The nation’s health care system is desperately in need of reform — as far too many Americans know from grim, personal experience. In this election, Barack Obama and John McCain are offering starkly different ideas for how to fix that system.
There is no shortage of problems:
¶ Some 45 million Americans lack health insurance, limiting their ability to get timely care.
¶ The costs of medical care and health insurance are rising much faster than household incomes, making it increasingly difficult for people to afford either.
¶ People can’t carry their insurance from one job to another, limiting their mobility. Outside the workplace, it is hard to find affordable insurance.
¶ Despite the wealth and technological prowess of this country, the quality of medical care often lags behind that available in other industrialized nations.
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We believe that Mr. McCain’s plan, which relies on reshaping the tax code, is far too risky. It is likely to erode employer-provided group health insurance and push more people into purchasing their own insurance on the dysfunctional open market, where insurers often reject applicants with pre-existing conditions.
Mr. Obama has focused primarily on extending coverage to a big chunk of the 45 million uninsured Americans by expanding existing private and public programs with the help of federal subsidies and mandates. His boldest innovation would be a new federally regulated exchange where Americans not covered at work would be able to choose — as federal employees currently can — among a variety of private group policies. He would also create a new public program to compete with the private insurers.
Mr. Obama’s plan is a better start than Mr. McCain’s. But it is still not likely to help all Americans who need and deserve affordable, high-quality medical care.
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"The Candidates’ Health Plans" (editorial, Oct. 28) reveals the critical flaw in both candidates’ proposals. Both merely redistribute the cost of health care; neither actually lowers the cost. Their common flaw: continued dependence on insurance companies.
Here’s a better plan: a single national nongovernment not-for-profit health insurance company financed by a payroll tax. By eliminating the profit margin and cost of marketing, we can reduce the cost of health insurance, and thus health care, dramatically.
Glenn Alan Cheney
Hanover, Conn., Oct. 28, 2008
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To the Editor:
Neither the candidates’ plans nor your editorial addresses one of the most glaring problems that I see in my legal practice, of health insurers’ knee-jerk denial of claims and/or permission for treatment.
For example, I was recently involved in a matter in which a 95-year-old man who had been in a hospital for weeks had been sent to rehabilitation by his doctors and the hospital, yet the (major) insurer involved refused to consent to the widely medically recommended proposed course of treatment.
Thus the man either had to pay for the rehabilitation stay on his own, which he could not afford, or go home and suffer, even though he had more than adequate insurance coverage.
This is not a unique case.
Any proposed presidential plan must include a mechanism to closely monitor and regulate the health insurers and give citizens a vehicle to have a government agency enforce their health policy entitlements. It must include fines and other sanctions for insurers who are guilty of patterns of wrongful denial.
Mark J. Bunim
New York, Oct. 28, 2008
The writer is a lawyer.
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To the Editor:
The candidates’ health plans that you describe are almost amusing in their complexity and inadequacy. Why are Americans unable to adopt plans that have served other nations of the developed world well for many decades?
My wife and I have experienced national health services in both Norway (our son was born there under socialized — yes, socialized — medicine) and in Canada. Our experiences have been excellent in both countries.
We now live under a national health plan, Medicare, in the United States, and with the same excellent results. Medicare should be made an open enrollment plan available to all, and let the private insurers try to compete with that.
We can’t afford it? We just blew $700 billion and counting on trying to rescue the financial system with less than two weeks’ debate. We lack not the means, only the will.
David W. Blair
Princeton, N.J., Oct. 28, 2008
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To the Editor:
Your editorial accurately describes the candidates’ plans. But it doesn’t reveal how inadequate they are.
In the face of a doubling of health care costs just since 1999, they propose nothing that would seriously contain costs or assure access to health care for the millions of Americans, both insured and uninsured, who today are one illness away from bankruptcy.
These plans continue to rely on a privately run insurance system that has shown itself to be too costly, too inflation-prone and too unreliable to meet our needs. As a result, they fail to provide the major system overhaul that the American people need and have been demanding.
Only a complete restructuring of the way we pay for health care, toward a publicly financed system that can assure access to care — much as Medicare does today for those over 65 — while containing costs can truly provide the solid foundation we need for the health care system of the future.
Leonard Rodberg
New York, Oct. 28, 2008
The writer is research director of the New York metro chapter, Physicians for a National Health Program.
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To the Editor:
No proposal for the delivery of health care in the United States will make a difference unless somewhere in the debate single payer (Medicare for all) figures in.
Americans must ask an important question: Who would be a more beneficent provider of health care, a well-financed nonprofit national program, or for-profit insurance companies whose primary responsibility is to shareholders and not patients?
Only through a government-sponsored Medicare-for-all model will every resident be guaranteed the basic health care that is the right of all of our citizens, privileged or not.
Richard L. Stivelman
Salisbury, Md., Oct. 28, 2008
The writer is a medical doctor.
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To the Editor:
While Senator Barack Obama’s health care plan is certainly sounder than Senator John McCain’s, it is far from what it needs to be if the goal is for all Americans to have quality, affordable health care.
In order to achieve that, we would need single-payer national health insurance, like almost every other industrialized nation has.
Barack Obama used to support a single-payer system, in which health care is publicly financed but privately delivered, as it is in Medicare. Unfortunately, on the way to becoming mainstream enough for the presidency, he stopped talking about single payer and now proposes a system that would preserve the role of for-profit insurance companies, with their administrative excesses.
Mr. Obama should know that as long as private insurers are allowed to waste our premiums finding ways to deny care and deliver dividends to shareholders, universal health care in the United States will never happen.
Sarah Ramer
Pittsburgh, Oct. 28, 2008
The writer is a second-year medical student.
We have several New and Better Democrats who support Single Payer running on Tuesday.
Let's elect all of them for a More and Better Democratic Congress.
And on Wednesday start fighting for Single Payer.