Today, during an appearance on Fox Business Channel, McCain adviser Nancy Pfotenhauer disingenuously argued that the senator’s health care plan would cover “30 million” uninsured Americans and would be “budget neutral over 10″ years:
HOST: So Nancy, who foots the bill?
PFOTENHAUER: Well, our plan is budget neutral over 10 years… we insure 30 million, approximately, and we’re budget neutral over 10.
- Among “Hispanic adults, the groups least likely to have a usual health care provider are men, the young, the less, educated, and those with no health insurance.”
- 41 percent: of Latinos say they lack health insurance because “they are seldom sick.”
- 49 percent: “of Latinos who lived in the United States for less than five years lack a usual health care provider, compared with 21 percent of those who have lived in the United States for 15 years or more.”
- 42 percent: “of the Latinos who have no health insurance lack a usual health care provider, compared with 19 percent of the insured.”
Comparatively, according to data form the U.S. Centers for Disease Control and Prevention, “Hispanics are twice as likely as non-Hispanic blacks and three times as likely as non-Hispanic whites to lack a regular health care provider.”
Lacking access to health care is both risky and costly. As the report notes, “preventive care and regular health monitoring are essential in maintaining good long-term health and limiting the severity of chronic diseases.” Unfortunately, Hispanics without a usual health care provider were much less likely to receive preventive treatment:
And while the “increase is the smallest Aon has seen in six years,” the jump in costs still outstrips the growth of Sen. John McCain’s (R-AZ)’s much-touted health care tax credit. As James Kvaal, Peter Harbage, and Ben Furnas argue in a recent CAPAF report, since McCain indexes his health tax credit — $2,500 for individuals and $5,000 for families — to inflation, and not growing premiums (which are driven by increased cost), his credit depreciates every year:
Sen. John McCain’s (R-AZ) plan to extend health benefits to veterans living in rural areas of the country received mostly negative reviews on Saturday from veterans attending the Disabled Veterans of America convention in Nevada.
Just one of 14 veterans interviewed by the Sun after his speech said he is a certain McCain voter, and the nonpartisan group’s legislative director expressed concerns about McCain’s proposed “Veterans’ Care Access Card.”
Indeed, prominent veterans organizations oppose McCain’s proposal to “give veterans the option to use a simple plastic card to receive timely and accessible care” outside of the VA system.
- “The VA’s specialized health-care programs…would suffer irreparable impact by the loss of veterans from those programs.”
- “The VA’s medical and prosthetic research program…would lose focus and purpose were service-connected and other enrolled veterans no longer present in VA health care.”
- If veterans turned to private practice, “they would lose the many safeguards built into the VA system through its patient safety program, evidence-based medicine, electronic medical records and bar code medication administration,” resulting in “lower quality of care for those who deserve it most.”
Rather than taking veterans out of a system that consistently delivers “higher quality of care,” McCain should expand its services and improve access. As the RAND study concludes, “if other health care providers followed the VA’s lead, it would be a major step toward improving the quality of care across the U.S. health care system.”
In yesterday’s New York Times, Paul Krugman argued that the “final hurdle facing health care reform is the risk that the next president and Congress will lose focus“:
There will be many problems crying out for solutions, from a weak economy to foreign policy crises. It will be easy and tempting to put health care on the back burner for a bit — and then forget about it.
Health Care For America Now! is calling on all Americans to contact their Congressional representatives “and ask them if they support our vision for health care reform.” Just click here and enter in your phone number and address. “Choose the elected official you want to talk to and in a few moments, we’ll call your phone and connect you automatically.”
McCain adviser Douglas Holtz-Eakin explained that “McCain today does not support raising taxes on cigarettes” and would oppose the legislation’s proposed $1.10-per-pack tax hike.
As the Wonk Room has pointed out, back in 1998, McCain wasn’t just a supporter of the legislation, he was its champion. McCain bulked the entire Republican leadership and the tobacco industry to sponsor what Republicans caricatured as a “a big-government liberal tax-and-spend” philosophy and promised to “never” give up on the legislation.
