Wednesday, October 29, 2008

The McCain Healthcare Plan

As I noted in a previous post on the future of healthcare in America, both candidates have dynamic proposals for reforming our healthcare system. Previously, I have discussed the Obama healthcare plan and what I found interesting about it. Today, I will address John McCain's healthcare plan. The entire plan can be found here: Straight Talk on Healthcare Reform

Here are the key points that I found interesting:
  • John McCain Will Reform Health Care Making It Easier For Individuals And Families To Obtain Insurance. An important part of his plan is to use competition to improve the quality of health insurance with greater variety to match people's needs, lower prices, and portability. Families should be able to purchase health insurance nationwide, across state lines.

    An interesting proposal, but seeing as most families receive their health insurance through their employer, I am not sure how this would be implemented. I assume he means that employers will be able to do this on behalf of their employees. Furthermore, while competition may indeed prove beneficial, health insurance differs from other goods due to the complex nature of what is covered. If policies end up competing primarily on price without regard to benefits, it is not clear how families would be better served.

  • John McCain Will Reform The Tax Code To Offer More Choices Beyond Employer-Based Health Insurance Coverage. While still having the option of employer-based coverage, every family will receive a direct refundable tax credit - effectively cash - of $2,500 for individuals and $5,000 for families to offset the cost of insurance. Families will be able to choose the insurance provider that suits them best and the money would be sent directly to the insurance provider

    Seems like a good idea, except from what I have heard, most plans start around $12,000 per year for a family of four, so I think the credit would have to be expanded.

  • John McCain Proposes Making Insurance More Portable. Americans need insurance that follows them from job to job. They want insurance that is still there if they retire early and does not change if they take a few years off to raise the kids.

    Makes sense, but how will this be enforced? What if the company fired the employee for poor performance or illicit behavior? This gets to the heart of the problem of tying insurance to employment. Sure, employee pools make for good pseudo-random groups to insure, but it doesn't make sense in the grand scheme of things, especially when one considers that sick people generally are not good workers.

  • John McCain Will Work With States To Establish A Guaranteed Access Plan. As President, John McCain will work with governors to develop a best practice model that states can follow - a Guaranteed Access Plan or GAP - that would reflect the best experience of the states to ensure these patients have access to health coverage. One approach would establish a nonprofit corporation that would contract with insurers to cover patients who have been denied insurance and could join with other state plans to enlarge pools and lower overhead costs. There would be reasonable limits on premiums, and assistance would be available for Americans below a certain income level.

    I don't understand how the government forming a "nonprofit corporation" (NPC) that covers apparently everyone that the insurance companies don't want to cover (ie, the costliest patients) is any different from a bastardized single payer system. If anything, this is worse than single payer, since this NPC would effectively take on the 'worst' patients leaving the insurance companies to cherry pick the lowest risks for themselves.

  • CHEAPER DRUGS: Lowering Drug Prices. John McCain will look to bring greater competition to our drug markets through safe re-importation of drugs and faster introduction of generic drugs.

    I have the same issues here as I did with Obama's version, namely who is going to regulate this? The FDA? Also, McCain does not address the 2003 Medicare bill.

  • TORT REFORM: Passing Medical Liability Reform. We must pass medical liability reform that eliminates lawsuits directed at doctors who follow clinical guidelines and adhere to safety protocols. Every patient should have access to legal remedies in cases of bad medical practice but that should not be an invitation to endless, frivolous lawsuits.

    Again, makes sense. However, without any specifics, it seems like empty rhetoric, especially under the current system, this is more a state-by-state issue, rather than a federal one.

  • John McCain is very concerned about the rising incidence of autism among America's children and has continually supported research into its causes and treatment

    A nice sentiment, but is this really a national issue? Somehow, I feel like McCain has only come to care about this in the last 8 weeks or so...

Overall, I think McCain's plan has some intriguinig ideas but without more specific details, it is hard to evaluate them. Both plans seem to suffer from a lack of detail in terms of how they will pay for these proposals, implement them, or enforce them. Still, it bothers me that McCain seems to think that the solution lies in putting more power in the hands of patients without many safeguards to ensure that they actually receive adequate care. Having a $5000 tax credit isn't much solace to someone with a new diagnosis of cancer, especially if they are uninsured, since the cancer is now a 'pre-existing condition,' meaning they will not be insured in the future. Perhaps the non-profit corportation would pick up the slack here, but without much detail, who knows how that would work?

