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Traction in the Health Care Debate

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Growing voter concerns over the financial crisis are closely connected to worries about health care. The latest Institute for America's Future Op Ed ad in Tuesday's NY Times links the two issues directly, with the headline: WILL WE LET CONSERVATIVES DO TO HEALTH CARE WHAT THEY DID TO BANKING ? As voters feel the economy go into a tailspin, they join the millions of Americans already fearful they will lose their jobs and their health coverage.

Conservatives generally ignore health care, but now all politicians are forced to say something. In just the last few several weeks, the national media have finally started to cover the stark differences between John McCain and Barack Obama on health care. And it took some active education to get them to report the story.

In early September, I started to give reporters and columnists a heads up that an important new analysis by four prominent economists was to be published September 16 in the journal Health Affairs demonstrating that John McCain's proposed cure for the health crisis might actually worsen the disease. As NY Times columnist Bob Herbert summarized, in a piece published that day and widely syndicated, "A study from scholars at Columbia, Harvard, Purdue and Michigan projects that 20 million Americans who have employment-based health insurance would lose it under the McCain plan."

At a health care event at Democratic Convention, I introduced Health Care for America Now Executive Director, Richard Kirsch, to Paul Krugman (columnist, blogger and now this year's Nobel Laureate in economics). Shortly thereafter Richard came across an unnoticed McCain quote and shared it with Krugman, who on September 19 shared it with the world on his blog:

A correspondent directs me to John McCain's article, Better Health Care at Lower Cost for Every American, in the Sept./Oct. issue of Contingencies the magazine of the American Academy of Actuaries. You might want to be seated before reading this. Here's what McCain has to say about the wonders of market-based health reform:

Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.

So McCain, who now poses as the scourge of Wall Street, was praising financial deregulation like 10 seconds ago -- and promising that if we marketize health care, it will perform as well as the financial industry!

In late September the EPI Policy Center produced a new report , by economists Josh Bivens and Elise Gould, which used a new methodology to confirm that 19-20 million people nationwide would be dropped from coverage by employers if the McCain plan were passed. Then, in early October, Health Care for America Now! (with the help of AFSCME, SEIU and the Center for American Progress Action Fund), released state-level versions of the EPI report in most states, generating press coverage and grass-roots public discusion. A sample headline: Under McCain Health Plan 344,991 People in Colorado Would Lose Employer-Sponsored Health Coverage. To see the numbers for your state, click here .

After a lot of work on the part of a growing health care movement, the country is now debating John McCain's radical agenda - and progressive alternatives. The global financial crash of the past few weeks has hammered home what should be common sense: a free market needs reasonable rules that safeguard the public interest. When you unshackle corporations and put the cops who would police them in handcuffs, ultimately everyone loses in the ensuing chaos.

As IAF's Tuesday, October 14 Op Ed ad in the New York Times points out, despite their spectacular "free market" economic failure, conservatives are still trying to use that recipe for disaster to reform an already failing health-care system. 116 million Americans are either uninsured, or under-insured, or financially vulnerable to unexpected medical costs --now the #1 cause of family bankruptcies. Those who have insurance are paying higher costs for policies that often have gaping holes in coverage. And insurance companies flat-out refuse to sell coverage to those already sick. And businesses, large and small, are burdened with rising costs.

Politicians are now debating solutions. But conservatives have taken their ideas off the shelf of right wing think tanks. Instead of working to guarantee health care for those without insurance, they want to tax the health benefits of the 160 million people who get insurance on the job - even though they acknowledge this would gradually dismantle the employer-based health care system. The EPI Policy Center and other experts calculate 20 million would lose coverage pretty quickly. These conservatives actually believe that group health insurance, provided by employers, encourages people to use too much medical care, driving up costs. Instead, they want all of us to buy insurance policies directly from private insurance companies. And they believe in this theory so strongly, they would also let those companies sell policies across state lines, effectively wiping out the minimal state regulations which require companies to do things like cover pregnancies and certain tests - or, in the best states, to cover people with pre-existing conditions.

Imagine a health-care system in which businesses decide to opt out of providing policies for their employees. Workers would instead search for policies in an environment in which costs aren't constrained by the bargaining power of employers and in which insurance companies would do just what banks have done--set up shop in the states that would allow them to operate with the fewest constraints.

For most people, this sounds like more of the same. US health care has never been heavily regulated, compared with other countries. But dismantling the one part of our insurance system that sort of works forcing everyone to buy health insurance on their own hardly seems a step forward for most people.

