A Step in the Right Direction

Copyright / The Charlotte Observer (All Rights Reserved)

As Election Day approaches, our health care system is a major domestic issue, second only behind the economy(1). The Bush Administration should be applauded for providing prescription drug coverage to seniors in the Medicare program. Other Bush Administration decisions, such as opposing the continuation of the State Child Health Insurance Program, should be vilified. So which candidate currently seeking our vote has the best ideas for the health of the nation?

As a basis for discussion, we must compare Senator John McCain’s and Senator Barack Obama’s health care plans to what the Institute of Medicine recommended four years ago in its landmark publication “Insuring America’s Health: Principles and Recommendations.”(2) Five core principles upon which the Institute of Medicine suggests America’s health reforms should build include:

Health care coverage should be universal.
Health care coverage should be continuous.
Health care coverage should be affordable to individuals and families.
The health insurance strategy should be affordable and sustainable for society.
Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.

Senators McCain and Obama share similar views on health care (3). Both believe firmly that focus needs to be placed on chronic disease prevention and management, smoking cessation, and patient responsibility. Both candidates believe that America can reduce costs by preventing the pharmaceutical industry from restricting lower cost generic medications. The candidates also agree that we ought to re-import pharmaceuticals that are sold in Canada or Europe at a fraction of the price we pay for them here in the United States. However, only Senator Obama explicitly states in his health care plan that he would remove the current ban on pharmaceutical price negotiation included in the Medicare Modernization Act. Doing so would permit pharmaceutical costs to decrease approximately 13-36% similar to the savings achieved by the Veterans Health Administration (4).

Both candidates also consider heavy investments in health information technology and increased competition in the health insurance marketplace critical features of health reform. Senators McCain and Obama both wish to establish a national health insurance exchange where health insurance can be offered across state lines. However, it is not the similarities but the differences where we clearly see that Senator Obama’s views on health care align with the best interests of the American people.

The McCain plan, while poorly detailed, possesses several distinct features. Senator McCain proposes eliminating the tax exemption for employer-sponsored health insurance and replacing it with a $2,500 individual tax credit (or $5,000 for a family). Considering that the average cost of health insurance for a family is now $12,860 (5), families will be required to spend at least an additional $7,000 in order to have health insurance. Consequently, Senator McCain’s health care plan will cost the average American more money.

Senator McCain also recommends a Guaranteed Access Plan (GAP) that would provide health insurance to patients with pre-existing medical conditions. Unfortunately, because traditional health care plans will continue to select healthier patients, persons with chronic health problems will flood the GAP. Ultimately, this guaranteed access plan would become insolvent because only the sickest, costliest, and previously un-insurable patients would be enrolled. America needs a health care system where everyone is included and no one excluded.

Senator McCain also believes that greater use of retail clinics will improve access to care. While certainly, more clinical sites will assist patients access certain aspects of health care, as clinicians, we believe there is no substitute for a true medical home in a physician’s office.

Senator Obama offers a health plan that stands out because he offers to create a new federal health plan (similar to the Federal Employees Health Benefits Program) which will require guaranteed enrollment, subsidies for the poor, and portability across state lines. This new insurance plan would compete side-by-side with the for-profit plans currently in existence. Considering that nearly 15% of patients’ health insurance premiums go to pay for administrative costs, profits, and the salaries of CEO’s, Senator Obama’s publicly operated non-for-profit plan would offer considerable cost savings to patients.

Another major component of Senator Obama’s plan is that employers must contribute towards their workers’ health care. In the state of Hawaii, where this strategy has been in effect since 1975, the uninsured rate is the country’s lowest (6). Additionally, Senator Obama will place responsibility on parents to purchase health insurance coverage for their children. While this will ultimately improve if not eliminate the number of uninsured children in the United States, it still falls short of providing for true universal coverage of all Americans as recommended by the Institute of Medicine.

Approximately one-third of Americans are Black, Latino, American Indian, or Asian/Pacific American. Even though American society has become extremely diverse, there are still large disparities in health status, access to health care, and health outcomes for racial and ethnic minorities. The United States Department of Health and Human Services has placed a priority on eliminating health disparities. Of our two presidential candidates, only Senator Obama’s plan will eliminate many inequities that plague our current health care system.

In summary, although we must be clear that neither plan truly achieves universal health care, Senator Obama’s plan takes our nation a step in the right direction. Both candidates seek health care that is continuous, high quality, and patient-centered. However, Senator McCain’s plan is clearly unaffordable for individuals and families. At present, we cannot predict if either plan will be affordable for society. However, considering the extreme burden health care places on our economy, if we fail to act now, there will come a time when the health care system – much like the financial system – needs to be bailed out.

Sincerely,

Cedric K. Dark, MD, MPH
Brittny Williams Howell, MD
Kameron Matthews, MD, Esq. (7)

Additional Supporters:

DaRel M. Barksdale, MPH
Win Cheung, PhD
James Daniels, MD
Stanley Frencher Jr., MD, MPH
Nathan Lott, MD
Camille McCormick, MD
Ndemie Mends, MD
Edjah Nduom, MD
Nicole Rodriguez, MPH
Leila Rowland Zucker, MS, MD

References:
(1) CNN Poll. http://www.cnn.com/ELECTION/2008/map/polling/index.html(Accessed October 3, 2008)
(2) Institute of Medicine. Insuring America’s Health: Principles and Recommendations. National Academies Press. 2004.
(3) www.johnmccain.com and www.barackobama.com (Accessed October 1, 2008)
(4) Health Affairs, 22, no. 3 (2003): 149-158 .
(5) Kaiser Family Foundation and Health Research & Educational Trust. Employers Health Benefits. 2008 Annual Survey.
(6) US Census Bureau. Income, Poverty, and Health Insurance Coverage in the United States: 2007. August 2008.
(7) Dr. Matthews discloses that she volunteers for the Obama for America Campaign. All other authors and supporters declare no official affiliation with either presidential campaign.