In the final judgment, I think both plans have significant deficiencies, but I believe the Obama plan to be the stronger of the two. Still, much change is needed before the U.S. healthcare system truly lives up to its potential. Your thoughts?


  1. Read or re-read the comments you have about single-payer being the solution. ("... a single-payer plan ... is the right way to go" and "Good comment! I strongly agree") I don't know how much those readers of yours know about non-profit single-payer national health insurance, but here is some information:

    -- eliminates bureaucracy
    -- saves money for citizens
    -- saves money for physicians: smaller staffs, lower malpractice insurance premium costs
    -- saves time and money for physicians, certainly including no dealing with dozens or hundreds of health insurance companies
    -- overall, makes physicians' lives MUCH less complicated, freeing up time and dramatically improving the doctor-patient relationship (the last point IS the whole point, isn't it, to care for people)
    -- improves the quality of life. People are dying unnecessarily in the United States, and we need to stop that. Equally important is the unnecessary pain and suffering of persons who are going to be dead because we happen to be 19th out of 19 countries in our ability to minimize deaths due to preventable diseases. Take a look at the numbers.

    We very much need this change, which all other industrialized countries have. Most of the other countries do not have socialized medicine, just a simple financing technique that makes their countries more globally competitive so they have a better chance to keep their businesses and jobs instead of losing them ..... and their life expectancy is longer and they have fewer people experiencing pain, suffering, and deaths).

    Remember: EVERY other industrialized country has Health Care for All with NOBODY in those countries losing their credit rating or their home or their life savings due to medical bills. Doctors will still run private practices, but they will pay more attention to patients, instead of having a huge staff to deal with the health insurance companies. Did you know that the U.S. has over 1300 health insurance companies. Let's go to non-profit, simple financing and pay for health care instead of excessive administrative costs.

    We will recover jobs, improve our health and save lives ... and improve the lives of physicians.

    By the way ...

    Single-payer REDUCES government involvement! Look at the government part of the bureaucracy that will be eliminated. The socialized programs will be eliminated, including Medicaid and other social programs at the federal, state and county levels. It will be a great relief to get rid of those social programs! What a complex mess, including being part of the current complexity for physicians! Those programs are a significant part of the problem! All workers will automatically pay, no matter what their income level is. Take a look at what the average Amerian worker will experience in terms of what they give and what they receive.

    Conclusion. This change is critical for our society. Medicare was implemented within one year without today's computer systems. (There was apparently a second phase of the implementation to take care of some details after that first year, but that basic implementation took one year.) People are in pain and suffering unnecessarily and are dying unnecessarily. The country is mis-spending around $350 billion that should be spent on health care. This is a contributor not only to our poor health performance and deaths, but also to lost businesses and lost jobs.

    Please get reminders to take action to get health care for all in the United States.

    We do NOT have much time. The so-called Medicare Modernization Act of 2003 made Medicare MORE complex and LESS efficient by ADDING health insurance companies and even SUBSIDIZING the health insurance companies with OUR taxes! This situation is SCHEDULED to get WORSE by 2010, less than two years from now. Read about this wrong direction!

    Health Care --- We need to move from "health insurance company regulated medicine" to "doctor and patient regulated medicine".

    Health Care Financing --- We need to move to "non-profit national health insurance" that is independent of the federal government and the 50 states! This has been insane, and we must move to simplicity! Pool our money together into ONE and ONLY ONE insurance pool and have health care costs paid from the public agency.

    And have a much better life for current and future physicians,

    - Bob Haiducek
    Bob the Health and Health Care Advocate
    Health Care for All Now

  2. Thanks for the comment, Bob. I think it's clear that I support the idea of a single-payer system in theory based on my comments. My reason for the post was to at least make sure I had given the McCain plan a fair and full reading before I went ahead and advocated against it, for many of the reasons you have stated.

    In the long run, I think the real problem here is not getting public support for such an idea (Medicare enjoys strong voter support), but rather getting the political votes / capital necessary, crafting a well-thought out system, and then carefully implementing any such plan. I hope that this will happen in the next administration, but I fear it will be another 12 to 20 years before the crushing costs of healthcare in the U.S. spurs lawmakers into action.



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