Report Rounds Up Health Issues In Election

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NPR's "Morning Edition" on Tuesday reported on the estimated cost of the health care proposal of Democratic presidential nominee Sen. Barack Obama (Ill.). The segment includes comments from Joe Antos, a health policy analyst at the American Enterprise Institute; David Cutler, an economist at Harvard University who helped develop the proposal; and health policy analyst Jeff Goldsmith (Rovner, "Morning Edition," NPR, 9/30).

In related news, American Public Media's "Marketplace" on Monday included discussions with employees at Ronald Reagan UCLA Medical Center about changes that they seek for the health care system under the next president. The segment includes comments from physicians, nurses and hospital CEO David Feinberg (Gardner, "Marketplace," American Public Media, 9/29).

Newsweek Interview

The Oct. 6 issue of Newsweek included an interview with Katherine Swartz, a professor of health policy and economics at Harvard University, in which she discussed the candidates' health care proposals.

According to Swartz, the proposal from Republican presidential nominee Sen. John McCain (Ariz.) -- which would replace a tax break for employees who receive health insurance from employers with a refundable tax credit of as much as $2,500 for individuals and $5,000 for families for the purchase of coverage through their employers or the individual market -- "would reduce favoritism in the tax system" but could "make it harder for low-income people to get insured." Under the proposal, "you have to purchase health insurance to get the tax credit, and low-income people still may not be able to do that," Swartz said. In addition, "the type of coverage on the individual market typically does not cover as many services as group policies," and U.S. residents with pre-existing medical conditions who purchase such coverage "are going to pay more out of pocket," she said. Swartz estimated that the proposal would cause about 21 million residents to lose health insurance in the first year and allow about 21 million higher-income residents to purchase coverage. "We worry that within five years, more employers would stop offering insurance, and we'd end up with more people uninsured than there are now," Swartz said.

Meanwhile, the Obama proposal -- which would establish a health insurance "exchange" that would allow residents to choose between private health plans and a public plan and also would require health insurers to accept all applicants, regardless of their health status -- would use an approach similar to one that has "worked very well in Massachusetts," Swartz said. In the event that the "national plan is quite generous in terms of services covered, the proposal's cost will be more than the campaign is estimating," she said. In addition, the requirement that health insurers accept all applicants would increase premiums, Swartz said. She added, however, that "people need to consider the alternative -- if patients are closed off form coverage, they still go" to the emergency department, and "we all pay for that." Under the proposal, about 6% of nonelderly people would lack health insurance, she said.

Swartz said, "Given the federal deficit ... I think it will be hard for either candidate to do much in the next few years" (Carmichael, Newsweek, 10/6).

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Opinion Pieces, Editorial

Summaries of two recent opinion pieces and an editorial that addressed health care issues in the presidential election appear below.

* Marianne Udow-Phillips, Detroit Free Press: Polls indicate that voters "are now more focused on the economy" than on health care, but "it is unwise to separate the two issues, implying that one could be 'fixed' without reforming the other," Udow-Phillips -- director of the Center for Health Care Research and Transformation, a joint project of Blue Cross Blue Shield of Michigan and the University of Michigan -- writes in a Free Press opinion piece. Health care "should be important to business" because the "lack of health insurance reduces productivity" and can "cause financial instability in our health system," she writes. Udow-Phillips adds, "It is clear that we cannot significantly improve our country's economy without addressing the issue of health care at the federal level" (Udow-Phillips, Detroit Free Press, 9/30).

* Henry Aaron, New Republic: "To many Democrats, it has long seemed self-evident that Barack Obama, if elected president, should promptly seek enactment of one big bill to achieve universal health insurance coverage and reform the U.S. health care system," but such a move "would be a serious mistake," Aaron, a senior fellow at the Brookings Institution, writes in a New Republic opinion piece. He writes that "seeking to reform the whole health care system in one, large bill is unwise" because the "chances of success are small," the "political fallout from failure would be devastating," a number of other problems "cannot wait" and the "'big bang' approach to health reform is the wrong strategy." According to Aaron, the "sensible strategy would be to enunciate a broad vision for reform and propose practical steps to move in the envisioned direction": expand SCHIP, "start testing effectiveness," encourage "states' efforts" and "create a national health insurance clearing house." He writes, "No element of this program should face insuperable legislative obstacles," and the program would "make material advances on all fronts and carry far less risk of political failure than the 'big bang' approach" (Aaron, New Republic, 9/29).

* Tampa Tribune: The McCain and Obama health care proposals both would involve "more costs and unpleasant side effects than either candidate predicts," according to a Tribune editorial. According to the editorial, McCain, who has "faith that market competition would cover more people at lower costs, overlooks several realities," such as that "administrative costs are higher for individual plans than for group plans" and that "those costs would have to be passed on to individuals." Obama "would help more people get health insurance but at high costs and with uncertain side effects," as his requirement that health insurers accept all applicants, regardless of their health status, "is bound to raise costs for the healthy," the editorial states. "Voters need to be aware that whether you prefer Obama's bigger-government approach or McCain's market solution, it's unrealistic to expect unlimited access to better health care at lower costs," the editorial states, adding, "Only when leaders are more honest about the tradeoffs will Congress be ready to make fundamental improvements" (Tampa Tribune, 9/29).

In addition, the New York Times' "Campaign Stops" blog on Sunday included posts that discussed the McCain and Obama health care proposals and the priority of the issue in the election. Summaries appear below.

* Stuart Butler: The McCain and Obama health care proposals will "have a tough time surviving politically," but only the McCain plan "is both prudent and has the seeds of potential bipartisanship," Butler, vice president for domestic policy at the Heritage Foundation, writes in the Times' "Campaign Stops" blog. Meanwhile, the Obama proposal, which "might be called 'expand and economize,'" would "add commitments and centralize and then try to offset costs with new revenue and efficiency improvements," Butler writes. He adds, "By allowing for a degree of diversity toward a common purpose," the McCain proposal "would be more likely to garner bipartisan and state support than a proposal for a more standardized national system" (Butler, "Campaign Stops," New York Times, 9/28).

* Ezekiel Emanuel: "When the campaigns began in late 2007, health care was the No. 1 domestic issue," and, although the health care system over the past year "has remained in critical condition with no improvement," the issue "has fallen off the radar screen" among other economic concerns, Emanuel, an oncologist and chair of the bioethics department at NIH, writes in the Times' "Campaign Stops" blog. According to Emanuel, health care "has hardly been mentioned by either candidate" since their acceptance speeches at the party conventions, and "there is only one advertisement by either candidate that gives a major role to health care." Emanuel adds, "More encouraging is that at least that Mr. Obama and his advisers also recognize that solving the deep problem of the economy cannot be done without solving the health care mess." Health care might "no longer be the acute pain at the forefront of the public's attention," but "it is a severe disease that will have to be cured to get the economy really going," he writes, adding, "Let's hope policymakers can rise above the immediate political agenda to solve the long-term problems" (Emanuel, "Campaign Stops," New York Times, 9/28).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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