Health Care

Health care is a major issue in the country this year. Surveys consistently show it to be second or third on voters' minds, after the economy and either just ahead or just behind Iraq. The voters are right to be worried, for the same kind of bubble that has thrown the housing sector into turmoil has been growing in the health care industry for some time too.

More and more Americans, up to and including middle and upper middle class Americans, are afraid for the first time in decades that they may be left without coverage or lose the coverage they have. An estimated 47 million Americans are currently without health insurance, a number that has been steadily increasing during the Bush years and will certainly grow further in the recession as more workers lose their jobs and more employers find themselves financially strapped.

The availability of health care is a moral and practical necessity. It is a national disgrace that anyone in America should be one illness away from bankruptcy, and that tens of thousands of preventable deaths occur annually because people without health insurance wait until it is too late to seek medical attention. The contention that the richest nation on earth cannot afford medical care for all its citizens is unpersuasive when a country like Turkey can and does. It is impractical as well, since some form of universal care would save billions in lost productivity, early deaths and expensive emergency room treatment for conditions that ought to have been taken care of earlier and cheaper in routine settings.

Senator McCain feels the present system can be made to run more efficiently. He supports tax credits for the purchase of insurance plans. He may be right about efficiency, but his approach does not solve the basic problems. Millions cannot afford policies, tax credits or no. And insurers do not want to insure less affluent people below market prices or those who are high risks. They are in business to make money, and there is no money to be made on such customers.

Senators Obama and Clinton have plans that are quite similar to each other. People could sign up for medicare-type coverage available to all or pay for any other plan, including those available to members of congress. There would be a limit to the percentage of a family's income they would have to pay themselves, and the rest would be government-subsidized. It would be transportable rather than tied to one's job. Employers would still be encouraged to provide coverage to their workers and would get breaks to do so. Insurers and providers would still need to compete; they could not decline coverage to anyone and medical services would still remain in private hands.

Obama's plan requires people to insure their children but not themselves. It is estimated his would cost at least $65-90 billion per year. Clinton's requires everyone to get insurance and is estimated to cost $90-120 billion per year. Both campaigns say they would pay for their programs by rescinding the Bush tax cuts on upper-income earners and perhaps levying unspecified taxes on employers, especially those who do not cover their employees. It may be noted that both plans cost far less than the War in Iraq, which both Democratic candidates have committed to end. That is another potential source of savings that might be applied to either of their health plans.

The voters will thus have a clear choice on health care this year. Will the United States continue to be the only advanced nation that does not make sure all its citizens can go to the doctor when they are ill? That will depend on which candidate and party better enunciates the case for its priorities and the downside if their rival's are adopted instead.