Obama. McCain. Healthcare. 2008.

There are 13 drafts sitting in my blog waiting to be written, edited or published, but there are more pressing matters here.  Again, instead of discussing the candidates, their merits and campaign promises overall, I’m going to delve into another tangential topic/issue.

[Side note: I think that we sould choose a President based on his character and ability to carry out projects as much, if not more so, as his platforms/issues.  Campaign promises are promises, which in the world of politics, don't always mean that much.  Instead we should base our judgments on the candidates as people (not 'normal people like you and me'; just people).  Believe that he + running mate will make the best decisions because choices beyond the restricted set of today's platforms will certainly arise in the future.]

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Yup! Today’s topic: health care.  I wrote an extensive analysis of some of the world’s universal health care systems, including those in Taiwan, Switzerland, England, Japan and Germany, based on a documentary from PBS- seriously, my fave station.  Each has it’s merits, but the most poignant lesson is that each system also has its flaws, and to move from the current (and yes, faulted) U.S. system to another just doesn’t make sense.

Health care in a minute.  To my knowledge (and confirmed here), employer sponsored health care started during World War II, when the government had instituted a salary cap (low supply of workforce during war and the government didn’t want inflation to get out of hand).  Because one company couldn’t compete by offering a higher salary, they opted for other benefits, i.e. health insurance.

But here are the problems with employee sponsored care:

• Whenever you switch jobs, you have to fill out paperwork (ew).  But the insurance companies are experiencing workers changing jobs all the time, so that creates tons of bureaucracy (double ew).
• People who are older, younger, unemployed, disabled or otherwise not with a company who provides health care are… well… screwed.  It’s really expensive to insure just one person.  Lots of companies recruit small companies and individuals to join an informal, non-work associated group, so that everyone can lower their insurance.  How often does that work?  If a small percentage of people use more of the insurance and raises the premiums for everyone, doesn’t it make sense to block them from entering a given group?

Another huge problem is the gross overvaluation of health related work.  Meaning we pay too damn much for doctors, nurses, insurance providers… everyone.  Yes, nurses are striking all the time, for better benefits, hours, etc.  And I don’t profess to know their plight.  I’m just saying compared to fees in other countries, the U.S. charges wayyyy to much.  In many countries, insurance companies are non-profits, doctors make an equivalent of about 60-80,000 instead of 100-200,000 and schooling for medicine costs a fraction of what it does in the States as well.  Because of the price restrictions abroad, pharmaceuticals, who invest millions of dollars in research, then are forced to charge what they can in order to make a profit.  (I’m not saying pharmas aren’t gouging us; what I am saying is that pharmas are charging an arbitrary ‘fair’ amount.  To me, it’s like buying a bottle of Coca-Cola in China vs. here.  It’s only 15 cents in China, but that’s because no one’s going to pay their equivalent of 8 RBM (bucks) for a bottle of soda there.)

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Barack’s got your back. And brain. And heart.  And heck, let’s throw in the rest of your body too.

From what I’ve read on the Obama site, Barack’s universal health plan would basically subscribe all the Americans who don’t have health insurance into one gigantic group.  The idea is that if you spread the risk over a really really large number of people, it would lower the premium for everyone.  However, he also promised extended medicaid help, an electronic infrastructure (cheaper in the long term but with a huge learning curve, initial investment and probably tons of bugs to iron out), and new initiatives in the AIDS fight, research, etc.  Even with employers obligated to contribute, there will probably be some hefty support coming from the government itself.  I know Barack’s changing the nation for the better, but the initial phase will probably hurt.  All change does.  And I’m really doubtful as to how he’s planning to pay for everything.

Several other points in his health care plan confuse me, i.e. I don’t know the details or how it would play out:

• Allowing Americans to buy drugs on the international market: How many Americans would take advantage of this?  If a third company begins to import drugs from abroad, that would jack up the prices abroad (due to increased demand) and piss off the international community even more.  (The smart pharmas would just lower prices in the U.S. to accommodate for the new law before third parties come into play.) If this happens, will the pharmas reduce revenue, causing a longer lead time before a new drug is profitable.  They may press for longer patent times, delaying generic production of a certain drug. It may also hinder research into new drugs due to budget cuts.  Yes, Obama supports new research, but government funded research is a fraction compared to commercial spending.  Of course there are other results.  I just don’t know enough details and hope the Obama Camp’s really thought through all the reprecussions.
• How is Obama planning on “challenge the medical system to eliminate inequities in health care through quality measurement and reporting, implementation of effective interventions such as patient navigation programs, and diversification of the health workforce”? Hospitals who deliver better care have patients who can afford to pay their bills.  No guidelines or committees will help a poor hospitals churn out enough revenue to cover the increase in care.  Also, how will he guarantee diversification in the workforce?  How will he convince a graduating MD to take a job at inner-city hospital A over rich hospital B, when the doctor has over $200,000 in loans (if he’s lucky)?  Will Obama raise the salary or offer student loan subsidies?  Who will pay for them?

There are genuine questions that hopefully he will be able to detail as the campaign moves towards November.  BTW, I LOVE LOVE LOOOOOVVVEEEE that he’s establishing a program to help prevent diseases.  That’s is (and always has been) the best solution to developed diseases (non-genetic).

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Is this mike on… McCain…? HElllloooooo…..!?!?!

Yeah, I read through McCain’s ‘plan.’  I’m actually pretty on the border in this election, and I understand health care reform isn’t on the top of the list for McCain.  With that in mind…

What I DO have a problem with (a big problem) is that most people won’t actually read through his or Barack’s sites.  And McCain’s site is a great example of 1400 words (1379 to be exact) that pretty much say nothing.

This is what I read:

• John McCain cares about you and your family.
• John McCain understands health care is getting more expensive.
• John McCain says we should pay less for healthcare.
• John McCain will ask states to lower costs.
• John McCain had an itch on his arm, but now that he scratched it, it’s ok.
• John McCain will give a stipend of $2,500 of individuals and $5,000 for families to arrange their own health care needs (here’s the money… good luck!).
• John McCain will import drugs.

Why, that sounds dandy, John McCain… HOW??

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*Do you hear crickets yet?*

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*How about now?*

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I will say the one good thing about McCain’s plan is that we probably won’t have an increased tax burden… cuz I don’t really see any concrete actions items, a.k.a. if you’re happy right now with your insurance, great!  If you’re not, good fucking luck.

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Of course, this doesn’t mean that I have a magical answer in my hands that will solve our needs. What I  think we should do is hire a 6-10 people coalition, who are deeply entrenched in the system as it stands right now, i.e. presidents of hospitals, doctors, nurses, mid-level insurance managers, pharma reps, lobyists, etc.  Give them 2 months to develop a research methodology, 8 months to carry it out and 2 months to generate a report.  From the raw data, they and 2 other groups (one of regular people in different health insurance situations and another similar to the ocalition) will interpret all the data and make recommendations.  Separate recommendations.  It doesn’t have to be an entire plan. Then these 30-odd people will pick the ideas that work best together, present it to government and recruit people to make the change happen.

I don’t think we should have ‘experts’ speaking about this or that (they lack the perpective), or have either candidates making any concrete plans without first consulting a plethora of people throughout the health care network and at all levels.