Diagnosing The Health Care Debate

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Our presidential candidates are offering their own proposals for how to improve our health care system. What changes can Americans look forward to, particularly those not insured? Our cover story is reported by Rita Braver:

At Signe's Heaven Bound Bakery and Café on Hilton Head Island, S.C., everything is made from scratch …

"Butter, sugar, eggs, there's nothing in a box, never in a box," said owner Signe Gardo.

The dozen or so employees who work here pride themselves on the food they turn out. But customers are blissfully unaware of something that troubles Gardo:

She cannot provide health insurance to her employees.

Gardo, who at age 67 is herself covered by Medicare, once did offer insurance.

But now she says, like some 40% of all small business owners, she just can't afford it.

"Recently I costed it out," she told Braver. "It could go as high as $70,000 for me. I mean, it's a matter of where do I appropriate the money? It's not coming, you know, through the door."

There are now about 46 million Americans without coverage. The folks who work at the Heaven Bound Café have been lucky - none of them has faced a health care crisis, yet.

But if you wonder what's it's like to be seriously ill, and have no health insurance, travel a few miles down the road and meet 48-year-old Sharon McGovern. Last year she was diagnosed with an aggressive type of cancer, follicular lymphoma.

"You never think that something like this is going to happen," she said.

"I was panicking, I didn't what to do. You know, some people with this disease can wait and watch. Some people can't and I just knew in myself that I could not."

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McGovern (left) had reason to be scared. In 1998 her then-32-year-old husband succumbed to liver cancer, after he put off getting treatment because his construction job offered no health insurance.

"How long between when he was diagnosed and when he passed away?" Braver asked.

"Six weeks."

Sharon was raising their son alone. She'd found a job with health insurance, and was doing fine … until she was laid off. She could have continued her old insurance by buying a temporary bridge plan but there was a problem:

If she had paid for what the health insurance was costing, she couldn't have kept paying her mortgage.

"No, I couldn't. I could not. We couldn't afford hardly anything at that point."

Before she could start a new job, her cancer was detected.

"And my greater fear is 'What's gonna happen?' I'm by myself. I have my child to take care of."

22,000 uninsured Americans die each year because they can't get care. And without insurance, Sharon McGovern was turned away by several doctors.

Her life was saved because she came to the Medical University of South Carolina, where she got onto a clinical drug trial.

"She wasn't just sick, she was dying sick," said Dr. Jack Feussner. "And somebody has to take care of the patients when that happens."

"Somebody" usually turns out to be a non-profit hospital like this one, says Dr. Feussner, chairman of the department of medicine.

"Our charity care has escalated in a frightening way to us: $80 to 100 million," he said. "We are getting to the point where this is threatening our financial solvency."

It's not just here: In 2006, American hospitals provided $3.2 billion worth of unpaid care.

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And patients like Chris Fleming (left), who works full-time for a property management company, still flock to emergency rooms all across the country.

"Has your work ever offered you any health insurance?" Braver asked.

"Eh, no, they have not," Fleming replied.

The hospital hires social workers like Stephanie Power to help find care for uninsured patients.

While the truly indigent are entitled to free insurance thru Medicaid benefits, and the elderly get Medicare, low-wage earners often turn up here because, under the law, hospitals must provide emergency room services for all patients.

But who really ends up paying for the uninsured? All of us.

"Maybe the standard amount that you charge a person with health insurance is a little bit higher to make up for all the uininsured?" Braver asked.

"Correct," said Dr. Feussner. "Patients with health insurance probably pay disproportionately more than they might if everybody was insured."

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The two presidential candidates have radically different approaches to the health insurance crisis.

Sen. John McCain says it's time to move away from employer-based care

"I want to give every American family a $5,000 refundable tax credit," he said. "Take it and get anywhere in America the health care that you wish."

As a trade off, McCain would tax - for the first time - employer-provided health insurance policies, which average about $12,000 annually for a family.

"The practical effect of the changes in the tax system that he's talking about are going to decrease employer sponsored insurance," said Linda Blumberg of the non-partisan Urban Institute's Health Policy Center.

That's because, according to Blumberg, young, healthy people will be able to find cheaper coverage on the open market than at work. And employers may no longer feel obligated to offer group insurance for everyone else.

The McCain plan, I think, would actually hurt people who have health conditions and people who are older, because they would not fare as well obtaining health insurance coverage away from their employers."

Fr the highest-risk patients, like Sharon McGovern, McCain says he would get states to subsidize special insurance pools called "guaranteed access plans." How they would be funded is unclear.

As for Sen. Barak Obama, he said, "If you've got health insurance through your employer, you can keep your health insurance, keep your choice of doctor, keep your plan."

Obama wants to build on the current employer-based system, subsidizing small businesses that can't afford insurance.

He would also create large insurance pools to sell affordable coverage to the uninsured, including those with severe health problems like Sharon. Larger businesses that don't offer employee health insurance would be required to pay in.

Health policy groups estimate that many more of the uninsured would be covered under Obama's plan. But it would be more expensive:

"The Obama plan just sounds like it's going to cost taxpayers so much money," Braver said.

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"Well, there is potential for big increases on spending if we're not careful about putting a serious emphasis on cost containment," Blumberg (left) said.

Today, more than half of all bankruptcies are due in part to health care expenses. It has not come to that yet for Sharon McGovern, though she did lose her house.

She doesn't know what she will do if her cancer goes out of remission.

"It's so scary," she said, "because I don't know what's going to happen."

What's more, she worries that no matter who wins the election, health care reform will become a low priority again:

"And that's one of my greatest concerns, is that it will get shoved under the rug because of the way the economy is right now."

And Dr. Feussner says hospitals like his have no choice but to keep trying to provide the best treatment possible, even as funds are harder to find.

"And what happens if we reach the breaking point?" he said. "Do I hope one of these candidates will become president and help with this? Yes, I do. I hope that they will do enough - if they don't do everything, that they will do enough - so that we don't have to look into that abyss."

"I don't know what the answer is," McGovern said, "but it should not be this way. How can we as an American people let people walk away or die because they can't afford health insurance?"
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