The number-one healthcare issue facing the country is not which prescription drug plan is best for seniors or whether a handful of patients will be able to sue their HMOs. It is the 44 million people, or nearly 20 percent of the population under age 65, who have no health insurance and, for many, no healthcare at all. The myth that emergency rooms provide all the care the uninsured require continues unchallenged. But the emergency room is not the place to get primary care, follow-up care or care for chronic conditions, which most people need. Federal law requires emergency rooms to stabilize patients. After that, they are sent on their way, especially if they have no money to pay for further treatment. When they are given prescriptions, 30 percent of the uninsured don’t fill them because of the cost.
Rationing specialty care for the uninsured is common. In Washington, DC, the uninsured wait four months for an MRI and two months for a CT scan. In California, some counties have money to screen women for breast cancer but no money for treatment. During the four to seven years following an initial diagnosis of breast cancer, one national study shows, uninsured women are 49 percent more likely to die than women with insurance. Community clinics that treat the uninsured rarely have specialists on their staffs and resort to begging area physicians to help out–not always with success.
The Bush and Gore solutions do little to help the uninsured and a lot to keep the healthcare system safe for insurance companies, the AMA, employers and the pharmaceutical industry, all of which have shoveled money into their campaigns. Bush proposes an annual refundable tax credit (that is, one that’s given even if a person owes no taxes) of up to $1,000 for individuals and $2,000 for families. His campaign literature makes tax credits sound ideal: “If a family earning $30,000 purchases a health insurance plan costing $2,222, the government will contribute $2,000 (90 percent).” Trouble is, most families can’t buy insurance for $2,222. The average premium for a family policy is $6,740 and for an individual, $2,542. Gore calls for a credit equal to 25 percent of the premium. Using the average premium as a benchmark, that’s about $1,700 for family coverage; a family wanting a policy would still have to cough up more than $5,000.
Tax credits, moreover, leave intact the ability of insurance companies to select good risks and exclude sick people who will cost them money. That, of course, is what the industry wants to protect–and is part of the payoff for its campaign largesse.
Both Bush and Gore would also fiddle with the Children’s Health Insurance Program (CHIP) to boost coverage. CHIP has brought health insurance to some 2.5 million kids, but 10 million still have none. Bush’s solution: Give the states more flexibility in administering the program. But many states have not even spent federal dollars already earmarked for them, and could be tempted into using the money for something other than insurance. Gore’s solution: Stretch the eligibility rules to include children whose families have incomes up to 250 percent of the federal poverty level, or $41,000 for a family of four. But what if a family’s income is above 250 percent, say $43,000? Gore’s answer: tax credits.