Elections will soon be upon us, bringing health care reform again to the forefront of public discussion. The American public rates access to health care as a major concern, but evaluating different proposals put forth by the candidates and others can be difficult for those of us who are not policy experts.
Several factors have brought the issue of health care reform back into the public eye in the last decade. According to a 2003 study, "the most important factor behind the rise in the number of uninsured over 2000-2002 was the decline in employer-sponsored health insurance coverage." Health insurance premium costs and medical expenses have increased while a weakened job market has left previously insured workers without coverage or with inadequate coverage. These elements strain public systems (including Medicare, Medicaid, the Veterans Administration and the Ryan White system, among others), as well as the private health sector.
In the United States, access to private health insurance is usually tied to employment. Many employers have responded to recent economic constraints and higher insurance costs with a reduction in worker health benefits. This crunch has particularly been felt by the middle class, who now bear a heavier weight from increased contributions to premiums, higher deductibles and co-pays and a more limited selection of medical providers. The bill for uncompensated care (care received by uninsured people without the means to pay their medical bills) in the U.S. is about $35 billion a year.
People without stable medical coverage have a shorter life expectancy and a worse health status. In addition to the toll of human suffering, there is an enormous financial cost to the country from reduced earnings and lower educational attainment. We can clearly see this in the HIV/AIDS community, where many people who are on disability are reluctant to go back to work if it means risking losing current medical benefits.
U.S. public spending per person for health care is greater than in other countries, yet the U.S. ranks lower than Germany, France, the United Kingdom, Canada, Italy and Sweden in life expectancy. Americans are seeing health care provision change, but not in a way that they desire. Tantalizing medications and procedures offer a longer and higher quality of life at a price that is increasingly out of reach for many. Medical care is in crisis and voters are looking to government for solutions.
The plans offered by the presidential candidates differ significantly in the percentage of people who would gain coverage (ranging from 10% to 100%), the cost of each plan (from $70 billion to $6 trillion over ten years) and the time it would take to put the plans into action. To summarize, the Bush plan focuses on tax credits and changes in malpractice awards, the Kerry plan mixes public and private elements with flexibility to move in stages toward universal coverage, while Kucinich's and Nader's plans call for a single-payer system with universal coverage. (Universal coverage means that everyone is covered in a plan, regardless of preexisting condition, marital status, employment status or age.)
Many states are considering or have implemented health care reform, including Maine, where the state is moving on a plan toward universal coverage, and California, where employers are required by law to provide insurance for workers or pay into a state fund that provides coverage. The current Canadian system of single-payer health care started in one province, then grew into a national system. It is likely that states will continue to pursue their own health care reforms rather than wait for an all-encompassing federal response.
In June 2004, a study was released by Georgians for a Common Sense Health Plan that evaluated the administration and funding of a particular universal coverage health proposal for Georgia. A full copy of the report on this proposal, called Georgia Secure Care, can be obtained through Laurie Iscaro at (404) 687-9891 or on the Internet at www.commonsensehealthplan.org.
"The American health care system is confronting a crisis. The health care delivery system is incapable of meeting the present, let along the future, needs of the American public."
-- National Academy of Sciences, November 19, 2002.
|Presidential Candidates' Web Sites Regarding Health Care Policy|
Mary Lynn Hemphill, L.M.S.W., can be reached at MLHemphill@aidssurvivalproject.org.