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How McCain and Obama’s Health Plans Would Affect Real People

By admin | November 2, 2008

By Trudy Lieberman , Columbia Journalism Review
Posted on September 15, 2008, Printed on September 15, 2008
http://www.alternet.org/story/98929/

This is the first in a series examining how the candidates’ health care proposals will affect ordinary people and how the press could cover that angle.

So far, mainstream media coverage of health care during the campaign has been characterized by stenographic reporting — simply transcribing what the candidates say, buzz words and all. Blogosphere coverage has trended the opposite direction — way too much wonk talk, angels dancing on the head of a pin-type stuff. What have been missing are the people stories. Exactly how will all these economic and political calculations and pronouncements affect those who struggle daily to fill their prescriptions, find a competent doctor, or pay their medical bills? These are the people whose stories the media have yet to tell.

Plenty of coverage has depicted the McCain and Obama plans in broad brush strokes: McCain wants to rip up the employer-based health care system, replace it with tax credits for families and individuals, and require workers to pay income taxes on the value of their health insurance benefits from employers. He also wants families to make medical decisions. Obama would let people keep insurance from their bosses but make it easier for those who are uninsured to buy coverage through a public plan like Medicare. Neither would require people to carry health insurance (except Obama requires it for kids). Both candidates promise tax subsidies. How big they will be and who they will help is anyone’s guess.

Last month, NPR aired just such a broad-brush plan-comparison story, featuring a health care policy researcher who drew distinctions between the two approaches. The most telling point he made was that “we pretty much have the same solutions that we’ve always had.” Okay, the solutions may be shop worn, but that’s no excuse for not showing people how they will be affected by them.

To begin what I hope will be an ongoing narrative about the candidates’ plans and where ordinary people fit into them, I went to Helena, Arkansas, a town of 6,300 along the Mississippi River, whose population and importance peaked in the early 1900s during the sharecropper era. It’s like many old river ports and tiny towns across America, in that the population vanished when the jobs did. There aren’t many opportunities to go out and find employment with good insurance, the standard advice for decades. Helena’s median family income in 1999 dollars was $21,500, compared to $50,000 for the U.S. at large.

The people I talked to represent the socio-economic strata of the town — from the head jailer and the garbage collector to the insurance agent and the soybean farmer who owns 5,000 acres. They all have health issues. Most people do. Twenty-seven percent of the population is disabled, and all will be affected one way or another by the strategies for reform pursued by John McCain and Barack Obama.

What struck me was that even with insurance, which many had, people were still paying large medical bills out of pocket, reflecting the big cost shift from those who traditionally pay the health care tab to patients themselves. They are the underinsured, that group of 25 million Americans just now coming into public focus but hardly mentioned by candidates or the press. Another thing stood out: How little they knew about the coming health care battle being waged in their name.

“We’re getting socialized medicine like Britain and Canada,” one man told me. How did he know? “The people on TV told me,” he said. All the words the media have produced are not sinking in. People need to see themselves in the context of the proposals. They need to know what’s at stake for them. As Irwin Landau, my former editor at Consumer Reports, reminded me recently: What touches you personally will be more interesting than what is not personal. It will not only be more interesting, but it will help people evaluate the ad messages, the special interest spiels, the propaganda, and the demagoguery that will surely come. Judging from the people I met in Helena, the media have a big job to do going into the election and beyond

 

Comparing The Plans

McCain: He would replace the current tax-free status of health insurance coverage provided by employers with refundable tax credits worth $2,500 for individuals and $5,000 for families to help purchase insurance. McCain would allow the sale of insurance policies across state lines, rather than state by state, as is currently the case.

Obama: He would create a new plan for those who lack other access to coverage, as well as a National Health Insurance Exchange to help pool the purchasing power of small businesses and individuals. Obama would also offer a combination of subsidies and tax credits to help make coverage more affordable. He would mandate health insurance coverage for children, but not adults. Obama would create a federally sponsored health insurance plan, similar to Medicare, that would compete with private plans for those under age 65.

 

Morning Edition, August 13, 2008 · Health care has fallen from its status as the top domestic issue in this year’s presidential campaign, but that doesn’t mean voters no longer care.

A poll released last week found more than 80 percent of those surveyed think the nation’s health care system needs fundamental change. Both Arizona Sen. John McCain and Illinois Sen. Barack Obama are promising that, but change is really the only feature their plans have in common.

McCain and Obama have very different prescriptions for solving the problem of ballooning health care costs, says Jonathan Oberlander, a professor of health politics and policy at the University of North Carolina at Chapel Hill.

“There are many issues where Obama and McCain differ,” he said. “I’m not sure there’s any issue where they differ as much as this. Sometimes we complain in politics that Democrats and Republicans run to the center, and they copy each other with their proposals. At least in health care, we don’t have to worry about that.”

McCain’s Plan

Of the two candidates, McCain is arguably the one whose plan would change the health system the most. Right now, if you get insurance from your employer, you don’t pay taxes on the value of that benefit.

But if you have to buy your own insurance and you’re not self-employed, you don’t get any tax help. McCain would change that: He’d make employer-provided insurance taxable, but then give everyone a tax credit.

“Our proposal is to give every family in America a $5,000 refundable tax credit, and they take that tax credit and that money — a refundable tax credit — to go across state lines, to go any place in America, and go online, and pick out the insurance policy they want,” McCain said.

There are lots of questions about McCain’s plan. How hard will it be for people who are already sick to buy insurance? Will people really be able to find policies they can afford when the average family policy now costs more than $13,000? And does the public really want to move away from a system in which employers provide most people’s health insurance to one where most people buy their own?

But McCain says in the end, there’s one main reason he wants to move in the direction he has chosen.

“I want the families to make the choices,” he said. “[Democrats] want the government to make the choices. That’s a fundamental difference.”

Obama’s Plan

What Obama is proposing isn’t really government-run health care. It doesn’t even have a requirement for individuals to have coverage, like the plans offered by his main Democratic primary opponents, former North Carolina Sen. John Edwards and New York Sen. Hillary Clinton.

Obama says that under his plan, if you already have insurance you like, you can keep it.

“But if you’re one of the 45 million Americans who don’t have health insurance, then you will have it available to you. No one will be turned away because of a pre-existing condition or illness,” Obama said. “Everyone will be able to buy into a new health insurance plan that’s similar to the one that every federal employee from a postal worker in Iowa to a congressman in Washington currently has for themselves.”

If you can’t afford coverage, you’ll get a subsidy. Employers would have to offer coverage to their workers, but they’d get government help, too.

Comparing The Candidates’ Plans

Oberlander says the McCain and Obama plans would essentially move the system in exactly opposite directions.

“While Sen. Obama wants to build on top of the employer-sponsored insurance system, Sen. McCain wants to build away from it and move more people to the individual insurance market,” he said.

In fact, says Oberlander, in many ways the current debate reminds him of the movie Groundhog Day — except he keeps waking up and thinking it’s 1992.

“The stock Democratic health reform solution, before Bill Clinton changed it, was a play-or-pay employer mandate, and that’s exactly what Barack Obama has,” Oberlander says. “And in 1992, the favorite GOP solution was tax credits to buy private health insurance. So, a lot of things have happened in 16 years; the health care system is much worse than it was, but we pretty much have the same solutions that we’ve always had.”

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