The Political Chase

McCain’s anything but universal health care plan

John McCain is scheduled to deliver a speech on health care today. Following are excerpts from his prepared remarks. As you can see, McCain makes no provision for the 47 million Americans that currently do not have health insurance. Instead, he says he will “work tirelessly to address the problem.” Has he already started? Does Quick Draw McGraw already have a bill pending?

Well, I suppose I overstated that a bit. If any of the 47 million uninsured have sufficient income to yield a $5,000 tax liability, they can get a $5,000 tax credit. Assuming they are fully employed, That will only put them about 18 months behind in the payment cycle, assuming they have the means to get started and an insurer that will accept them. And, if their premiums will be as expensive as mine are ($900+ per month w/high deductible for just me and that’s with only one family-physician visit in seven years), the $5,000 might be as useful as $0.05. The point is, $5,000 tax credits are realistically only applicable to middle- or higher-income brackets.

Moreover, he intends to have the A-Team (”insurers, businesses, state legislators”) and “patients” to hammer out a plan to “reach out” to “at risk people” and will ultimately be managed by the states, that is, if the “states consent.” That smells, at best, like No Child Left Behind, but with an option to say no and consequently block benefits from whatever special-interest-centric plan the A-Team and “patients” will develop.

I would also like to know how “patients” working on the A-Team will be determined. Will Ronald A. Williams of Aetna be an A-Team patient? Will any of the homeless veterans sleeping under bridges be included in the “patient” group? Will Donnie Ingram, who lost his job in January when his Lancaster County, SC textile mill employer outsourced its operations to Brazil, be an A-Team patient? And, of course, there is always the option of yanking that myocardial infarction patient out of Trauma Room No. 1 for a four-hour video conference.

Maybe Mr. Bush Mr. McCain will address it in his speech, but there is nothing in the advance excerpts about S-CHIP, which George Bush refused to sign. (If he has signed it over the past few months, I’m not aware of it.)

The key to real reform is to restore control over our health-care system to the patients themselves. Right now, even those with access to health care often have no assurance that it is appropriate care. Too much of the system is built on getting paid just for providing services, regardless of whether those services are necessary or produce quality care and outcomes. American families should only pay for getting the right care: care that is intended to improve and safeguard their health.

When families are informed about medical choices, they are more capable of making their own decisions, less likely to choose the most expensive and often unnecessary options, and are more satisfied with their choices. We took an important step in this direction with the creation of Health Savings Accounts, tax-preferred accounts that are used to pay insurance premiums and other health costs. These accounts put the family in charge of what they pay for. And, as president, I would seek to encourage and expand the benefits of these accounts to more American families.

Even so, those without prior group coverage and those with pre-existing conditions do have the most difficulty on the individual market, and we need to make sure they get the high-quality coverage they need. I will work tirelessly to address the problem. But I won’t create another entitlement program that Washington will let get out of control. Nor will I saddle states with another unfunded mandate. The states have been very active in experimenting with ways to cover the “uninsurables.” The State of North Carolina, for example, has an agreement with Blue Cross to act as insurer of “last resort.” Over thirty states have some form of “high-risk” pool, and over twenty states have plans that limit premiums charged to people suffering an illness and who have been denied insurance.

As President, I will meet with the governors to solicit their ideas about a best practice model that states can follow – a Guaranteed Access Plan or GAP that would reflect the best experience of the states. I will work with Congress, the governors, and industry to make sure that it is funded adequately and has the right incentives to reduce costs such as disease management, individual case management, and health and wellness programs. These programs reach out to people who are at risk for different diseases and chronic conditions and provide them with nurse care managers to make sure they receive the proper care and avoid unnecessary treatments and emergency room visits. The details of a Guaranteed Access Plan will be worked out with the collaboration and consent of the states. But, conceptually, federal assistance could be provided to a nonprofit GAP that operated under the direction of a board that included all stakeholders groups – legislators, insurers, business and medical community representatives, and, most importantly, patients. The board would contract with insurers to cover patients who have been denied insurance and could join with other state plans to enlarge pools and lower overhead costs. There would be reasonable limits on premiums, and assistance would be available for Americans below a certain income level.