Diabetes Self-Management Blog

Everybody’s talking about the election. I don’t have much confidence in Obama and none at all in McCain, but I have looked into their positions on health issues. Here’s my scorecard.

Health Insurance
Both of them want to keep the same screwed-up system with dozens of insurance companies controlling health care and adding tremendously to the costs. McCain’s plan would make private health insurance more affordable by providing a $2,500 tax credit for individuals and $5,000 for families. But it would do so by taxing employer health plans, which would push many employers into dropping their coverage.

So the net effect would be to push people from group (employer) plans on to individual plans, which have worse benefits. Jane Bryant Quinn of Newsweek says this would be hard on elders, women, and people with chronic illness. Overall, Quinn says, McCain’s plan would probably lead to one million more people getting coverage (out of about 45 million uninsured).

Obama’s plan seems a bit better better. It focuses on getting more people covered and would involve government in paying for “catastrophic care,” the really expensive stuff that drives up the price of health insurance for all. Medicare-like coverage would be made available to some people under 65. Obama says that about 30 million more people would be covered, at a cost of perhaps $60 billion a year at first. (It may drop if bargaining power helps control expenses.) So it’s not single-payer, but it’s something.

Advantage: Obama

War as a Health Issue
The American occupations of Afghanistan and Iraq and our government’s threats of more wars are major health problems. The cost of veterans’ long-term care alone may be well over $1 trillion, according to Nobel Prize-winning economist Joseph Stiglitz. Over 4,500 Americans are dead in the two occupations, over 30,000 are wounded, and who knows how many hundreds of thousands have post-traumatic stress disorder (PTSD).

Unfortunately, neither candidate seems to want to end these occupations. Neither will commit to avoiding more wars, although Obama says he will talk with people before he bombs them. Obama wants to move troops from Iraq to Afghanistan, but it is hard to see that as much of an improvement. But at least he doesn’t want the troops there for 100 years, as McCain has suggested.

Slight advantage: Obama

Reproductive Health
Well, here there is a real difference. Obama is for abortion rights and sex education. McCain is not only against abortion (unless the woman’s life is in danger), but against birth control as well. He and Governor Palin want abstinence-only sex education. Unwanted children are the biggest health risk of all, for themselves and others. (Think about being unwanted by your own mother. How would you feel about yourself?)

Big advantage: Obama

Future of Medicare
A lot of DSM readers rely on Medicare. So do I. But Medicare is in big financial trouble. In its present form, it can’t run much longer. Part of this is because the Bush administration stopped collecting most taxes on rich people. It also added the expensive Part D drug benefits without paying for them.

McCain does not want to start taxing the rich again; Obama does. So right there, Medicare has a better chance with Obama. But we would still need to make major changes in the system, moving it more toward self-management and healthier environments, and away from the focus on drugs, surgery, and heroic end-of-life care.

A Commonwealth Fund article points out that Medicare was originally intended as the first step toward health coverage for all, a single-payer plan. Perhaps Medicare could be made more sustainable and be expanded to the rest of the population. A 2003 Pew poll found that 72% of Americans favored government-guaranteed health insurance for all, and the number is probably higher now.

McCain would never go there. Would Obama? Probably not. But who to vote for is your call.

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Comments
  1. We have had troops in Europe since 1945, but we have not been at war there since. We have had troops in South Korea since 1953, but we have not been at war there since. McCain was not talking about being at war in Iraq for 100 years; just that we will keep some troops there for as long as needed - even if it’s 100 years. Which we may well reach in Europe and South Korea. After all, we’ve been in both places more than half a century now.

    (As an aside, there is a souvenir shop in Korea’s DMZ. I’ve been there. And I’ve stayed on a U.S. Army Post in Korea and in Europe. So, yeah, I know we’re there.)

    Jan

    Posted by Jan Chait |
  2. As long as we have the government intervening in our healthcare system, we will have an inefficient system in which many of our citizens are uninsured, underinsured, or insufficiently cared-for. Please note that “healthcare system” includes the inefficient and Big-Pharma-friendly, little-guy-averse FDA. A free market system such as that advocated by our Libertarian candidates would allow the costs of research and development, and care, to normalize at a lower level as the bureaucratic delays and costs, and time-to-market, drop considerably. This would make health care more complete and more affordable for all of us.

    My vote goes for Bob Barr, Libertarian candidate for President.

    Posted by tmana |
  3. Dear David.

    It is remarquable that someone still believes that the “free market” can fix things. We have seen how the free market financial engineers on wall street fixed our future.

    War is the biggest treat to health care. Canada’s fairly low tech army has had 100 killed, and blown 18 billion dollars (multiply by 10 to put in a USA perspective), not including all of the veterans cost listed above which I believe that the Govt owes the veterans. Pissed off a 1/2 billion Muslims, and thereby made us less safe. And we are loosing.

    This kind of money, is puny by USA military spending standards, could have restored our Govt health care to a high degree of efficiency. But then again our right wing likes G. Bush very much and admires his “free market” approach. During the comming depression this ideology will become very unpopular.