During that period, McCain conceded that “public health groups are the experts…they certainly have a significant impact [on the tobacco legislation]“ and publicly agreed that a tax increase on a pack of cigarettes could deter youth smoking [FDCH Transcript, 6/17/1998]:
Experts say the most important deterrent to youth smoking is to raise the price per pack of cigarettes. Where is that? Right here… going from 65 cents in 1999 to a $1.10 in the year 2003. That by the way, is the administration’s requested number of $1.10 a pack. [FDCH Transcript, 3/30/1998]
And while the data hasn’t changed, McCain’s opinion has. During his July 24, 2008 appearance at the Livestrong forum, McCain suddenly expressed doubt about the effectiveness of a cigarette tax in deterring smokers:
ZAHN: So is there any circumstance that could be proven to you, if there was a direct correlation between taxes going up and the use of tobacco going down?
MCCAIN: It would have to be proven and frankly the constitution of this Congress, they couldn’t prove it to me, because I don’t believe them. I don’t. I’ve seen corruption in Congress. Ok? We have former members of Congress now residing in Federal prison. So, we’d have to clean up Congress and I think the American people are ready to do that.
McCain also argued that since tobacco companies spent millions of dollars advertising tobacco products, it would be unfair to tax smokers for falling victim to their pitch. But as Satyam Khanna points out, “McCain’s flip-flop suggests” that he has fallen to the conservatives’ pitch, “pandering to his anti-tax base, after catching heat from conservatives for saying that “payroll tax increases” were not “off the table” regarding Social Security.
Ironically, back in 1998, the late Boston Globe columnist David Nyhan noted this about McCain’s efforts to pass the tobacco bill: “you cannot break McCain’s will. You cannot make him quit. You cannot coerce him with threats, bribes, bluster, or 30-second attack ads…If his fellow senators abandon him on this one, they deserve the craven reputation they have earned.” [Boston Globe, 6/3/1998] Today, McCain joins this “craven” bunch.
During Douglas Holtz-Eakin’s appearance on CNBC’s Squawk Box yesterday, John Harwood questioned Sen. John McCain’s (R-AZ) ability to provide insurance for individuals whose pre-existing conditions disqualify them from coverage in the individual marketplace. Harwood argued that McCain’s proposal to federally subsidize high-risk pools to the tune of $7 to $10 billion is not “really adequate to get those at-risk into health insurance.” Holtz-Eakin begged to differ:
The Senator’s commitment was to devise a best practice…so his idea was let’s look at the practices, get the one that works and make the commitment to fund it. ‘Cause you know, in the end these are high-cost patients who might need more money. So his 7 to 10 estimate, it was a ballpark estimate. It could be higher. The commitment is to get the job done…It could be $20 billion and you could make it work if you do the rest of the reforms in the McCain plan. The important thing is to change the cost of care, and there’s a long list of reforms that the Senator’s proposed. It means changing incentives.
Holtz-Eakin is spinning his wheels as the McCain campaign scrambles to explain how their individual-market centric health care proposal would deliver health coverage to the millions of Americans with chronic illnesses.The McCain health care plan has been a patchwork of conflicting proposals from the very beginning:
- In April, Elizabeth Edwards, a Senior Fellow at The Center for American Progress Action Fund, astutely noted that McCain’s plan offered nothing for the sickest Americans.
- In response to her criticism, McCain offered his current high-risk pool enhancement plan, G.A.P.
- Seven days ago, senior adviser Carly Fiorina floated the idea of establishing “a nonprofit corporation that would contract with insurers” and “partner with other state plans to broaden insurance pools” and cover the sickest Americans.
Holtz-Eakin’s funding boost is the latest inadequate variation. As the Tax Policy Center pointed out, McCain’s high-risk pools would need about $100 billion a year to “prevent large losses in insurance coverage among the sick and needy.”
