Doctor on presidential campaign: Prognosis poor for healthcare reform

by Jordan Green

The fellowship hall at Holy Trinity Episcopal Church in Greensboro was substantially full on a recent Tuesday as members of the League of Women Voters of the Piedmont – mostly retired or winding down careers, generally liberal in political orientation, and not exclusively women – dined on gumbo and cold-cut sandwiches while listening to a longtime doctor and professor diagnose the US healthcare system.

“Our healthcare system’s too expensive, too dehumanized, too technically complicated and not sufficiently patient centered,” said Dr. Timothy Lane, a professor at UNC-Chapel Hill and former chief of Moses Cone Memorial Hospital’s internal medicine program. “We’re in enormous disarray.”

He described two poles of thought in healthcare delivery, leaving little doubt which one he favored.

One philosophical school views healthcare as a capitalistic good to be traded on the open market, Lane suggested, while the other describes it as a social good, guaranteed to all. Capitalist healthcare is based on the premise that when consumers have sufficient knowledge they are able to make rational decisions in weighing price against quality in the selection of options. Because of the urgency of personal healthcare needs and the complexity of medical practices, he proposed, consumers rarely have enough information to make timely and intelligent decisions about their healthcare.

“It’s very hard to get this to perform as a capitalistic good,” Lane said.

The hunger for political change, with a host of campaigns from president to county commissioner bearing down with unforgiving speed this year, was palpable in the room. Dr. Lane’s prognosis was not good.

“Although healthcare is right at the top of the priorities of the electorate, it’s not going to change after the election in November,” he said. “It’s so complex. It’s the third rail. Nobody’s going to address it until there’s a rising up… When a six-year-old child dies of a perforated appendix because he was unable to get timely treatment, I think then as a society we’re going to do something about it.”

In fact, a Gallup poll study released earlier this month found that a modest 13 percent of respondents rated the high cost and disappointing quality of healthcare as the most important problem facing the nation. That number has remained steady since July 2007 while a related concern about the economy has tripled from 6 to 18 percent over the same time period. Respondents pointed to the war in Iraq in greater number than healthcare, but fewer expressed concerns about immigration.

Lane characterized the United States as having the most dysfunctional healthcare system in the developed world, stating that $7,200 is spent annually per person on healthcare in the United States, compared to about $4,500 in Switzerland, which has the second most expensive system in the world.

“Most health insurance provided by private health companies is profit motivated and investor owned,” he said. “With private insurance, twenty to thirty cents on the dollar go to overhead, marketing and management. With Medicaid, three cents on the dollar goes to overhead, promotion and management. It’s a much more efficient arrangement.”

Lane told his audience: “We have the best healthcare system in the world.” He quickly added, “That’s a statement you could get away with six or seven years ago. Now, if you said that in a hall, they’d laugh you out of the room.”

One Republican candidate for president, whose standing in the national polls has tumbled since the Iowa caucus and the New Hampshire primaries, does say that. On a heavily edited video posted to his campaign website, Rudy Giuliani, the former mayor of New York, champions the United States’ healthcare delivery system utilizing a network of private insurers supplemented by limited government programs for the poor and elderly in exactly those words.

Giuliani, like Republican rival John McCain, favors giving individuals and families tax deductions, which they would be encouraged to invest in private health insurance, Giuliani’s plan being the more generous of the two.

McCain’s healthcare platform emphasizes consumer choice and promoting competition among private insurers. Other proposals by the Arizona senator to pass tort reform to eliminate frivolous lawsuits against doctors and hospitals and to allow workers to carry health plans with them from job to job would seem to hold little promise for expanding and improving coverage.

Former Arkansas governor Mike Huckabee, capitalizing on the political season’s scarcely defined watchword of “change,” declares on his campaign website that “the healthcare system in this country is irrevocably broken” and promises “a complete overhaul.” In an offensive thrust against the Democratic field, he stakes out what changes he wouldn’t support: “We don’t need universal healthcare mandated by federal edict.”