    Posted by CalgaryDiabetic |
  4. Dear Jan,
    There is unfortunately no comparison between Germany, Korea, and Iraq. After WWII, Most Germans wanted us there to protect them from the Russians, and they needed the money the bases brought in when times in Europe were very hard. Similarly with Korea and protection from China.

    But Iraqis want us out now, or sooner if possible. [url="http://theradicalmormon.wordpress.com/2008/03/17/new-poll-70-of-iraqis-want-the-us-military-out-of-iraq/"] Large majorities of Iraqi Arabs say it’s OK to kill American soldiers.

    Remember, the Iraqis didn’t start this and they never wanted it. We have no right to be there. And BTW, we should get out of Germany and Korea (and maybe Hawaii too.) The residents don’t want us anymore, and this military empire is bankrupting us.
    David

    Posted by David Spero RN |
  5. Dear Jan and David.

    There is one thing true about the free market: that monetary well being affects the political attitude of people.

    The South Koreans and Germans benefited greatly form the economic fall out of occupation by American troops. A Japanese prime minister called the Korean war a gift from the Gods (for the Japanese economy at that time).

    In Iraq the economic benefit of getting rid of Saddam has been greatly negative. When you see pictures of a hodge podge of electric wires on the utilities poles you can suspect that the people no longer even have a reliable supply of electricity. Imagine this in an extremely hot climate. This is why the US army chief of staff said prior to the last war that upwards of 500,000 troops where required and was fired by G. Bush. We invaded Germany with a combined allied strenght of 12,000,000 troops Nazi resistance or trouble making was out of the question.

    Posted by CalgaryDiabetic |
  6. Being in favor of a certain plan to improve the country’s health care is one thing and that’s great. Being able to get legislation out of committee and voted on and passed without too much extra add-ons is a completely different thing. We do need to get out of Iraq unless a better plan is presented because the present one is certainly not working. But having said that, I doubt that any of that money saved by this action would go to help defray the rising health costs. It doesn’t work like that in the real world. Sorry to disappoint you.

    Posted by Cathy |
  7. Think about being unwanted by your own mother. How would you feel about yourself?)

    So what you are saying, you would have rather be dead than feeling unwanted???

    Posted by Tim |
  8. you run a fine newsletter but you should not be envolved in the politics end of it. no matter which way we go its going to be bad, lets face it (he) the president sets a budget and congress acts on it. So if things are going to change we should put the homeless in congress to pass the laws we live by!!!!!! It is congress that does this not the president….

    Posted by cabocraig |
  9. Hi Tim,
    I wrote:
    Think about being unwanted by your own mother. How would you feel about yourself?)

    You replied:
    So what you are saying, you would have rather be dead than feeling unwanted???

    I’m saying that being an unwanted child sets up, almost guarantees, that you will have poor health, a sad life, low self-esteem, and quite probably a lot of antisocial behavior. What I’m saying is that all children should be wanted children.

    Say next time I was offered a choice. Would I rather not be born (stay dead) or be born unwanted? I’d choose to stay dead. I have had the experience of feeling unwanted by lovers as a relationship was falling apart. That’s horrible, but I can’t imagine how bad it would be to be unwanted from birth.
    What do you think?
    David

    Posted by David Spero |
  10. This is not the correct avenue for politics. But, don’t worry about being unwanted. Obama is in favor or abortion and partial birth abortion. And, we need to blame congress rather than the office of the president.

    Posted by ml |
  11. Your suggestion of legalized abortion in order to prevent unwanted and potentially unloved children is nothing more than legallized murder for the convenience of the unresponsible adult. Allowing women to terminate poorly planned pregnancies (which is the same as murdering a child) serves only to foster self-centerdness and unresponsibility among parents which is a major cause of children being neglected. As a school teacher, I meet parents every year who do not give their children the attention and care that they need because their focus is on themselves rather than their child. Since when is murder the answer to unloved, unwanted, and mistreated children. What happens when it’s a ten year old girl being abused? Who do you kill then -the family member or the child? What kind of mentality can accept and justify the murder of an innocent life based on “what ifs” and conveniences?

    Posted by Cheryl |
  12. Cheryl,
    Thanks for sharing, but I don’t agree.
    You say terminating an unwanted pregnancy is the “same as murdering a child.” You even ask “what if it were an abused 10 - year old?”

    Well, it’s not a ten year old child. It’s a fetus. And I didn’t advoctate abortion for the “convenience” of “self-centered” parents as you say. I advocate saving an unborn child (and those around the child) from a life of pain, and giving another chance to women who become unintentionally pregnant.

    It must be hard for you as a teacher, “meeting parents every year who do not give their children the attention and care that they need because their focus is on themselves rather than their child.” Those kids must be hard to deal with.

    But your solution is to force them to have children they don’t even want? How does that help? I’m saying it would have been better for everyone if they hadn’t become parents in the first place.

    Make every child a wanted child.

    David

    Posted by David Spero |

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