Implementing “the rest of the reforms in the McCain plan” would only overburden high-risk pools. As The Wonk Room previously pointed out, McCain’ plan to deregulate the insurance industry and push healthy Americans into the individual market could shift sick people — who can’t find coverage in the individual market or afford the increasing cost of insurance in their old risk pools once the healthy people have opted out — into high-risk pools.
These programs don’t spread risks and costs across a mixed pool population of healthy and sick people and would force millions of Americans with pre-existing conditions to pay astronomical insurance premiums and deductibles.
Thus, while McCain’s proposals have changed, his message has remained the same: don’t get sick.
After McCain suggested that the Veterans Administration should ration health care by “concentrating” its efforts on “those wounds and disabilities that are directly the result of combat,” veterans organizations across America criticized McCain. Paul Sullivan, executive director of Veterans for Common Sense, said McCain “appears to want to significantly narrow the number of veterans who can use VA, and that would alarm many veterans.”
McCain’s veterans health plan is no better than his record. According to veterans groups, the proposal — which would “give veterans the option to use a simple plastic card to receive timely and accessible care at a convenient location through a provider of their choosing” — may actually undermine veterans care.
According to The Independent Budget, a report published by AMVETS, Disabled American Veterans, Paralyzed Veterans of America, and the Veterans
of Foreign Wars, contracting out health care for rural veterans on a broad scale would undermine the existing VA system, “a system of immense value to veterans”:
While some service-connected veterans might seek care in the private sector as a matter of personal convenience as a result of enactment of these vouchering and privatization bills, they would lose the many safeguards built into the VA system through its patient safety program, evidence-based medicine, electronic medical records, and bar code medication administration (BCMA). These unique VA features culminate in the highest quality care available, public or private. Loss of these safeguards, which are generally not available in private sector systems, would equate to diminished oversight and coordination of care, and, ultimately, may result in lower quality of care for those who deserve it most.
During an appearance on CNBC’s Squawk Box today, Sen. John McCain’s (R-AZ) senior policy adviser Douglas Holtz-Eakin disingenuously argued that the McCain’s health care plan would “buttress” “the traditional source of health insurance” and proudly proclaimed that under McCain’s plan, Warren Buffet and his secretary would receive the same health care subsidy:
This is actually not a plan that relies on the individual market, it relies on the traditional source of health insurance, which is employers. And it would buttress that by taking the traditional subsidy, that exclusion from tax, for private health insurance and spreading it more fairly. Instead of only getting it in the employer market, you would get it regardless of your source of insurance. And you get the same amount whether you’re rich or poor, $5,000 for every working family.
The key to real reform is to restore control over our health-care system to the patients themselves… When families are informed about medical choices, they are more capable of making their own decisions, less likely to choose the most expensive and often unnecessary options, and are more satisfied with their choices….Americans need new choices beyond those offered in employment-based coverage. Americans want a system built so that wherever you go and wherever you work, your health plan is goes with you. And there is a very straightforward way to achieve this.
As the Wonk Room has previously pointed out, rather than building on the “traditional source of health insurance,” McCain’s plan would tear it down. By equalizing the tax treatment of employer based coverage with insurance bought in the individual insurance market, the McCain plan would remove the employer’s incentive to provide coverage and could potentially unravel the current system. Here is why:
- McCain would entice healthy workers to buy cheaper but less substantive insurance in the individual market place.
- The exodus of healthier workers from employer-pools would increase the average health care costs for sicker employees who can’t find coverage in the individual market, forcing them to opt out entirely.
The one-size-fits-all tax cut offered by McCain, along with numerous other factors, will contribute to the increase. Under McCain’s plan, a chronically ill older patient, who require more care or more expensive care, would obtain the same amount for health care as a younger, healthier, or wealthier American.
Sicker or poorer Americans would not be able to stretch McCain’s $5,000 per family, $2,500 per individual tax credit to cover substantive insurance policies which meet their health needs.
CLAIM:“John McCain’s plan builds on the current system and allows for greater choices for American families that more uniquely fit their needs, including allowing families to keep their existing coverage.”
