Health Reform and the 2008 Presidential Election Jonathan Oberlander Department of Health Policy & Administration Department of Social Medicine UNC-Chapel Hill

The Real Election

Roadmap I.The U.S. Health Care System II.Health Reform & The 2008 Election III.What’s Next?

Sicko & The Terminator

Health Reform Fever Contracted by otherwise politically healthy American adults every years. Symptoms include delusional belief that health reform is inevitable or just around the corner, and misplaced faith in the American political process. Only known cure is a harsh dose of political reality, to be applied repeatedly to prevent relapse.

I.The U.S. Health Care System

Number of Noneldery Uninsured, in Millions: Source: US Census Bureau, Changed methods in 1999

Percentage of Firms Offering Health Benefits: Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits,

Beyond the Numbers

When Health Insurance is Not a Safeguard New York Times, October 23, 2005 “Zachery Dorsett's parents thought their son was an average child who was having trouble getting over a passing illness. He was 7 months old, and it was his second case of pneumonia… But Zachery, who was eventually found to have an immune system disorder, kept getting sick, and the expense of his treatment - fees for tests, hospitalizations, medicine - kept mounting, eventually costing the family $12,000 to $20,000 a year… Earlier this year, the Dorsetts stopped making mortgage payments on their ranch house, because they could not afford them. In March, they filed for bankruptcy.”

Blue Cross Cancellations Called Illegal Los Angeles Times, March 23, 2007 “ The state investigation found that Blue Cross used computer programs and a dedicated department to systematically investigate and cancel the policies of pregnant women and the chronically ill regardless of whether they intentionally lied on their applications to cover up preexisting medical conditions - a standard required by state law for canceling individual policies.”

II. Health Reform & The Election

Candidates’ Reform Plans Attention All North Carolina Voters. Read These Plans at Your Own Risk. Telling the Truth is Politically Risky (ask Walter Mondale). Plans May Change Without Notice When Candidate Enters the White House.

Clinton Health Plan

Obama Health Plan

Obama-Clinton Plan Modified employer mandate (small business exemption) Creation of purchasing pools Establishment of new public insurance program Regulation of insurance industry Financing through repeal of tax cuts for those making over $250,000

Obama-Clinton Feud: Individual Mandates ''You know,'' Mrs. Clinton said, ''when I proposed a universal health care plan, as did Senator Edwards, we took a big risk, because we know it's politically controversial to say we're going to cover everyone. And you chose not to do that. You chose to put forth a health care plan that will leave out at least 15 million people. That's a big difference.”

McCain Health Plan Tax credits ($2500 and $5000) Replace tax exclusion for employer- sponsored insurance Encourage individual purchase of insurance Deregulate insurance market Health Savings Accounts

Common Ground on Cost Control Prevention Disease Management Coordination of Chronic Care Electronic Medical Records

Political Challenges DemocratsRepublicans Universal Coverage Employer mandate Regulate insurers Create new Medicare- like government plan Establish purchasing pools Individual mandate Raise taxes to cover the uninsured Tax health insurance benefits Move away from employer-sponsored insurance Convince people they currently have too much insurance

Obstacles to Reform Power of the Status Quo Stakeholder Opposition Congress & 60 Votes Agenda Competition (Iraq, Taxes etc.) Budget Deficit & PAYGO Limits of Consensus Ideological & Partisan Divide

III. What’s Next for Health Reform?

“ Mr/s. President. I Know It’s 3AM. But Here’s How to Pass Health Reform.”

Memo to the Next President Time is not on your side Make the economic case Persuade the insured Explain costs of not reforming the health care system And don’t forget….

The Improbable is Not The Impossible