An estimated 47 million citizens do not have health insurance. Millions more are worrying about how much coverage they have and how much the subsequent year is going to cost. Employers are increasingly moving toward providing Wal-Mart-style health coverage, putting the responsibility of payment on employees. Workers are forced to battle high premiums, copayments, and deductibles - that is, if they are able to afford the coverage at all.
It is believed that a quarter of the uninsured 47 million are children, and the cost of family coverage is becoming more and more expensive. The candidates for the 2008 presidential election are proposing "solutions" to this hideous health care state of affairs. I think it is important for us to understand what each one means before hitting the polls next year.
The theme of Healthcare 2.0, the Hillary Clinton blueprint, is choices for Americans. Albeit a general catastrophe of a health care system, or lack thereof, there are individuals who are content with the private coverage they have. Unlike Clinton's one-size-fits-all pitch in 1993, Healthcare 2.0 offers the option of sticking with current doctors and plans. Medical insurance will be bought much like car insurance, consumer to agency. Those citizens unable to afford coverage will fall under a government-subsidized blanket, including the one-third of uninsured Americans who can actually afford indemnity, yet do not think they need it (think healthy young adults). This will make insurance less expensive for everyone else, as subsidization of care for these uninsured would be eliminated.
Sen. John Edwards' plan is very similar to Healthcare 2.0, although he calls for an "employer mandate," in which businesses are required to help finance health care for employees, if not provide it altogether. It would also require Americans to go to the doctor regularly for preventive care. Edwards' proposal has faced scrutiny by big businesses for the employer mandate, and the requirement for all citizens to attend routine check-ups will be torn apart by those trying to keep the government out of their lives.
One of the main elements in Sen. Barack Obama's template is emphasizing the lowering of prescription drug costs by increasing competition in the insurance and drug markets. Obama plans to keep the large pharmaceutical companies from abusing their monopoly power by preventing unjustified price increases and forcing insurers to spend more on patient care rather than keeping large amounts for profits and administration. Obama's plan has been criticized, however, for not providing universal coverage. It would exempt small businesses from having to provide employees with health care, and unlike Clinton's, those people who can afford coverage but choose not to would still be able to fly under the radar, keeping subsidies high.
Former Massachusetts governer Mitt Romney is proposing a federalist approach - the manner in which health care is provided will be determined by individual state legislatures. He and Mayor Rudolph Giuliani are both stressing a privatization of coverage in order to keep taxes low. Romney is nostalgic for the plan he created for Massachusetts, focusing on tax breaks and streamlining regulations, making it a market-based approach. Former New York City mayor Giuliani wants to expand upon President Bush's current plan and give more power to the consumer.
Ultimately, a flawed system will always have flawed solutions. The biggest problem is that all of these plans call for one thing: money (the annual budget for Clinton's plan is $110 billion). Taxes will be sure to increase, and I would be shocked if businesses required to provide for employees didn't go down without a fight. I can appreciate the Romney/Giuliani laissez-faire attempts to lower taxes the most, but many Americans will be left out in the uninsured cold. Clinton has been called a socialist for her template. Edwards' plan sounds nice in theory, with required visits to the doctor, but the bottom line is that people do not like being told what to do. And if the problem is that America doesn't have "universal" health care, then Obama should probably figure out how to make his plan just that.
The one thing we can agree on is that health care in America is a mess - let's see if it can be fixed within a few years.
Katherine Buck is a Heights staff columnist. She welcomes comments at kbuck@bcheights.com.
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