FACT: McCain’s vision places the 158 million Americans who receive their health care through their jobs in danger of losing coverage.
- McCain replaces the current tax breaks for employer-sponsored health insurance with a one-size-fits-all tax credit of $2,500 for individuals and $5,000 for families, equalizing the tax treatment of employer and individual plans and enticing healthy workers to buy cheaper but less substantive insurance in the individual market place.
- The departure of healthy workers from employer insurance pools would drive up average health costs, forcing more workers to opt out entirely. The entire employer health insurance system could unravel, “ending this as an option for Americans who prefer it.”
CLAIM:“He believes that Americans should be able to purchase health insurance in a national market, across state lines, should they so desire. That will, in turn, drive insurance rates down and simultaneously allow Americans access to a greater diversity of insurance plans…”
On Monday, during an appearance on Fox Business News’ Countdown to the Closing Bell, Humana CEO Mike McCallister endorsed the progressive prescription of universal health insurance:
HOST: Can we cover everybody, Michael? Is that possible, universal health care?
MCCALLISTER: We can. It’s heavy lifting. And there is no simple, silver bullet answer to that…. we don’t have the right economic model because not everyone is in the risk pool, as we say in our industry. So it’s possible, the money is there. It’s going to take a real concerted effort and it’s not simple….getting everyone in the risk pool or getting them covered is the right thing to do. We’re wealthy nation, we should find a way to do that.
McCallister joins the majority of Americans who already support universal coverage. According to an ABC News/Washington Post poll from June, 66% of Americans believe that “providing health care coverage for all Americans” is more important “even if it means raising taxes.”
Similarly, a Quinnipiac University poll from May found that 61% of Americans “think it’s the government’s responsibility to make sure that everyone in the United States has adequate health care.”
After Sen. John McCain (R-AZ) implied that he may support rationing veterans health care, veterans organizations from around the country criticized the senator for suggesting that the Veterans Association should “concentrate our efforts to handle those wounds and disabilities that are directly the result of combat.” Paul Sullivan, executive director of Veterans for Common Sense, said McCain “appears to want to significantly narrow the number of veterans who can use VA, and that would alarm many veterans”:
[Veterans] should be very concerned by any effort to restrict access to VA health care and benefits by excluding other veterans with medical conditions clearly linked with their military service, such as illnesses related to Agent Orange poisoning, injures incurred in the combat zone, injuries due to training, and the adverse side effects of vaccines and experimental drugs.
But McCain’s comments, while worthy of denunciation, are not surprising. On the contrary, rationing health care is the foundation of McCain’s health care philosophy. His plan to replace the current tax breaks for employer-sponsored health insurance with a one-size-fits-all tax credit would leave many Americans with pre-existing conditions or fixed incomes without health care coverage.
In short, McCain’s plan provides health care insurance to the healthy and wealthy and leaves millions without coverage:
Today, while reporting on a new study that found that nearly one-third of the 47 million Americans without health insurance suffer from chronic conditions, CNN implied that the “16 million people in this country with a chronic condition but no insurance to pay for medical care” could use Sen. John McCain’s (R-AZ) proposed tax credits or money saved in Health Care Savings Accounts to purchase health insurance with “tax-free dollars”:
You know, this problem has been around forever and lots of great minds have opined about what to do about it. The two candidates are no exception…Now senator McCain wants to do this more through the private sector. He wants to give tax breaks to people so that,if they have more money, because they’re not using it for taxes, they could use it to buy insurance and also help savings accounts so that people could help pay for medical expenses with tax-free dollars. It’ll be interesting to see which solution the voters like better.
But McCain’s solution doesn’t solve the problem. While McCain would give $2,500 to individuals and $5,000 to families to buy health insurance in the individual market place, most insurance companies won’t provide insurance to the so-called uninsurables or individuals who “have conditions like cardiovascular disease, hypertension, and diabetes.”
