Health care: Clean bill of health?

More Americans are forgoing medical care they can’t afford or struggling to pay health care-related bills, according to recent studies, problems both presidential candidates have pledged to address if elected.

Local health care professionals say that while the shortcomings in health care are obvious, government action alone can not solve them.

Both candidates – Democrat Barack Obama and Republican John McCain -- have proposed plans they say will make health insurance available and affordable to more Americans, but in very different ways.

McCain favors a refundable tax credit of $2,500 for single persons and $5,000 for families as an incentive to buy insurance on the open market, while Obama would require that children be covered and large employers either provide health insurance or pay into a public insurance program. Smaller businesses, according to the Obama proposal, would receive a refundable tax credit of up to 50 percent of premiums paid on behalf of their workers.

Obama’s plan – which he estimates would cost the federal government between $50 billion and $65 billion annually – borders on universal health care, though he plans to achieve coverage for all through a mix of private and expanded public insurance.

McCain opposes establishing a mandate for coverage but would reform the tax code to allow an employee’s health benefits to be considered income and would ease up on medical insurance guidelines to allow consumers more flexibility in purchasing plans.

“When the candidates speak globally, it’s very difficult to react or say one is better than the other,” said Frank Trembulak, executive vice president of Geisinger Health Care Systems. He said the candidates are busy campaigning and no payment structures have been determined.

Debt mounting

A study done by The Commonwealth Fund, a private foundation, shows 72 million adults under age 65 said they had problems paying bills or had outstanding medical debt in 2007. That number, the biennial study said, is up from 58 million in 2005.

The Kaiser Family Foundation and the Health Research and Educational Trust last week said premiums rose 5 percent this year for participants in small-employer plans, a slower rate of increase than over the past decade. But the research also found a shift toward higher deductibles and co-payments that require workers to pay more out-of-pocket.

Tom Hannigan, a member of The Times Leader voter panel, said he’d rather pay for health care than have the federal government make his medical decisions. He cites acquaintances in Canada, which has government-funded universal health care, who choose to buy private insurance.

Hannigan said he is told the Canadian system is “so controlled or problematic.”

Another panel member, Dorene Schutz, said U.S. officials can find the money to fund a universal program.

“If they cut some of the pork, there is plenty of money for health care,” Schutz said.

Denise S. Cesare, president and chief executive officer of Blue Cross of Northeastern Pennsylvania, said the health care industry needs to convince consumers to take a more active role in maintaining their health.

“The cost of health care keeps rising in part because the current system is fractured, and the players – physicians, hospitals, insurers and consumers – have widely divergent incentives,” Cesare said. “As a health care community, we need to work together to align the incentives of all parties so that everyone is working in concert to help patients get well and stay well.”

Maggie Koehler, senior vice president/chief financial officer for Wyoming Valley Health Care System, said once people reach chronic disease stage, the cost of care skyrockets.

“If people took more interest in their health prior to getting sick, the cost of health care would decrease significantly,” Koehler said. “But people want to live bad lifestyles – smoking, drinking and eating to excess – and that causes many health issues. People don’t want to be accountable for paying for conditions they are largely responsible for having.”

Dr. Susan Sordoni, founder of the Volunteers in Medicine Clinic in downtown Wilkes-Barre, said the 35,000 residents of Luzerne County without health insurance have difficulty finding a primary care physician, so they go to emergency rooms, which cost far more.

People with life-threatening diseases, such as diabetes, hypertension, asthma and high cholesterol, could be treated, educated and monitored by a primary care physician on a regular basis if they had health insurance, she said.

Koehler said the obvious way to increase coverage is to make it more affordable, and having more healthy people in the system would keep costs down.

“A large part of our uninsured population are uninsured by choice,” she said. “Most are fresh out of college; graduates who don’t feel they want to spend money on health care benefits.”

Koehler contrasted the situation to the car insurance industry, where costs are kept reasonable because of the high number of participants who pay into it, but are accident-free. She said if more people paid into the health care system and didn’t access it, costs could be kept lower.

McCain thinks more competition among insurance companies – and resulting lower premiums – could be stimulated by permitting the sale of insurance on a national level, instead of having it regulated state by state.

Obama promotes insurer competition through a National Health Insurance Exchange and by regulating the portion of health plan premiums that must be paid out in benefits would help.

Both candidates offer plans to improve preventive care so that Americans can avoid chronic illnesses as they age.

The nonpartisan Tax Policy Institute estimates 34 million more people would have insurance coverage after 10 years under Obama’s plan.

Many employers would drop health care benefits under McCain’s plan, the institute said, resulting in a net gain of 1 million insured.

Whenever Obama uses the term “universal coverage” on the campaign trail, voter panel member Jack McIntyre of Plains Township cringes.

“As far as Obama’s plan, that is nothing but socialized medicine and he will pay for it by taxing us more and more as he expands the size of the federal government to pay for all his grand plans,” McIntyre said. “I support McCain’s plan to make health care affordable and hope he institutes a better drug plan for Medicare recipients.”

Another panel member, John Barnes, thinks Obama’s health care proposition is exactly what America needs. Barnes, a college administrator, calls the current health care situation a “national crisis.”

“Sen. Obama believes, as do I, that ‘every American has the right to affordable health care,’ ” he said.

Cesare said that beyond insurance coverage, there needs to be more support for improving the quality of care.

“The government needs to establish minimum standards for coverage and health outcomes,” she said. “Providers must adhere to standards of quality and efficiency. And payers have to provide options and partnerships that help ensure the delivery of the right services at the right time for the right people.”

McCain says he will set national standards for care and use technology to share information on “best practices.” Obama wants independent research on preventable errors and would reward providers who perform well.

Geisinger’s Trembulak said that while the candidates’ plans are intriguing, there is no silver bullet to insuring every American right now.

“You’d have to reform the overall system, so attempting to deal with one part is tough,” he explained. Having a baseline of benefits for everyone would be a step in the right direction, he said.

Now go vote

Individuals can register to vote in the Nov. 4 general election through Monday, Oct. 6.

A U.S. citizen, a resident of Pennsylvania and the election district in which the individual desires to register and vote for at least 30 days before the election; and at least 18 years of age on or before Nov. 4.

Voter registration forms are available at the Luzerne County Bureau of Elections office, 20 N. Pennsylvania Ave., Suite 207, Wilkes-Barre or the County Annex at 123 Warren St., Hazleton.

Completed forms should be brought or mailed to: Luzerne County Bureau of Elections Voter Registration Division, 20 N. Pennsylvania Ave., Suite 207, Wilkes-Barre, PA 18701-3505