Fear of illness. Fear of injury. Fear of debt
Those fears are all too familiar to the 47 million Americans and more than 50,000 Onondaga County residents without medical insurance.
Consider these statistics:
- Nationally, 15 percent of Americans — about one in six — are uninsured, according to 2006 U.S. Census.
- In Onondaga County, 11 percent of the population — about one in nine — are uninsured, according to a 2006 New York Child Protective Services report.
The lack of insurance makes many Americans sicker. The uninsured often go without important routine medical examinations, experts warn. They face anxiety that they will get sick and not be able to pay for proper treatment. And those who do get seriously sick or injured often incur sky-high medical bills, sinking them into debt.
Something has to be done, experts and others agree. Health care is one of the top three issues voters want to hear about from the presidential candidates, coming second to the Iraq War, according to a June 2007 Kaiser Foundation poll.
“Health care benefits are a principal of anxiety for workers, not just blue-collar workers, but all workers,” said Roger Battistella, a Cornell University professor in health policy and management.
But what to do is a political minefield. Most of the presidential candidates have announced health care plans aimed at getting coverage for uninsured Americans. They vary from the Republicans’ plans based on tax incentives to more sweeping reforms from the Democrats.
The three Democratic frontrunners — Hillary Clinton, John Edwards and Barack Obama — have released three similar health care plans, all aiming at universal coverage. All three plans combine a mixture of private and expanded public insurance. Here’s a quick summary:
- Both Hillary Clinton and John Edwards plans include mandates, which would require that all individuals purchase health insurance. Obama’s plan differs in that he would only mandate that children have health insurance.
- All three plans incorporate an employer “pay or play” philosophy, which requires employers to provide insurance or pay fines.
- All three plans allow individuals to buy through government-run purchasing pools, which is how government employees now receive health insurance.
- All three plans offer government subsidies to help those who cannot afford insurance to pay for it.
- All three candidates call for the rolling back of tax cuts won by the Bush administration for those with incomes above $250,000 to help pay for the program.
Thomas Dennison has worked in health care throughout his career. These days, he teaches about health services management and policy as a Syracuse University public policy professor. Before becoming a professor, he worked as a chief executive officer of a hospital, administrator at a nursing home and executive director of a network of ambulatory care centers.
Dennison has mild praise for the three Democrats’ plans. The mixed plans are a better fit than previous one-size-fits all health care proposals of the past because there is such a variety of uninsured Americans, Dennison said.
“The uninsured are not a homogenous population,” he said. “They are all at risk. But they are very different risks depending on the person.”
The majority of the uninsured come from working families—more than 70 percent from families with one or more full-time workers, according to the Kaiser Foundation Commission on the Uninsured. But they come from very many different places and situations.
Imagine these two very different circumstances: A 56-year-old diabetic and overweight woman who lost her insurance after a divorce would be “a stroke waiting to happen” without proper medical treatment, Dennison said. A 22-year-old healthy recent college graduate whose new job doesn’t provide benefits and decides to risk it without insurance won’t face immediate medical risks. But one “fall off of a barstool,” as Dennison put it, and that college graduate is $20,000 in debt.
The Democratic plans aim at preventing such problems. Experts say they will fix some of the problem of the uninsured.
Dennison, the SU health policy professor, predicted the three Democrats’ plans would help to increase the number of insured Americans. The requirement for everyone to buy insurance, he said, will be the plans’ most effective tool. He cited such other countries as Switzerland with mandated coverage as examples of where such plans have worked.
The government-run purchasing pools, he also said, would also help because often insurance companies don’t provide affordable plans to individuals. “The people who have the hardest time getting insurance coverage are people who don’t have any group-purchasing ability,” he said.
National health care expert Helen Halpin, of the Center for Health and Public Policy Studies at the University of California-Berkeley, praised the plans because of their many options.
“If you’re not happy with what you have or you don’t have anything, there are lots of options presented,” said Halpin. “And if you are happy with you have, you don’t have to change anything, which should deflect a lot of the prior criticism.”
Halpin predicted the plans will help to increase the number of insured Americans with or without a mandate. “Most people want insurance,” she said. “This is not a behavior that we need to coerce.”
Cornell University’s Battistella was less enthusiastic about the plans. He argued more must be done to stop the spiraling costs of health care in order for the plans to work. He cited such possibilities as targeting the insurance companies by limiting the profits they can make.
“We need to deal with the problem of the uninsured,” he said, “But in doing so we have to be more practical minded.”
(Melanie Hicken is a junior newspaper major.)
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