So what's the alternative? We believe that quality, affordable health care should be a right. A person's ability to get health care should not dependent on their ability to bargain in the free market, where only the strong survive. As we say in the ad, we need clear rules requiring private insurance companies to cover everyone--even those with pre-existing conditions. And we need the security of knowing we can keep our current health plan, or we can choose a public plan like Medicare, so we're not at the mercy of the same profit-driven companies that got us into this mess!

The United States spends more for health care, and gets less for its money, than any industrialized nation. Our enormously wasteful and chaotically organized system is a drag on our global competitiveness as well as a drain on our wallets. Still, the millions of dollars the insurance and pharmaceutical industries spend on lobbying and political contributions have only served to prop up a failing system and drown out the voices for change. The silver lining in the economic shock we've experienced is that the country may be more ready than ever to contrast the false promise of an unregulated market with a bold, progressive approach that extends health care to every American.

The Institute for America's Future is a member of Health Care for America Now , the nation-wide campaign for health care for all. IAF's ad invites everyone to join the debate about health care. We are challenging the misguided power of the insurance and pharmaceutical industries. And we are building a people's movement to shape a health care system that works for all of us. We invite you to join us.


6 Comments

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I think McCain's plan is a poor one for a lot of reasons (mostly because it does nothing to help the uninsured), but I am puzzled about how it costs employers more. Employers' health care costs are currently tax-deductible expenses and as far as I can see that won't change. The taxes are actually levied on the employee in McCain's plan, at least as far as I understand it. Right now, the tax code allows you to get contributions from your employer tax free (rather than treating those contributions as income) and it allows you to use pre-tax money to make your own contributions to your employer-sponsored plan. So the full contribution (employee and employer) is not taxed as income to the employee. As I understand it, McCain's plan ends that tax deduction so the employee, not the employer, will have to pay income (and maybe FICA) taxes on the amount of their own and their employer's contributions to their health care coverage.

I guess it's possible that McCain is going to tax the earnings of trust funds that self-insured employers use to fund health care expenses. But I haven't heard that yet.

Can someone please clarify?

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I ask this, by the way, because if the tax cost is all on the employee side, employers won't necessarily drop coverage. Instead employees will drop out because they can't afford their employer's plan once the tax break is taken away. This is insidious, because it makes it look like employers are providing benefits but employees are just opting out willingly, rather than being forced out by the cost.

I should note, that for most employees, though, a $5,000 tax refund would more than cancel out the tax cost (which would typically be around $3,000), at least in the first few years. The question is when that tax refund would be given to employees. If it were given at the end of the year, employees might still not be able to afford their coverage.

For people without employer coverage, a $5,000 credit won't be very helpful unless it's $5,000 per person ($10,000 for a family)--and even then, it's borderline whether it will help since reasonable private plans are often significantly more expensive than comparable employer-sponsored plans. If the employer plan is $12,000, the private plan may well be in the $20,000s.

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As a candidate McCain needed some sort of statement in respect to health care and health insurance. And thus, we are introduced to "John McCain's Vision for Health Care Reform."

Tactically, McCain's campaign opponents are surely right to point out that his vision would be better described as a nightmare and to do their best to force him to defend it. The upshot will be a demonstration that health care reform is not something McCain takes seriously.

But from a practical viewpoint the plan hasn't a snow ball's chance in hell of getting out of Committee let alone being voted upon. And absent the threat of it ever being enacted, McCain's plan just doesn't seem likely to generate an interesting public policy discussion.

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Please sign the Health Care for America Now petition on Progressive Future's website that tells our new President and the new Congress that we want health care to be a top priority for 2009.

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Conservatives acknowledge that this will dismantle the system and yet they press on! The ultimate in theory overwhelming practice. This oughtta consign them to history's dust bin!

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Maybe the GOP figured Mccain was going to lose anyway so they let him come up with this utter turkey of a plan which could only please a handful of think tank wingnuts? I thought the GOP had marked well the lesson of 1994: do not threaten people's existing healthcare in any way whatsoever. The Democrats figured that out this year and all their healthcare reform plans were careful not to threaten any disruption of what people currently have. Moreover the McCain plan is not even pleasing to the big insurers who like group plans and would have to change their business models enormously if group plans went away. Only a handful of piranha insurance companies (like the former Godlen Rule) favor a plan like this, since they are skilled at cherry-picking and hate group plans, and would pick up a lot of young and healthy customers from the big insurers this way.

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