured, that group of 25 million Americans just now coming into public focus but hardly mentioned by candidates or the press. Another thing stood out: How little they knew about the coming health care battle being waged in their name.

"We're getting socialized medicine like Britain and Canada," one man told me. How did he know? "The people on TV told me," he said. All the words the media have produced are not sinking in. People need to see themselves in the context of the proposals. They need to know what's at stake for them. As Irwin Landau, my former editor at Consumer Reports, reminded me recently: What touches you personally will be more interesting than what is not personal. It will not only be more interesting, but it will help people evaluate the ad messages, the special interest spiels, the propaganda, and the demagoguery that will surely come. Judging from the people I met in Helena, the media have a big job to do going into the election and beyond.


Part Two

Obama and McCain's Health Care Plans: The Story Mainstream Press Won't Tell

James Bell III and James Bell IV

Father and son walked into the Dr. Vesudevan Wellness Center, a Delta Area Health Education Center jointly funded by the state of Arkansas and the federal government. The elder James, age sixty-two, looked healthy; his son, age forty-three, did not. James Bell IV was a diabetic and had been for eleven years. He had trouble breathing, and it was almost hard for him to talk. He said he hadn't seen an eye doctor in years; his feet were numb and often swollen, making it hard to stand or walk,or hold a job. He had thought about applying for a job at Wal-Mart, but a worker there told him the company might not hire him because he was so sick. His HBA1C level, a marker of how well the disease is controlled, registered a nine -- too high, and he knew it, but he had no insurance or money to buy the insulin and the test strips needed to monitor and control his blood sugars.

The Bells had been to a health clinic in another town, but it had no insulin to give out and wasn't much help otherwise. "They'll give you a meter (to test your blood) but not the strips," said James the younger. Strips cost eighty dollars for a supply of 100. A doctor's visit costs thirty dollars, but to someone without money, it might as well be thirty million.

His father, who works two jobs as the county's head jailer and as a grill cook on the night shift at McDonalds, was trying to help, but his own income is only about $30,000 a year before taxes. At least he has health coverage -- a 70 percent, 30 percent arrangement. The insurer pays 70 percent of a bill; he pays 30 percent, along with copayments for doctors' visits and premiums totaling $480 a month. (Add to that another $30 for blood pressure medication.) His wife of forty-four years has no coverage, as he can't afford to add her to the policy.

The health center helped the younger Bell apply for assistance from a drug company that makes medicines available to the very poor; he qualified for both insulin and test strips. Abbott Laboratories was willing to give him free strips as long as he applied for Medicaid and was rejected. He was. In Arkansas, single men without children generally don't qualify for Medicaid. Getting to a doctor regularly, though, is problematic. "I don't have any money to take him," says his father. "I'm just broke." What spare cash he once had, he used to send his youngest daughter to college. Still, he was planning to use eighty dollars from the $570 paycheck he would get the next day to buy test strips for his son to tide him over until Abbott's supply arrived.

How they would fare under McCain.

Neither father nor son would fare well under McCain's proposals. Bell the elder would have to pay taxes on the value of his health insurance benefits. Economists argue that removing the tax exclusion for employer-provided benefits is a move toward equity, since the exclusion now favors highly paid people who get rich benefits. Equity or not, Bell would have to find the money to pay the extra taxes on an income that hardly covers the essentials. In exchange, he would get a $2500 tax credit to buy his own coverage, as an incentive to leave the county's health plan.

The flat tax credit would favor younger people, enabling them to buy more coverage; policies in the individual market cost less if you are young. Using the credit, Bell might be able to spend less on premiums for an Arkansas Blue Cross Blue Shield policy with a $1000 deductible and 20 percent coinsurance -- if the carrier would insure him at all and if it didn't tack on a 50 percent surcharge for having high blood pressure and being overweight (as measured by the insurer). Under McCain's scheme, insurers would not have to cover people who are already sick.

Bell the younger would have the same problem. Even with the $2500 tax credit and additional federal subsidies, most likely he would still be uninsured. His diabetes makes him uninsurable. McCain proposes putting people like him in a special high risk pool for the sickest of the sick, where premiums would be sky-high and benefits may be limited. Without an income to pay the premiums required by the high risk pool, or very generous subsidies, it's hard to see how this would be much of an option. Bottom line: James Bell IV would still have troubled getting needed care.

How they would fare under Obama.

Neither father nor son would be required to buy insurance. The elder Bell could keep his coverage, which will probably get more expensive. Although Obama has promised that he would lower the cost of premiums by $2500 for the typical family, health analysts dispute whether this is achievable. Obama talks of a public plan option: Medicare-like coverage that people could choose instead of buying from commercial carriers. Whether this option will be cheaper depends on who provides the coverage.

If the government offers the benefits, as it does for Medicare, it's possible that Bell's premiums and other out-of-pocket expenses could be lower. There would also be a uniform comprehensive benefit package. If private insurers, with their high marketing and administrative costs, offer the benefits, then it's not clear which option would be preferable. Too much is unknown, and, as the Democratic Party's platform notes, all this will be thrashed out in the legislative process anyway.

Bell the younger has a shot at getting the consistent, ongoing care so necessary for diabetics. Under an Obama plan, he might be able to choose coverage in the public plan, assuming subsidies that are high enough to cover the premiums. If by some chance the legislative sausage grinder turns out a provision for automatic enrollment in existing public plans, like Medicaid or the State Children's Health Insurance Program (SCHIP), he would qualify, giving him fairly comprehensive benefits and a way to pay for care. All this assumes, of course, he can still pay the modest copayments that would likely be required, and that the federal government offers the states enough funding to provide additional coverage for currently ineligible people like Bell the younger.

If a public program doesn't come out of the legislative give and take, or if insurers are successful at maintaining their ability to turn away bad risks like Bell, he might remain uninsured, relying on his dad to pay the doctors and Abbott Laboratories to give him the test strips.

Trudy Lieberman - Part 1 September 15 - Part 2 September 22, 2008

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Submitted by SadInAmerica on Thu, 09/25/2008 - 2:29pm.