Transcript Updated Slides - UNC Gillings School of Global Public Health

Health Reform and the 2008
Presidential Election
Jonathan Oberlander
Department of Health Policy & Administration
Department of Social Medicine
UNC-Chapel Hill
The Real Election
Roadmap
I. The U.S. Health Care System
II. Health Reform & The 2008 Election
III. What’s Next?
Sicko & The Terminator
Health Reform Fever
Contracted by otherwise politically healthy
American adults every 10-20 years.
Symptoms include delusional belief that
health reform is inevitable or just around the
corner, and misplaced faith in the American
political process. Only known cure is a
harsh dose of political reality, to be applied
repeatedly to prevent relapse.
I.
The U.S. Health Care
System
Number of Noneldery Uninsured, in
Millions: 1998-2006
50
47
45
43
42
41
39
40
43
44
45
40
38
35
Source: US Census Bureau, Changed methods in 1999
20
06
20
05
20
04
20
03
20
02
20
01
20
00
19
99
19
99
19
98
30
Percentage of Firms Offering
Health Benefits: 2000-2007
70%
69%
68%
66%
66%
63%
60%
61%
60%
60%
50%
40%
30%
2000 2001 2002 2003 2004 2005 2006 2007
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2007
Beyond the Numbers
When Health Insurance is Not a Safeguard
New York Times, October 23, 2005
“Zachery Dorsett's parents thought their son
was an average child who was having trouble
getting over a passing illness. He was 7
months old, and it was his second case of
pneumonia… But Zachery, who was
eventually found to have an immune
system disorder, kept getting sick, and the
expense of his treatment - fees for tests,
hospitalizations, medicine - kept
mounting, eventually costing the family
$12,000 to $20,000 a year… Earlier this
year, the Dorsetts stopped making mortgage
payments on their ranch house, because they
could not afford them. In March, they filed
for bankruptcy.”
Blue Cross Cancellations Called Illegal
Los Angeles Times, March 23, 2007
“ The state investigation found that Blue
Cross used computer programs and a
dedicated department to systematically
investigate and cancel the policies of
pregnant women and the chronically ill
regardless of whether they intentionally lied
on their applications to cover up preexisting
medical conditions - a standard required by
state law for canceling individual policies.”
II. Health Reform & The Election
Candidates’ Reform Plans
Attention All North Carolina Voters.
Read These Plans at Your Own Risk.
Telling the Truth is Politically Risky (ask
Walter Mondale). Plans May Change
Without Notice When Candidate Enters
the White House.
Clinton Health Plan
Obama Health Plan
Obama-Clinton Plan
• Modified employer mandate (small
business exemption)
• Creation of purchasing pools
• Establishment of new public insurance
program
• Regulation of insurance industry
• Financing through repeal of tax cuts for
those making over $250,000
Obama-Clinton Feud:
Individual Mandates
''You know,'' Mrs. Clinton
said, ''when I proposed a
universal health care plan,
as did Senator Edwards, we
took a big risk, because we
know it's politically
controversial to say we're
going to cover everyone.
And you chose not to do
that. You chose to put forth
a health care plan that will
leave out at least 15 million
people. That's a big
difference.”
McCain Health Plan
• Tax credits ($2500 and $5000)
• Replace tax exclusion for employersponsored insurance
• Encourage individual purchase of
insurance
• Deregulate insurance market
• Health Savings Accounts
Common Ground on Cost Control
•
•
•
•
Prevention
Disease Management
Coordination of Chronic Care
Electronic Medical Records
Political Challenges
Democrats
•
•
•
•
Republicans
Universal Coverage
• Tax health insurance
benefits
Employer mandate
• Move away from
Regulate insurers
employer-sponsored
Create new Medicareinsurance
like government plan
• Convince people they
• Establish purchasing
currently have too
pools
much insurance
• Individual mandate
• Raise taxes to cover
the uninsured
Obstacles to Reform
•
•
•
•
•
•
•
Power of the Status Quo
Stakeholder Opposition
Congress & 60 Votes
Agenda Competition (Iraq, Taxes etc.)
Budget Deficit & PAYGO
Limits of Consensus
Ideological & Partisan Divide
III. What’s Next for Health Reform?
“Mr/s. President. I Know It’s 3AM. But
Here’s How to Pass Health Reform.”
Memo to the Next President
•
•
•
•
Time is not on your side
Make the economic case
Persuade the insured
Explain costs of not reforming the
health care system
And don’t forget….
The Improbable is Not The
Impossible