A Healthy Choice

As far as John Bartimole is concerned, neither Sen. John McCain, R-Ariz., nor Sen. Barack Obama, D-Ill., has done a good job explaining to the voting public their specific ideas for addressing the nation's health care problems should they be elected president next month.

Bartimole, who is the executive vice president for the Western New York Healthcare Association, a regional health care advocacy group that represents more than 550 health care organizations throughout New York, said the candidates have instead given voters a ''very broad-strokes'' idea of their plans. And, he said in an interview Tuesday, that's not enough.

''I think both candidates have some good ideas,'' he said. ''The trouble is that the proposals from both candidates have some very steep challenges to overcome. Whether or not those challenges can be overcome is the real question. 'The devil is in the details,' as they say, and it's no different where presidential campaigns are concerned.''

UNIVERSAL HEALTH COVERAGE

Bartimole pointed out that Obama is more likely than McCain to push for ''some kind of universal coverage.'' But if the nation's next president moves America toward a ''single payer system like the one Canada has,'' the country's health care sector could face what Bartimole called ''enormous challenges.''

''The reality in America is that we don't have a national health care system,'' he said. ''We've got a variety - every system is different. Every insurance company is different. You honestly don't know what coverage you've got until you find out what you don't.''

If America moved toward a system that excluded already-established insurance companies, Bartimole said, ''imagine the number of lost jobs.''

''Besides, the government has historically been unable to prove that it's good at managing things,'' he said.

By contrast, McCain has said he wants to implement a program through which citizens would receive a direct refundable tax credit of $2,500 for individuals and $5,000 for families to offset the cost of insurance.

''McCain does plan on taxing health care benefits,'' Bartimole said. ''Where does that leave citizens?''

TECHNOLOGY UPGRADES

For both candidates, technology upgrades are cornerstones of their plans. Obama wants to invest $10 billion a year over the next five years to move America's health care system toward ''broad adoption of standards-based electronic health information systems, including electronic health records.'' McCain, by contrast, said he would make greater use of information technology to reduce costs by ''promoting the rapid deployment of 21st century information systems and technology that allows doctors to practice across state lines.''

While Bartimole called such support for technological advances ''admirable,'' he pointed out that it would leave smaller, independent health care providers ''in the dust.''

''It would be absolutely wonderful if all we had to do was take out a little card and swipe it to give our doctor access to all of our health records and information,'' Bartimole said. ''However, the problem is the independent physicians who have already made an enormous investment in technology. I'm certain many hospitals are making use of electronic health records, but what about the little guys? What would they do? ''

Bartimole also said electronic records present another problem - across-the-board compatibility.

''How can the smaller health organizations and independent physicians keep up with the newest version of software? That's a huge concern, especially when one considers that the majority of health records in this country come from primary care physicians,'' he said. ''What happens if some organizations use software that's no longer compatible with the new software used by the hospitals and bigger organizations? Would information be lost?''

PORTABLE HEALTH COVERAGE

Obama and McCain both have said it's important for citizens to have portable health insurance, or insurance policies they can take from job-to-job as opposed to the current system, which forces citizens to sign up for the insurance policy their company uses.

''That's wonderful in concept,'' Bartimole said. ''But keep in mind that we do not have a single-payer system like Canada does. That means the insurance companies would have to buy into the concept, which may be easier said than done.''

If insurance companies did buy into the idea of ''portable'' health insurance policies, Bartimole said they would ''almost be required to make re-existing conditions insurable.''

''It's not your fault if you were sick before you got onto the 'portable' health insurance policy,'' he said. ''But again, the insurance companies would have to buy into that. Eventually, health care in America is going to need some universal principles.''

AT THE CRISIS POINT

Had the nation's economy not worsened so badly, Bartimole said it may well be one of the most important campaign issues. But, as a recent study released by the Kaiser Family Foundation suggests, health care and the economy are inextricably linked.

When tough economic times hit, most Americans change their spending habits. They might not purchase lattes every morning or eat out as often. But the foundation's study found that a growing number of Americans are delaying trips to the doctor, skimping on medicine and putting off preventative screenings such as mammograms.

''Health care is now every bit as much an economic issue for the American people as it job insecurity, mortgage payments and credit card debt,'' said Drew Altman, the foundation's president and CEO. ''Our survey suggests that medical bills are a real issue for a lot of families. People have reported there are times they neglect taking care of their health problems.''

Between Oct. 3 and Oct. 13, the foundation randomly polled 1,217 adults over the age of 18, including 1,115 who are registered to vote. The poll has a margin of error of plus or minus 3 percentage points.

Thirty-six percent of those polled said they postponed getting necessary health care, up from 29 percent who were asked the same question in April. Thirty-one percent reported skipping a recommended medical test or treatment while 27 percent left prescriptions unfilled and 22 percent cut pills or skipped doses.

''In the voters' minds, the financial meltdown has not displaced the need for health reform,'' Altman said.

Sixty-two percent of those polled say it is more important than ever to take on health reform now. The foundation's poll found an interesting partisan gap amongst those polled - Democratic and independent voters said health care reform is more important now than ever, while more than half of the Republican voters polled said health care reform shouldn't be addressed now.

Amongst those who were polled and registered to vote, 50 percent said making health care and health insurance more affordable is the most important health care issue, while just 23 percent said expanding health insurance coverage for the uninsured is the most important health care issue.

MCCAIN'S PLAN

The cornerstone of the McCain-Palin health insurance plan is the idea that increasing government control of health care is not the best way to help small businesses and employers afford health care. Instead, McCain says on his Web site, it's best to ''bring the rising costs of health care under control and give people the option of having personal, portable health insurance.''

