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Might As Well Vote

David Spero

October 15, 2008

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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