Huckabee’s platform also promises a continued role for states and reinforces the capitalist model of healthcare. His website states, “I value the states’ role as laboratories for new market-based approaches.”

Former Massachusetts governor Mitt Romney’s healthcare platform explores variations on his fellow Republicans’ positions. He emphasizes personal choice and the role of the states in healthcare reform. He promises to expand and deregulate the private health insurance market, which he says will decrease costs and increase affordability, and to cap punitive damage awards against doctors and hospitals. He calls for making all healthcare expenses tax deductible and proposes transferring money spent on emergency-room care for the uninsured to vouchers to help the poor buy insurance.

The three candidates at the front of the Democratic pack all promise that their healthcare reform plans would cover all Americans, but none has pressed the issue as hard as former North Carolina senator John Edwards, who claims to have the only truly universal healthcare plan.

Publicly endorsed by Service Employees International Union president Andy Stern, Edwards’ plan promises to “cover every man, woman and child in America, and get better care at lower cost,” and indeed would require every American to be insured. Despite its stated universality, the Edwards plan leaves the current free-market, private-provider system intact. To accomplish this, the candidate has promised to fight the insurance companies, and reduce costs to consumers through government regulation. He promises to provide insurance at an affordable price for all families not currently covered by requiring businesses that don’t provide health insurance for to pay to do so and by creating new tax credits for families and individuals.

Taking a page from the Republican playbook, Sen. Hillary Clinton’s plan emphasized consumer choice.” So-called “working families” would receive tax credits to help pay their premiums, along with small businesses that provide health coverage to their employees. Her plan also contains an Edwards-style regulatory mechanism: Insurance companies would be prohibited from denying coverage to consumers with preexisting health conditions.

“If you’re one of the tens of millions of Americans without coverage or if you don’t like the coverage you have, you will have a choice of plans to pick from and that coverage will be affordable,” Clinton’s website states. “Of course, if you like the plan you have, you can keep it.”

Illinois Sen. Barack Obama offers a hybrid plan, borrowing from the Republican Party with a promise to increase competition among private insurers, while forcing insurers to pay out a “reasonable” share of premiums instead of “keeping exorbitant amounts for profits and administration.” Similar to Edwards, he would require employers that don’t provide health insurance to their employees to pay into a national fund. He would require all children to have coverage and expand the State Children’s Health Insurance program. He promises to “make available a new national health plan to all Americans” at some undisclosed time.

“If you already have health insurance, the only thing that will change for you under this plan is the amount of money you will spend on premiums; that will be less,” he told an audience in Iowa City, Iowa last May. “If you are one of 45 million Americans who don’t have health insurance, you will have it after this plan becomes law. No one will be turned away because of a preexisting condition or illness.”

The only candidate proposing a single-payer system in which taxpayers fund a government healthcare system that guarantees care for all is Ohio Rep. Dennis Kucinich. A long-shot liberal Democrat from Cleveland stuck in the single digits, Kucinich is the coauthor of US National Healthcare Act. Bearing a marked resemblance to Great Britain’s socialized healthcare, the proposed law would “establish Medicare for all – a universal, single-payer, not-for-profit healthcare system.” All individuals residing in the United States would be provided with free healthcare, including “all medically necessary care, such as primary care and prevention, prescription drugs, emergency care and mental health services.”

Private health insurers would be prohibited from duplicating benefits provided under the act, but would be allowed to underwrite benefits that are not medically necessary, such as cosmetic surgery. The system would be financed by increasing personal income taxes on the top 5 percent of income earners, by instituting a progressive excise tax on payroll and self-employment income, and by adding a tax on stock and bond transactions. The bill has been stuck in the House Health Subcommittee since February 2007.

“All three Democratic candidates are trying to expand access for people who don’t have coverage,” said Dr. Lane, the UNC-Chapel Hill professor. “Some of their plans are mandated. Mr. Obama’s is a little more conservative. The other side is saying, ‘We should have tax incentives so that you get that money and invest it in your own personal healthcare plan.’ The question is, ‘How much money do you get and when you get the money, what if the transmission falls out of your car? What are you going to do?'”

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