A centerpiece of the McCain-Palin plan is a fundamental change in the way health premiums paid for by employers are taxed. Currently, the amount a company pays for health premiums is not counted as personal income for tax purposes. McCain's plan will tax those amounts for the individual in an effort to make the consumer indifferent between taking the company plan or shopping for an outside health insurance plan.

McCain and Palin would also implement a flat tax credit of $2,500 for individuals and $5,000 for families. For people with employer-sponsored plans, McCain has said his tax credit would be used to offset the increase in reported wage income. For those with private health plans, the tax credit would represent relief for the insurance they're already buying. For the uninsured, McCain hopes the tax credit would be an incentive to purchase health insurance.

According to their campaign Web site, www.johnmccain.com, McCain and Palin would work with state governments to create what they call ''a guaranteed access plan.''

Called a ''best practice model,'' the Guaranteed Access Plan would reflect the best experience of the states to ensure patients have access to health coverage. McCain and Palin propose establishing a non-profit corporation that would contract with insurers to cover patients who have been denied insurance and could join with other state plans to enlarge pools and lower overhead costs. Assistance would be available for citizens who are under a certain income level and limits would be imposed on premiums.

McCain and Palin have said they want to ''bring greater competition to drug markets through 'safe reimportation' of drugs and faster introduction of generic drugs.'' They have proposed placing an emphasis on prevention, early intervention, healthy habits, new treatment models, new public health infrastructure, smoking cessation programs, and the use of information technology to help lower health care costs.

They would also promote what they call ''coordinated care'' - an effort to make health care providers collaborate on how to produce the best health care and offer better outcomes at lower costs.

''We should pay a single bill for high-quality disease care which will make every single provider accountable and responsive to patient needs,'' McCain said on his Web site.

One of McCain's proposals would reform the payment systems used by Medicaid and Medicare to ''compensate providers for diagnosis, prevention and care coordination'' because ''Medicaid and Medicare should not pay for preventable medical errors or mismanagement.''

McCain and Palin would also work to pass medical liability reform that ''eliminates lawsuits against doctors who follow clinical guidelines and adhere to safety protocols.''

More transparency in health care costs would be required under a McCain-Palin administration. Their proposal would require transparency regarding medical outcomes, quality of care, costs and prices. A McCain-Palin administration would also work to ''facilitate the development of national standards for measuring and recording treatments and outcomes.''

OBAMA'S PLAN

The cornerstone of the Obama-Biden health insurance plan is the creation of a government-sponsored health plan for uninsured Americans. Similar to the plan provided to federal employees and members of Congress, the plan would provide guaranteed eligibility for those with pre-existing conditions.

Those who participate in the new public plan and the National Health Insurance Exchange that Obama and Biden would create would be able to take their insurance plan with them from job-to-job.

The National Health Insurance Exchange would help individuals who want to purchase private insurance plans. It would act as a watchdog group that would help reform the private insurance market by creating rules and standards for participating.

By ''cutting waste, improving technology, expanding coverage to all Americans and paying for some high-cost cases,'' Obama and Biden say their plan will save ''a typical family'' up to $2,500 on premiums. By ''reducing health care costs,'' they say their plan will save employers $140 billion per year.

Individuals and families who do not qualify for Medicaid or the State Children's Health Insurance Plan, or SCHIP, but who still need financial assistance, would receive an income-related federal subsidy. That money could be used to buy into the new government-sponsored health plan or purchase a private health care plan.

The Obama-Biden plan would create a ''pay to play'' system that would force employers who do not provide employer-sponsored health insurance plans to contribute additional payroll taxes to the government-sponsored health plan.

As an incentive, small businesses would get tax credits to offer employer-sponsored plans to employees. Such businesses would get a refundable tax credit of up to 50 percent on premiums paid on behalf of employees. That provision was added to Obama's plan as a compromise to supporters of Sen. Hillary Clinton after she ended her campaign.

Under the Obama-Biden plan, Americans would be able to purchase medicine from other developed countries. It would become mandatory to provide health insurance to children, and the number of health insurance options for young adults would be expanded. Eligibility for Medicaid and SCHIP would be expanded.

Over the next five years, Obama and Biden say they would invest $10 billion a year to move America's health care system to what they call a ''broad adoption of standards-based electronic health information systems, including electronic health records,'' while ensuring patient privacy is protected.

Obama and Biden also say they will repeal the ban preventing the federal government from negotiating with drug companies, which they say will result in as much as $30 billion in savings.

When fully phased in, the Obama-Biden plan will cost between $50 billion and $65 billion per year.

According to their campaign Web site, www.barackobama.com, Obama and Biden say their plan will be paid for by the ''tremendous savings'' that will be realized within the health care system. They also say the money for up-front investments in technology and to help those who cannot afford health insurance is ''more than covered'' by allowing ''the Bush tax cuts'' to expire for people making $250,000 per year.

Member Comments

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Aaron1

10-26-08 7:00 AM »Report Abuse

Where the candidates stand on Health Care should only be relevent as to their basic philosophy of government for this great nation. No where in our Constitution is the Government in anyway responsible for providing the citizens health care or health insurance. Health care and the associated costs are too expensive at the present time simply because the GOVERNMENT folks have created a blizzard of paperwork which eats up at least 1/3 of our total costs. Without the paperwork, our system would be fine; and if you think the government needs to be involved simply think "KATRINA".

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