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Universal Health Care — Causing a Headache?

By Masao Donahue • Apr 28th, 2008 • Category: Public Affairs

For Erin Noll, a 24-year old sociology major and junior at Hunter College, her birthday this Fall will mark a significant turning point in her life – the day she loses the medical coverage under her parents’ insurance. She will abruptly join the 47 million other Americans bereft of health coverage.

Cases like Noll’s represent the shortcomings of the American health care system, where the richest country in the world fails to cover roughly one in six of its citizens.

So Noll, along with many others, follows the current presidential campaign with extra interest. The issue of medical coverage is definitely on the table, and the leading Democratic candidates, senators Hillary Rodham Clinton (D-NY) and Barack Obama (D-IL) have proposed significant changes. They are both offering “universal coverage,” a bold and exciting overhaul of the health care system.

Cases like Noll’s represent the shortcomings of the American health care system, where the richest country in the world fails to cover roughly one in six of its citizens.

John McCain (R-AZ), the presumptive Republican nominee, has offered a more modest health care plan in hopes of keeping the insurance industry in the hands of private businesses. Plans to bring about universal coverage would contradict core Republican values by allowing government involvement in private life. McCain is looking to modify the current system, not replace it.

If you’re left scratching your head over what constitutes “universal coverage,” you’re not alone. For Clinton, it means mandatory coverage for those 47 million uninsured Americans through a federal mandate. For citizens, they would be required to purchase medical insurance and be subject to fines if they did not.

She has been vague about how she would enforce the mandate, but one way would be by garnishing peoples’ wages – deducting money directly from their paychecks.

Although Obama’s plan is often called universal, it only requires that parents obtain coverage for their children. Obama’s version of “universal coverage” seems to rest on his hope that by making health care affordable, and therefore available, to every single American, everyone would decide to buy it.

This distinction is important for Noll, who says, “Forcing health care coverage onto people takes away their right to choose. Regardless of how affordable health care may become, individuals should be the ones who determine whether to buy coverage, not the government.”

Clinton emphasizes the breadth of her plan, contending that Obama would leave 15 million Americans uninsured.

Clinton emphasizes the breadth of her coverage plan, contending that Obama’s plan would leave 15 million Americans uninsured. She has declared herself as the only candidate truly advocating universal health care, though her plan does not address how the unemployed would afford insurance.

Perhaps more “universal” than either Clinton or Obama’s plans were schemes from candidates no longer in the running. “Single-payer” health care covers everyone under a single government plan that completely eliminates private companies. First proposed in the United States by President Harry S. Truman in 1948, single-payer health insurance was a major feature in the campaigns of Dennis Kucinich (D-OH) and Mike Gravel (D-AL) before they dropped out of the race.

Despite their differences, Clinton and Obama both want to expand coverage through existing private programs, as well as create a national health care program based largely on the benefits enjoyed by members of Congress.

Clinton’s public plan builds off Medicare, the government-run insurance program that covers citizens or legal residents 65 years or older, as well as people with disabilities.

Obama too would seek to expand coverage for Medicaid as well as the State Children’s Health Insurance Program (SCHIP), which provide coverage for low-income families and children.

People who are satisfied with their existing private company coverage would see no changes, except for lowered costs. Those who cannot afford private plans would have the option of buying into the national health care program.

Also, both candidates want to widen coverage by putting an end to the discriminatory practices of many insurance companies, who often turn down policies for low-income families or those with pre-existing conditions.

Employed part-time, Noll is currently ineligible for employer-based coverage, leaving her with few economically viable options once she loses coverage through her parents’ policy. “Prescriptions will end up costing around $300 monthly – which I simply cannot afford,” she said.

Because providing health care is costly, it is rare for companies to offer benefits to part-time employees. To address this problem, the two candidates have outlined initiatives to share responsibility between employers, employees, and the government that would assist in meeting the costs of insurance.

Through the proposals, Noll would have the option of receiving coverage at her current job – which would be required to offer her coverage – buy into the national plan or into a private plan. For Noll, gaining coverage through her job would be the most appealing option – a factor she says would greatly impact her decision to remain there. Also, under the new policies, she would still be covered under the company’s policy if she left the job, until she found a different plan.

For small business owners who have difficulty paying for policies for their employees, the two Democrats offer two plans.

Under Clinton, employers would be able to apply for tax credits, which would be based on a percentage of the company’s revenue. On the other hand, Obama would provide the option of donating a percentage of a company’s revenue into the national health care plan.

But what would all this cost?

Clinton’s plan would cost an estimated $123 billion annually. The tab for Obama’s plan has been estimated at $102 billion per year. But, keep in mind, the higher cost of Clinton’s plan would bring coverage to more people. In comparison, the Bush administration spent $69 billion for health care in 2007.

Both Democrats would pay for their plans by letting President George W. Bush’s recent tax breaks for those making over $250,000 expire in 2010. They assure voters that their plans will work without raising taxes. According to the nonpartisan Tax Policy Center, eliminating Bush’s tax cuts would save up to $140 billion annually – enough money to cover either plan.

To save money, all three candidates say they would develop an electronic health information system to streamline record-keeping.

Preventive care, both candidates say, will further reduce costs. Early detection programs, such as free cancer screenings, can catch ailments when they are easier, and less expensive, to treat.

Making Americans healthier and thereby lowering health care costs may seem simple, but the task of raising awareness has been the downfall of many campaigns. Arlene Spark, a Nutrition and Food Sciences professor at Hunter College said the government should be more active – even in small steps like putting healthy food in school vending machines and developing more bike lanes to encourage exercise.

Although Noll says she will back whichever Democratic candidate wins the nomination, she is still uncertain which one she prefers. “Obama’s interest in the people and his call for change are inspiring,” she says, “but I question whether he would be able to push for health care policies when faced with opposition.” She said Clinton may have greater conviction and experience, but she added, “Forcing people to buy insurance who cannot afford it may make matters worse.”

For More Information:

Americans for Health Care and the National Coalition on Health Care offer compelling depictions of the current sorry state of health care in the United States.

For more information on the candidates’ proposals, their campaign websites – HillaryClinton.com, JohnMcCain.com, and BarackObama.com, are an obvious but still excellent resource.

The CNN Election Center, in addition to its primary coverage, provides a brief overview of where the candidates stand on key issues.

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Masao Donahue is a third-year media studies major at Hunter College, focusing on journalism. Born in Japan, he came to New York City at the age of three and, aside from two years in Connecticut, has lived here ever since. His hopes and dreams rested on naming this online publication “HoJ-Podge,” but because of the unhelpful nature of his peers, his dream will never become a reality. Discouraged, he now wanders New York City -- attempting to find a new purpose.
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