Remember Health Care? It's Still a Problem

With two excellent Democratic candidates left, there has been some fear that our party would emulate Republicans and run our nomination process to maximize the probability of actually winning the presidency. So in the last month or so we have formed a circular firing squad to avoid the risk that such a win would sully our quest for personal and ideological purity.

It's hard to avoid killing each other in a tough nomination fight, but it's worth remembering that the differences between Senators Obama and Clinton are dwarfed by their differences with John McCain, and that a Democratic victory in November would change millions of people's lives for the better. It seems that we've stopped talking about this stuff lately.

I was reminded of this at a recent event at Northwestern University's Feinberg School of Medicine, in which emissaries from the various political camps discussed our different approaches of healthcare reform. I was ready to offer the familiar defenses of the Obama plan against charges leveled by Senator Clinton and her supporters. As it turned out, Senator McCain was the only other candidate represented there. So my beautiful Powerpoint slides were made somewhat moot.

The McCain representative argued six broad points:

(1) The problems of the uninsured are vastly overstated, and in any event are not getting worse.
(2) The United States has the best healthcare system in the world, while
(3) People in Canada, France, Germany, and other wealthy democracies are trapped in systems of rationed socialized medicine akin to a stereotyped image of the British National Health Service, circa 1952.
(4) That the Democrats are pushing for nanny-state solutions that emulate the highly rationed and inefficient models mentioned above.
(5) That innovations such as medical savings accounts would greatly improve our health care system by placing greater financial and decision-making responsibility on individual patients and their families.
(6) That a $2,500 federal tax rebate for individuals and $5,000 per family (to replace current federal tax benefits for health coverage), along with unspecified requirements on "any state receiving Medicaid to develop a financial 'risk adjustment' bonus" [See here] will ensure access to coverage among low-income families and individuals with pre-existing conditions.

He is a good guy, but he presents a crazy vision of what's wrong with our healthcare system. I believe that all six of the above points are wrong. To recapitulate some high points:

The problems faced by 47 million uninsured people (and millions more who are underinsured) are a national disgrace. Despite spending $2.1 trillion, we do not treat people decently. We leave almost 20 percent of our population uncovered, thus allowing our urban medical and public health infrastructures to buckle under an unsustainable financial load.

Our nation scores very poorly on international rankings of health system performance and public health. Although we have many excellent providers, many excellent technology, and spend tons of money, our financial and oversight systems are a mess. Considering what we have to work with, our healthcare system is decidedly mediocre.

Although American health care includes countless "market failures" and inefficiencies, there is little evidence that greater reliance on market solutions would address the worse problems we face. Many of our financing and access problems are actually predictable outcomes of a competitive insurance market, particularly in the market for individual health coverage.

The tax credits promised under the McCain plan don't come close to what is required to provide even minimal coverage to many low-income families, let alone those facing significant medical concerns. A vague requirement on states to address the problem is hardly a plan.

I realize that I'm making bullet-point arguments here on a range of complicated subjects. If you are reading Huffington Post, you probably already agree with me. If you are a health services researcher, you can probably cite trainloads of studies that refute the main arguments behind the McCain plan.

Every leading Democrat this year argued that our nation has a responsibility to seek universal coverage, to provide significant public resources to help low-income families buy health coverage, to reform insurance markets to forbid firms from discriminating on the basis of pre-existing conditions.

Whatever voters believe about Reverend Wright, Geraldine Ferraro, Governor Spitzer's sex life, and whatever else comes along, most Americans agree with us on this one. Most people hope that our next president will do something effective that helps the millions of people who can't afford health coverage.

We've stopped talking about the important stuff lately. Perhaps this is understandable since both Senator Clinton and Senator Obama have ambitious health plans and because a few other things have come up. It's still unfortunate, because we have more in common with each other than we do with Senator McCain, who is now getting a free ride.

I, for one, can't wait for this nominating contest to end, so we can turn our political firepower on our actual opponent instead of each other. Every day we are bogged down in campaign ephemera, many thousands of Americans are failing to get needed care, falling into medical bankruptcy, or are losing health insurance coverage. We need to put the focus back on that as soon as possible. If Americans seriously consider which party has the better plan to achieve universal coverage, we'll do alright come November.