Healthcare and the Election – an Overview (Part I of III)


Many important issues face our nation at this point of our history.   Yet one issue is guaranteed to touch essentially everyone, either directly because of personal involvement, or indirectly because of friends or family.   That issue is the future of healthcare.   Whether one is a Republican, Democrat, Independent or uncommitted, the future of healthcare in 21 st century America will touch you sooner or later.   So the choices Americans make in this election cycle will shape what kind of care you and your loved ones will receive.   Healthcare is such a large topic that I have opted to break this into three parts.   The first will be an overview of core healthcare issues that have political implications.   The second of this series will examine how differently Senator Kerry and President Bush approach those issues.   The last part of this series will appear after the election and will be my suggested roadmap to resolving key barriers to affordable quality healthcare for all Americans.   With the space constraints inherent in these articles, I will not attempt to be exhaustive, but provide a primer on issues, key differences and potential solutions.


Coverage and Affordability.   One of the greatest benefits one can have is healthcare insurance provided by an employer.   However if one is unemployed, or employed by an enterprise that does not provide healthcare coverage or family member of such an individual, that person is one of 45 million Americans without healthcare insurance, and there are many more millions who are under-insured for potentially devastatingly costly care.   Healthcare benefits are often at the core of labor disputes.   Workers want healthcare coverage, often in lieu of wage increases.   Businesses may want to provide healthcare benefits, but at a cost they can afford to remain profitable and competitive.   Businesses may offer less expensive (to them) managed care (HMO) plans with less choice of provider and benefits, and/or attempt to shift more of the cost to the employee.   Even though there has been an average 12.4% increase in earnings for those with jobs since President Bush took office, there has been a 36% increase in workers' costs for healthcare insurance, often with diminishing benefits.   The average worker now pays more than $220 a month for family health insurance.   How the candidates propose to provide affordable, quality healthcare is a topic we will explore in Part II.


Medicare.   Once one of the best examples of the American healthcare system, Medicare is in a crisis mode.   It is hard to believe that prior to 1965 when Medicare was enacted to the consternation of the American Medical Association that labeled it as socialism, retired persons had to fend for themselves using up life savings intended to care for themselves and their spouses during their “golden years.”   If one has worked and paid into the Medicare system, Medicare has covered the retired and disabled with no one turned away.   But the cost of healthcare has soared, and with rising national debt, Congress has under-funded Medicare.   This has resulted in rising premiums to Medicare recipients, including the stunning 17% increase just announced.   In an attempt to control costs and shift Medicare management to private plans, the White House and Congress have authorized and funded small demonstration projects to evaluate privatization (Part II of this series).


Pharmaceutical coverage.   Although a relatively small part of the healthcare costs, drugs have often had fairly spotty coverage by healthcare and retirement benefit plans, making out-of-pocket costs loom large in consumer impact.   Even with good quality and less expensive generic drugs coming increasingly to market as excellent name-brand drugs lose patent protection, patients often have to pay considerable out-of-pocket expenses for co-pays or the entire prescription.   Since many patients, and certainly the sickest of our citizens, require multiple medications, these expenses can be budget-busters.   With fixed incomes common in the elderly, terrible choices need to considered in dosing or even filling the prescriptions.   The prescription drug benefit enacted by the White House and Congress has not impacted mainstream drug costs, and has proven to be far more expensive than originally claimed by the White House.   Re-importation of medications from Canada has been a cost-saving solution promulgated by state and regional governments, in potential violation of current federal laws.   Certainly my patients are doing it.   But safety of re-imported drugs is a concern.   How Senator Kerry and President Bush view these issues will be outlined in Part II of this three part series.


Stem cell research.   The potential for developing quality-of-life enhancing or truly life-saving treatments for illnesses like diabetes, Alzheimer's, certain cancers and other illnesses is an unfulfilled promise of stem cell research.   Although the White House and Congress have provided limited funding for stem cell, basic and clinical scientists have pleaded for more funding and expansion of cell lines to fully explore the potential of stem cell research.   Certainly Senator Kerry and President Bush disagree on this issue and those points of disagreement will be summarized in Part II.