Universal Health Care Canada Style

Yep, the wife and I made a killing on tax rebates last year.

My Aunt (who lives in Toronto) got AIDS from a blood transfusion during a routine operation. She learned of it many years later when she had blood tests done for a life insurance policy. It turns out (and I'm not an expert so forgive me if I get a few details wrong) the Government and Health System knew of tainted blood but did nothing to test it or remove it from the system, nor did they do anything to inform potential victims.

Medical costs are out of sight in the U.S. because 1) we are the most law suit happy people on the planet and 2) there is nobody watching the bills, and 3) the government's artificially low payouts force everybody else's costs higher.

My doctor pays almost $150,000 a year just for his malpractice insurance alone and then the medical people on his staff also need that insurance as do clinics and hospitals. As most of the lawmakers in state houses and in Congress are attorneys, there is little chance they'll make any serious attempt to cap malpractice suits or class action suits.

The doctors/hospitals are forced to over prescribe medication and tests to avoid being sued for any inavertent oversight. When medicare, medicade, Champus payments are capped at low levels, doctors and medical facilities either stop accepting such patients at all or they make up their costs by charging all the other patients more. Few of us ever see the part of our bill that insurance pays. The money just disappears in some black hole somewhere.

What if medical care could be structured like car insurance. You pay for your tires and windshield wipers and oil changes and other affordable maintenance and repairs. Your (or somebody else's) insurance company pays for the big stuff that wouldn't be affordable. And you could choose whatever procedures your doctor recommended and skip those s/he judged to be less important or effective with no fear the doctor would be sued if something got missed because of that.

Or the medical savings accounts make sense. I guarantee that anybody who is paying a medical bill up front is going to question the charge for a surgery room that was never used or a $5.00 aspirin.

There are so many things we can do without dismantling and downgrading what nevertheless is the best health care in the world.

Tue, Jul. 20, 2004

Bush, Kerry have different health care solutions

By JOHN A. MACDONALD
Hartford Courant

WASHINGTON - Super size or economy size? Voters concerned that one in seven Americans has no health insurance will have a clear choice of solutions in this year's presidential election.

Sen. John F. Kerry, who will claim the Democratic nomination at his party's convention next week, has put forward a comprehensive proposal that would substantially reduce the number of uninsured, now at about 44 million.

President Bush supports a much more modest plan with a correspondingly smaller impact.

The key question: Will either plan matter on Election Day?

Most nationwide polls place health care a distant fourth among voters' concerns, after Iraq, terrorism and the economy. Still, some analysts think the emphasis could change as voters zero in on two campaign constants - peace and prosperity.

Kerry has merged health care into a new economic message that focuses on the "middle-class squeeze," said Bruce F. Freed, a Washington political analyst. Meanwhile, polls in battleground states such as Ohio, Pennsylvania and Florida show voters believe the economy is the most important issue in the election.

The Kerry message paints a picture of beleaguered workers caught between tiny wage increases and rising costs for such items as a college education, gasoline and health care. "I think (health care) is going to be part of a broader constellation of issues that constitute the middle-class squeeze," Freed said. "I think that becomes a powerful issue."

This fall, Kerry wants to offer voters a stark choice between his economic vision for the future and Bush's, a distinction that critics brand as "class warfare." But some analysts point out that in Democratic primaries, Kerry was successful at differentiating himself from his rivals with his comprehensive health care plan.

The result was a proposal that would cost $653 billion over the next decade. Now, as early in the year, critics say Kerry's plan is too expensive, especially at a time of record federal budget deficits.

After signing a major overhaul of Medicare late last year, Bush has been content to offer a series of narrowly focused plans to expand insurance coverage that would cost an estimated $90 billion. The rap on Bush's plan, which he mentions only in passing in his campaign speeches, is that it is too small.

Kenneth E. Thorpe, an Emory University professor of health policy who has evaluated both plans, estimates that Kerry's would reduce the number of uninsured by nearly 27 million; Bush's would cut it by 2.4 million.

Besides the effect on insurance coverage, the proposals differ in two other ways. Kerry would pay for his plan by rolling back tax cuts for the wealthiest 2 percent of Americans, cuts that Bush firmly defends. Bush emphasizes the private sector to expand coverage, while Kerry would rely on a mix of government and private insurance.