Secondly, as Health Care For America Now points out, health care savings accounts would not work for those with chronic conditions because such plans “by definition favor the wealthy and/or the healthy”:
For those that never go to the doctor, or who can afford the high out-of-pocket costs incurred when using health savings accounts (you need to pay $1,050 as an individual or $2,100 for a family before your insurance will cover the rest), health savings accounts are great….For the rest of us, however, health savings accounts don’t work. If we get sick and see the doctor often, we have to pay those huge costs often; that means we have to save a lot of money in that health savings account. For those on fixed incomes, or even those just barely scraping by (and that’s a lot of us in today’s economic climate), putting away even $4,000 in a health savings account is out of the question.
As CAPAF Senior Fellow Peter Harbage and Director of Health Policy Karen Davenport argue in a new report, until the uninsured are part of the health care system, there will be no way to get a handle on their health care spending. Thus, “policies aimed at achieving savings while also improving quality would be even more effective in improving overall health system performance if they were combined with a policy to extend affordable health insurance coverage to everyone in the United States.”
Unfortunately, rather than analyzing the effects of McCain’s plan on the uninsured, CNN regurgitated McCain talking points. Such vapid reporting will not help voters decide “which solution [they] like better.”
The challenge of chronic disease is intricately related to the goals of sustainable health reform. Both will require a comprehensive approach—one that provides access to care for all Americans and ensures that such care is delivered in an integrated system where providers are paid for the quality, and not just the quantity of care.
California wants to take on the largely unregulated individual health insurance market — a system within which insurance companies impose waiting periods for pre-existing conditions, offer less comprehensive benefits than employer-based coverage, charge higher premiums and deductibles, successfully exclude high-risk individuals form coverage, charge higher rates to higher-risk patients, offer a limited range of benefits, and spend a relatively small proportion of premiums on actual medical care.
- The new rules “would set a maximum amount patients would have to pay each year toward their bills” and “restrict insurers’ ability to cancel policies retroactively.”
- Another proposal would “limit cancellations to the first 18 months of coverage and require insurers to obtain approval from regulators before revoking a policy.”
- Schwarzenegger would have “independent arbitrators decide whether an insurer could cancel a policy.”
- State regulators “would sort policies into categories based on the benefits they offer and establish minimum benefits for each category. Presumably, that would allow consumers to compare what competing companies offer.”
- Insurers may be “be required to spend at least 85% of the premiums they collect on medical care, limiting the amount they keep as profit and for administrative expenses.”
The new rules would provide patients “with preexisting conditions and other medical problems” greater “access to quality, affordable health care” and begin to establish the individual market place as a viable source of insurance for the millions of Americans who are currently denied coverage.
On Saturday, the Center for Disease Control (CDC) reported that the number of Americans infected with HIV is “much higher than previously thought.” According to the study, 56,300 people became infected with HIV in 2006, “40% higher than previous figures.”
Responding to the new data, Rep. Henry Waxman (D-CA) pointed out that under the Bush administration, the inflation-adjusted HIV prevention budget “had fallen over the past six years by 19%.” Sen. John McCain (R-AZ), while promising to “work closely with non-profit, government, and private sector stakeholders to continue the fight against HIV/AIDS,” would likely continue neglecting America’s domestic AIDS epidemic:
- Has not called for a national AIDS strategy: Even though the United States committed to developing a national AIDS strategy in 2001, it lacks a national plan. “In 2004, the Institute of Medicine determined that fragmentation of insurance coverage, and differing eligibility requirements and services across states, “do not allow for comprehensive and sustained access to quality HIV care,’ in the US.”
- Did not support federal funding for syringe exchange: While McCain opposes lifting the ban on federal funding for syringe exchange programs, “eight federally funded research reports concluded that needle and syringe programs, as part of a comprehensive HIV prevention strategy, are an effective public health intervention that reduces HIV transmission without increasing the use of illicit drugs.”
As senator, McCain rarely supported initiatives to prevent new HIV infections. In 2007, McCain admitted that he has “never gotten into these issues or thought much about” the effectiveness of condoms in stopping sexually transmitted disease,” but regularly opposed expanding access to contraception.