The Real Reformer
McCain's superior prescription for health care.
by Robert Goldberg
03/10/2008, Volume 013, Issue 25
John McCain's proposal for health care reform is more than a plan for making health care more affordable and for controlling costs through deregulation and market competition. It is also an attempt to restore independence and human dignity to patients. Both of his potential opponents in the fall presidential race speak only of extending the government's role in health care--a position supported in the main by large corporations, unions, and the managed-care lobbies. McCain's patient-centered position makes him--not Clinton or Obama--the force for change in health care.
McCain's plan is based around patient-centered initiatives that already have broad support among Republicans in Congress. They include letting people buy health insurance nationally instead of only from state-regulated firms; giving people the choice of purchasing coverage through cooperatives or other organizations (churches or civic groups, for example); expanding health savings accounts; and making health insurance portable by giving people tax credits of up to $5,000 per family to buy their own coverage instead of getting it through an employer.
His chief concern is for people to take ownership of their health care. McCain likes to note that "Ronald Reagan said nobody ever washed a rental car. And that's true in health insurance. If they're responsible for it, then they will take more care of it."
At the heart of McCain's proposals is his effort to allow veterans, particularly soldiers returning from Iraq with traumatic brain injury and mental illness, to get care anywhere rather than just through the Veterans Health Administration (VA): "America's veterans have fought for our freedom. We should give them freedom to choose to carry their VA dollars to a provider that gives them the timely care at high quality and in the best location."
What stirs McCain are stories like that of Sergeant Eric Edmundson who returned from Iraq unable to walk or talk after being hit by a roadside bomb. Edmundson was sent to a VA hospital in Richmond, Virginia, for rehabilitation care. After six months, doctors said he was in a permanent vegetative state and tried to send him to a nursing home where he would be discharged from the Army. But Edmundson's father found out that his son could use his GI vocational benefits (available only after he received VA care but also only if he remained in the service) to receive treatment at one of the world's leading traumatic brain injury (TBI) centers: the Rehabilitation Institute in Chicago. His father prevailed over VA objections. After six months of therapy at the Chicago center, Edmundson was able to talk and walked out of the rehab center under his own power.
The VA system that McCain is attacking is the starting point for the Democratic plans for universal health care. Both Hillary Clinton and Barack Obama want to expand the VA's electronic health care system to the rest of the country. Obama has promised to spend $50 billion on electronic health records based on the VA model. And Clinton likes to claim credit for that model, which she calls an astounding success:
We started during the Clinton administration to transition the VA system to a paperless system. .â€‰â€‰.â€‰â€‰. The VA is leading the way in reducing medical errors, improving patient safety, and delivering high quality care; now this is a lesson about what can be done when we have a plan. A plan that is evidence-based, a plan that uses what we know works, and a system that we can actually get to respond to that evidence-based planning.
In fact, as a government audit discovered, the VA's paperless system has created a huge bottleneck, losing track of 53,000 veterans.
Last year, Obama introduced legislation requiring the VA to treat each returning vet in 30 days. Yet, the VA already had such a requirement, and, according to internal VA audits, 25 percent of all vets wait more than 30 days for their first exam. Of the veterans kept waiting, 27 percent had serious service-connected disabilities, including amputations and chronic problems such as frequent panic attacks. Iraq war vets often have to wait six months for their first appointment.
In some VA hospitals, vets wait 18 months for surgeries--a record worse than Canada's or England's national health care systems. The VA's budget for its health care system has doubled since 2001, and Obama still proposes to give more money.
The differences between McCain and the Democratic candidates on health care boil down to freedom of choice. Clinton and Obama want in varying degrees to force Americans to enroll in health plans designed by the government and pay premiums set by the government. Companies that don't cover workers would be required to pay an additional tax to subsidize what amounts to Medicaid for all. If previous experience with S-chip is a guide, it will lead private firms to dump employees into government-run plans. Both Obama and Clinton would limit what drugs and services plans pay for to what the government deems "cost effective."
If you don't want government health care, you won't be able to set up a health savings account as they will be illegal. McCain would increase the opportunities for individuals to choose the care that's best for them by giving patients and doctors the dollars, information, and freedom to make medical decisions instead of a government agency.
Indeed, if Eric Edmundson's father had possessed the freedom to take his son to the best place for care instead of waiting for a bureaucrat's approval, his son would have been walking sooner. McCain's health care plan reflects his desire to make the medical system for vets embody the same freedom and dignity they fought for in Iraq. That's a powerful vision for reforming the whole health care system.
Robert Goldberg is the vice president of the Center for Medicine in the Public Interest.
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