"My reading of these two proposals," Thorpe said, "is that health care on the domestic side is likely to be the biggest area of policy difference between these two campaigns, both in terms of the impact the proposals would have, the structure of the proposals and the financing of the proposals."

The addition of Sen. John R. Edwards to the Democratic ticket could lead to renewed interest in another issue - allowing patients to sue their health plans in state courts over coverage disputes, several analysts said. Edwards, a former North Carolina trial lawyer, was a leading advocate of legislation allowing such lawsuits before it died in Congress last year, largely because of Bush's intervention. The Supreme Court recently struck down laws allowing patients to sue in state courts and invited Congress to look at the issue again.

Kerry and Edwards also have inserted health care into the widening campaign debate over values. Bush portrays himself as a champion of Main Street values who supports tax cuts and opposes gay marriage and late-term abortions. The Democratic ticket responds that a candidate's priorities on the economy, jobs and health care are an equally good measure of values.

But Thomas E. Mann, a political analyst at the Brookings Institution, a Washington think tank, said the Democrats' use of the values issue "is a bit of a stretch."

"Health care availability and costs are serious concerns in their own right without a link to values," Mann said. "I think (health care) will be the most important domestic policy issue other than the general state of the economy."

Instead of values, Kerry needs to focus on rising insurance premiums and prescription drug costs because those are voters' biggest concerns with the health care system, said Robert J. Blendon, a Harvard University expert on public attitudes on health care. "(Kerry) has to redirect his emphasis to focus on costs, not just the uninsured."

Bush and Kerry have sharp differences over proposals to bring down health care costs. The president favors capping medical malpractice lawsuits; Kerry opposes such caps. Kerry wants to allow Americans to import low-cost prescription drugs from Canada; Bush has repeatedly rejected the idea. Congress has had the medical malpractice and importation issues before it for two years but has not taken conclusive action.

The two candidates also disagree on the Medicare overhaul. The legislation offers Medicare beneficiaries a discount card that will serve as a bridge to a broader prescription drug benefit starting in 2006. Many seniors have found the discount card confusing, and a wide range of analysts say the legislation no longer looks like the political winner that Republicans anticipated. Kerry opposed the measure.

Most critiques of the Bush and Kerry plans to expand insurance coverage follow political lines. Conservatives and business groups tend to applaud Bush's ideas, while liberals and labor unions favor Kerry's suggestions.

Jack A. Meyer, president of the Economic and Social Research Institute, a think tank that studies health and social problems, sought a middle ground when he called Kerry's proposal "an ambitious but realistic set of goals." But he cautioned that parts of the plan are too complicated. Bush's plan, which relies on tax credits to help uninsured workers buy private insurance, "needs to be scaled up," Meyer said.

A new Congress will take office in January and could handcuff Bush or Kerry, analysts said. If Republicans continue to control Congress, Kerry's health care proposals would be especially vulnerable because they would depend on lawmakers repealing the president's tax cuts for the wealthy and devoting most of the money to health benefits, a trade-off that could have limited voter appeal.

"Increased taxes in any way, shape or form would be a tough sell in Ohio," said Eric W. Rademacher, co-director of the University of Cincinnati's Ohio Poll.

Even in northeastern Ohio, the heart of the Democrats' base in the state, John C. Green, director of the University of Akron's Bliss Institute of Applied Politics, has a similar view. "A lot of people in northeastern Ohio like the tax cuts," Green said. "A lot of ordinary people got sizable (refund) checks" because of the cuts.

A second problem for Kerry is that his plan envisions hundreds of billions in new domestic spending at a point when the government is running a $475 billion annual budget deficit, an amount that is beginning to prompt calls for spending restraint from both political parties.

Kerry's pledge to keep all his new spending proposals within the amount raised by rolling back tax cuts for the wealthy "only keeps things from getting a lot worse," said Isabel V. Sawhill, a Brookings Institution budget expert. "The Bush administration doesn't look any better," Sawhill said, because it wants to make the tax cuts permanent beyond their expiration at the end of the decade.

Regardless of who wins in November, analysts agree that Congress will tackle the Bush or Kerry health plans piece by piece rather than in a single big package.

Janet Stokes Trautwein, vice president of the National Association of Health Underwriters, favors Bush's approach. But if Kerry wins, she reflected the views of other analysts when she said, "I can see pieces passing. I don't think the whole thing will go."