At the New England Journal of Medicine, Dr. David Blumenthal reviews McCain's healthcare plans - and finds the same old Republican "I'm alright,
October 18, 2008

At the New England Journal of Medicine, Dr. David Blumenthal reviews McCain's healthcare plans - and finds the same old Republican "I'm alright, Jack" philosphy. (h/t Avedon)

John McCain emerges not as a maverick or centrist but as a radical social conservative firmly in the grip of the ideology that animates the domestic policies of President George W. Bush. The central purpose of President Bush's health policy, and John McCain's, is to reduce the role of insurance and make Americans pay a larger part of their health care bills out of pocket. Their embrace of market forces, fierce antagonism toward government, and determination to force individuals to have more "skin in the game" are overriding — all other goals are subsidiary. Indeed, the Republican commitment to market-oriented reforms is so strong that, to attain their vision, Bush and McCain seem willing to take huge risks with the efficiency, equity, and stability of our health care system. Specifically, the McCain plan would profoundly threaten the current system of employer-sponsored insurance on which more than three fifths of Americans depend, increase reliance on unregulated individual insurance markets (which are notoriously inefficient), and leave the number of uninsured Americans virtually unchanged. A side effect of the McCain plan would be to threaten access to adequate insurance for millions of America's sickest citizens.

The main purposes of Mccain's plan appears to be to dump more money into private health insurer's coffers and enable insurers to dump bad risks (those currently covered but paying high premiums) onto the State by making insurance unaffordable for them:

In the individual market, administrative costs consume 30 to 50% of premiums, as compared with 12 to 15% in the large-group, employer-sponsored insurance market. The McCain plan, therefore, could cause administrative waste to skyrocket. Because of these high administrative expenses, and because insurers want to avoid sick people, individual health insurance tends to be less generous than employer-sponsored plans, requiring higher deductibles and copayments and offering less coverage of preventive and catastrophic care. Perhaps most worrisome is that many chronically ill patients who lose employer-sponsored coverage will have trouble finding any insurance at all in the individual market. The McCain plan calls for deregulating private insurance markets — eliminating, for example, state requirements that insurers offer plans to persons with preexisting conditions.

To counter these side effects, McCain will offer a $2,500 tax credit for individuals and a $5,000 tax credit for families to help them purchase health insurance. But consider the math. The average family policy in the United States now costs about $12,000, of which the average employer contributes about 75% ($9,000). Thus, if they could find comparable insurance in the individual market, that coverage would cost families losing employer-sponsored insurance $4,000 more than they previously paid ($9,000 minus $5,000). Many of these families will enter the ranks of the uninsured.

All those new uninsured would join the ranks of those who wait until their health problem becomes an emergency and then head to EMS, increasing the cost of their care dramatically and leaving many unable to pay - at which point the State picks up a huge bill which could have been far lower if it had only been the healthcare provider in the first place.

The choice facing health care professionals, like all Americans, is basic: Who deserves to be trusted with the stewardship of America's health care system? The McCain proposal violates the bedrock principle that major health policy reforms should first do no harm. It would risk the viability of employer-sponsored insurance and the welfare of chronically ill Americans in pell-mell pursuit of a radical vision of consumer-driven health care. Senator McCain's plan does not demonstrate the kind of judgment needed in a potential commander in chief of our health care system.

Blumenthal is an unpaid Obama campaign adviser, so he's certainly biased - but the situation is actually worse than he admits. Not only is McCain's healthcare plan a disaster, but so is Obama's - although one on slo-mo - because there is no long-term viability in employer-sponsored health insurance. Companies and corportations are collapsing under the weight of such schemes. It';s significant that in 2004 big auto manufacturers begged Canada to keep its national healthcare system, so they could keep their own costs down and saty in business across North America. In 2003, GM spent $4.5 billion on health care for its US- based employees and retirees, at a cost of $1,200 per car, according to a GM spokesman. "If we cannot get our arms around this [healthcare] issue as a nation, our manufacturing base and many of our other businesses are in danger," warned Ford's Vice Chairman Allan Gilmour.

But the correct alternative to pick is a national health service, which could be funded at a level of 11% of GDP, higher than that of any other Western nation, without a single tax raise - if only insurance company profits and beaurocracy weren't sucking all the good out of the system. Dr. Steffie Woolhandler, co-author of a 2001 study and an Associate Professor of Medicine at Harvard, put it best:

We pay the world's highest health care taxes. But much of the money is squandered. The wealthy get tax breaks. And HMOs and drug companies pocket billions in profits at the taxpayers' expense. But politicians claim we can't afford universal coverage. Every other developed nation has national health insurance. We already pay for it, but we don't get it.

Deborah Burger, President of the California Nurses Association, says that in a supposedly civilized nation healthcare should be a right, not a responsibility:

Crossposted from Newshoggers

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