Diagnosing The Health Care Debate

(CBS)  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."

(CBS)

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.

(CBS)

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."

(CBS)

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.

(CBS)

"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?"

[somedoctor]

I did a calculation for a friend about his health care expense under McCain''s proposal. He was convinced his healthcare expense would go up because of the taxation component. He is a healthy person, aged 30 something, with an individual policy. If he can use the health care savings provision to the maximum allowable, he would actually save money (although the money would be in his health care savings account). At least the plan provides a tax incentive for healthy people to save money for when they eventually develop health problems. More importantly, it helps separate health insurance from your employement. It is only the insurance companies that benefit from tying insurance to employment.

[somedoctor]

If the media wants to compare our healthcare system to socialized healthcare systems, why don''t they compare it to the VA medical system. Everybody knows someone who is a vet. Just ask them what they think of socialized healthcare.

[guatom]

A plastic valve with some pig tissue attached costs more than a new SUV. This does not include freight, handling, and installation. These are add-ons. An good artificial leg costs more than a SUV. This does include freight, handling, and installation. The cost of these devices ranges $600,000 a pound to the low of about $5,000 a pound for the plastic leg. Such a deal.

[dudelookslikeachimp]

Quick call your contacts in the McCain camp.

The correct McCain Public Health Care plan should be funded by rerouting all punitive awards in malpractice and other medical lawsuits to the Public Health Care fund. Punitive awards do not bring back the dead or cure handicaps. Other award sections cover reimbursement of lost livelihood and medical costs. So that no lawyer could still walk off with a windfall, if such lawsuit is done for a share of the award -- lawyer fees would be limited by both a maximum of 5% of punitive award or the median regional legal billing rate -- whichever is lower given the tendency to inflate billable hours.

This should provide more than adequate funds for those with no medical insurance according to Republican claims. At least until lawsuit profiteers stop suing for excessive amounts. By the time that happens medical costs should have dropped significantly according to Republican sources.

McCain might also want to make doctor service rankings (cost, malpractice, experience, specialty, training, etc) publicly available nationwide -- on the theory these are PROFESSIONAL and therefore PUBLIC instead of personal and private. This would help everyone -- including bad but honest doctors (who could go for more training or get out of riskier services).

[dudelookslikeachimp]

Yes Obama healthcare is bad when you look deep...but shame on McCain. He simply lacked the courage to tell voters to "FO" on health care. Apparently McCain felt obligated to match the Obama sales point with something.

I know lots of Republicans who agree with the "FO" - but curiously none except paid commentators and fanatics are claiming McCain''s plan actually improves anything in personal health care.

McCain could have formed committees during the summer to show people how to improve medicine within the current system before the election -- like forming private Health Unions to mass buy drugs, how to select insurance policies, etc. He choose not to undermine Obama that way.

But in the end McCain''s chose to try sleight of hand deception. His only change is a reflexive Republican attempt to move money from federal health care programs to direct spending vouchers/tax credits by citizens on existing commercial medical care. It is still a federal handout McCain and it surely isn''t going to stretch farther spend in private medicine.

[mcapek]

"Doctors can choose NOT to work with the VA. Nor is the VA consistently high quality" Yup, you will not find the best doctors, nurses, whatever in VA, that is for sure!! Mediocre at best..

[dudelookslikeachimp]

Also note that what makes the VA acceptable for many vets is the chance to talk with people with a common mindset and experience base -- veteran soldiers.

Now put the random collection of US citizens and especially disrespectful youth in the same waiting room...and I bet the vets care rating would drop like a rock even if actual care remained pretty much the same for vets.

Who have to wait with half a day makes a big difference in acceptability...even when you have the financial freedom to wait all day.

How is Obama covering those lost wages or work hours to business? Let me guess it will be declared a right that businesses will be expected to foot the bill for like pregancy leave. Absenteeism will disappear as employees can now go wait for aspirin when they are hung over with no consequence allowed.

[dudelookslikeachimp]

VA care for immediate combat wounds is normally top notch...the active military and Congressional interests oversee that closely. Heads roll when that fails.

But as that wound heals as best as it can and time distances the vet from active service?

VA responses in long term care are definitely a few notches down. While they do their best with the people and resources they have -- within the regulatory hoops -- most VA employees admit that if you have good medical insurance or money you might well be better off elsewhere. I am a vet and have been told this many times.

[dudelookslikeachimp]

LOL - you take Congressional Record figures at face value? Any Congressperson can publish what he wants in the CR. The CR is NOT edited for being factual or unbiased. It is very much like campaign ads...just edited a bit more carefully.

The first rule of the federal government is "if you got an embarrassing problem, it can be made to disappear by narrowing the definition of terms".

So how do we know lawsuits add to health care bills?
The most accurate way is comparing medical lawsuit awards in collection (law review) to total health care bills for one year. All awards are somehow absorbed and passed to consumer patients and their insurance companies. When you got a trillion dollars in lawsuit awards in one year...

I suspect the statistics given were bent by

(1) Excluding all malpractice insurance costs

("logic"...courts awards are covered by insurance and all business have insurance -- so this is not a special cost no matter how expensive. Gaps between court award and coverage are "business errors" that should not be passed to consumers.)

(2) Costs of lawsuits only count if directly passed to consumer patients by a medical retailer like a doctor or pharmacist

(In other words price increases due to lawsuits against pharmaceutical companies and medical equipment companies do not count. Because manufacturers do not directly sell to or bill patients, this is not a patient cost but part of "regular" retail business overhead to pharmacy or doctor.)

[dudelookslikeachimp]

Yes the VA is better than other free federal medical programs -- no surprise.

Less costly? Only for what the patient is billed. The VA is NOT self-supporting like the Post Office. Gee, the Federal government pays the other "hidden" costs with taxes? Yes Virgina some still picks up those billions in costs the patients do not pay. That is why the VA has been a Presidential cabinet position -- huge budget plus a lot of votes.

The VA efficient? Sometimes but often not. The VA sunk over $20 billion during the 1980-mid1990s period into replacing computer records system. The several high dollar programs failed to produce much improvement or results BEFORE the mid-1990s. Then they spent another $8 billion deploying and tuning that final system through the early 2000s.

Any private hospital system would have had to declare bankruptcy several times over. Lots of heads would have rolled long before all that initial money went down the toilet - not just the handful of VA directors and program managers who did.