Curing our sick system

The need to reform our health care system is pressing and has been neglected for too long; the next president must act.

John Sharkey

Pennsylvania, unsurprisingly, told us nothing. The Democrats are no closer to choosing a presidential nominee; Sen. Hillary Clinton won, but not by enough to make any serious dent in Sen. Barack Obama’s lead. Although we still don’t know who will be facing Sen. John McCain in the fall, we should be giving thanks for a relatively unnewsworthy primary – it gives us the chance to actually stop and consider substantive issues instead of indulging in mindless horse-race election coverage. For example, we can talk about health care.

Health policy has faded somewhat from the campaign over the past few weeks. The Democratic candidates started sniping at each other, and McCain has just been sitting back and hosting barbeques for his friends in the press. We can’t afford to let the issue fade from sight. Some of the numbers are especially grim. More than 40 million Americans do not have health insurance. In areas throughout the south and lower Midwest, life expectancy for women is actually dropping. The problem is, of course, largely class-driven: being born to the highest socioeconomic class means an average lifespan 4.5 years longer than someone from the lowest class.

Perpetually failed presidential candidate Dennis Kucinich is fond of saying that “we’re already paying for a universal standard of care – we’re just not getting it.” On this front, Kucinich is actually correct. Compared to the other developed countries, we spend an obscene amount of money on health care. The United Kingdom, for example, spends 8.3 percent of its gross domestic product on health care. We spend 15.3 percent. We spend more than $6,000 per person each year. Countries like France and Sweden spend about half of that. Our health outcomes are no better than any of the other developed countries, and in some areas (like heart disease and infant mortality) we fare significantly worse. Our system, quite simply, is broken.

Various individual states (like Massachusetts and Tennessee) have attempted to fix the problem on their own, but state-based efforts are doomed to fail. It comes down to simple budgetary realities: during economic downturns, the state-funded health care plans become more important than ever. Unfortunately, those same hard times driving people to the health care plan also mean that the state is collecting less revenue. That leads to budget cuts and the end of the program. Any solution must be implemented on a national level to ensure long-term viability.

Of course, health care is about more than just money. After all, we would spend quite a bit less on health care if nobody lived past the age of 30. Good health care will often cost more simply because people live longer. But our situation is so far out of whack that we can manage to both save money and improve the quality of care. Doing so will require a fundamental reorganization of our health care framework, and national leadership with the political will to push reform through to the end.

Some of the presidential candidates have shown willingness to fight for the necessary reform; others are named McCain. The Republican nominee’s plan for “fixing” health care is rather pathetic. McCain seems to believe that the fundamental problem with our health care system is that people use it too much. The centerpiece of his proposal is an end to the employer-based health care system (which is actually a good idea) coupled with a new $2,500 tax credit to each citizen; families receive a $5,000 credit. People can then save any of the money they do not spend on health care. That would lead to people buying health care with high out-of-pocket deductibles, meaning people would then go to the doctor less often. Ezra Klein of “The American Prospect” sums up the McCain plan as being “like if I tried to make food cheaper by encouraging you to diet.” Like most of McCain’s domestic platform, it’s difficult to tell if he doesn’t understand the issue or if he just doesn’t care. Spending $2,500 per person would obviously slash our health care costs, but with the unfortunate side effect of creating an unhealthy population. That’s real Straight Talk.

Both Democratic nominees fare far better on the health care front. Clinton and Obama’s plans both call for community rating (charging all people the same amount for health insurance, instead of charging different amounts based on your health history) and require insurance companies to provide coverage to everyone regardless of pre-existing conditions. These are both vital changes, because one of the keys to long-term health care success is the ability to spread risk and cost out as broadly as possible. The average cost may be $6,000, but that includes the person getting the $30,000 surgery and the person who hasn’t been to a doctor in five years. Spreading the risk and cost makes it possible to cover everyone against the worst while still making the plan affordable enough to work.

Various details of the Obama and Clinton plans differ, but the starkest contrast is over the issue of mandates: Clinton’s plan requires every person to enroll in a health insurance plan, while Obama’s does not. Here, Obama misses the mark. Numerous studies (like one recently published by the Urban Institute called “Do Individual Mandates Matter?”) have shown that required enrollment is the only way to make the system work; otherwise, the system ends up overloaded with expensive patients with no relatively healthy citizens to help spread the risk. Cost containment becomes impossible.

More important than the specific plans of the candidates, though, is a willingness to push for reform. Indeed, Congress is already laying the groundwork for post-Bush reform. The Healthy Americans Act, co-sponsored by Democrat Sen. Ron Wyden and Republican Sen. Bob Bennett, is an excellent plan that would guarantee coverage to every American while freeing health insurance from employment. Ultimate legislative success, as Bill Clinton learned in the early 1990s, requires strong Congressional partnerships and a willingness to work with senators and representatives to forge a politically acceptable bill. Change is always difficult, and health care has been famously hard to reform. With an open-minded Congress and a president willing to press the issue, we may be able to finally fix our malfunctioning system. We (literally) can’t afford to let that chance get away.

John Sharkey welcomes comments at [email protected]