Monday, October 11, 2004

So Alike, Rivals Make It Personal

Why does the NYT publish this idioticy. I know many who believe that our American Democracy has been corrupted (and there's not that much difference to be made by who is elected), but this editorial is just so superficial I can't believe it's not a way to try to calm the populace down or something.

For those who need reminding:

1) The budget deficit is not a personal issue.
2) The integrity of the Social Security System is not personal.
3) Healthcare access and costs are not personal.
4) Our outlaw war activities are not personal.
5) The betrayal by the 911 Coverup Commission is not personal.
6) The police state authorizations of the Patriot Acts are not personal!
7) The collaspe of Enron was not personal.

This list could go on and on and on. I'm not saying John Kerry is on the right side of these issues, but an editorial like this glosses over the reality that we have a mentally ill criminal in the White House.

Below is a Boston Global piece:

Kerry, Bush plans offer a stark choice
By Raja Mishra, Globe Staff | October 10, 2004

Both presidential candidates agree the American health care system is troubled: Coverage is too costly, too many are uninsured.

But President Bush and Democratic nominee John F. Kerry drastically diverge on the solution, offering voters a stark choice in November.

Bush seeks to allow more people to buy health care on their own, rather than through employers or government, arguing that consumer choice would force health care costs down.

Kerry would spend significantly more taxpayer money than Bush on health care, but his plan would provide insurance to nearly three times more people.

''Both candidates' plans provide an expansion of coverage for people currently lacking health insurance," said John Sheils, vice president of the nonpartisan Lewin Group consulting firm, which analyzed both plans earlier this month. ''But the two plans differ in their scope. ''

A Lewin Group analysis found that Kerry's plan would insure 25.2 million more Americans, at a cost of $1.2 trillion; Bush's plan would cover 8.2 million people with a $227.5 billion price tag. More partisan analyses differ, though the wide differences in scope and cost between the plans are a common theme of virtually all of them.

Neither proposal, however, would cover all Americans or significantly slow the health care price increases bedeviling so many families and businesses, according to analysts. And both plans are unlikely to pass in a Congress still deeply split over health care more than a decade after Bill Clinton launched his unsuccessful reform effort.

''It's going to take a generation to make the changes needed," said Joseph Antos, health policy specialist at the conservative-leaning American Enterprise Institute. ''The will just isn't there now."

The nation's health care woes are most dramatically personified by the nearly 45 million Americans lacking health insurance in 2003, up 1.4 million from the year before. These people can still get medical care in hospitals, but typically they postpone care until symptoms become serious. Thus, they often fare worse than those with insurance, who get care earlier and are generally healthier.

Moreover, the uninsured raise health care costs for everyone else. Hospitals treat them for free, but turn around and charge other patients more to make up the costs.

The largest chunks of the uninsured population fall into several categories: working families not poor enough to qualify for government programs but unable to afford insurance; healthy young adults willing to risk forgoing insurance; part-time workers and the self-employed; poor people unwilling to sign up for government programs because of the perceived stigma.

And rising health care costs are forcing more and more people to join the ranks of the uninsured. Workers' average monthly contributions for insurance coverage have risen to $201 in 2003 from $52 in 1988. By 2006, the average annual family premium is expected to be $14,500.

However, the spike is actually a symptom of a desirable trend. It reflects the fact that ever more medical technologies -- surgeries, drugs, tests -- are available to treat sickness. Of course, there is more sickness: As people live longer, they develop all sorts of chronic ailments that require lifelong care. Nonetheless, other countries with similar access to high-tech medicine, such as Germany, Canada, and France, manage to do it at a lower cost and cover their populations. These nations have government-run systems that offer universal coverage.

Bush has signed into law one major health care change: the addition of drug coverage to Medicare, the government program that pays for seniors' care.

He pushed though legislation expanding use of Medical Savings Accounts (MSAs), which allow workers to start tax-free accounts to pay for health care rather than buying insurance through employers. Money not spent on health care would be saved rather than lost, as is the case with insurance.

Still, few Americans have opted in, and MSAs remain a marginal part of the system.

Also, Bush proposed a cap on medical malpractice awards, which many argue add to health costs by forcing doctors and insurers to pay out exorbitant amounts in court cases. His bill is stalled in Congress. Finally, Bush has opened or expanded more than 600 community health centers, many in poor and rural areas, giving millions better access to primary care.

Still, the number of uninsured people and health care costs have spiraled upward during his first term.

Kerry proposes expanding government-funded coverage. He would spend between $653 billion and $1.5 trillion over 10 years. (Health care costs are complex and hard to predict, and therefore estimates vary.) To pay for this, he would raise taxes on those making over $200,000 a year.

''The Kerry proposal is a big proposal, not a huge proposal like the Clinton plan, but a big one. It's also much more expensive. The Bush proposal is much smaller," said Harvard economist David Cutler, who advised the Kerry team on health care.

Kerry offers a two-pronged plan: First, Kerry would expand existing government programs in order to cover virtually every American child lacking insurance, as well as millions more adults.

Secondly, he would help companies pay for very sick patients. These ''catastrophic patients" usually suffer from chronic conditions and although they make up about 1 percent of those in the health care system, they use 30 percent of the health care dollars spent. Kerry would pay 75 percent of companies' catastrophic costs. Companies would save money on health care, and be able to afford to cover more workers while charging them lower premiums. Kerry's campaign estimates that the average worker at companies participating -- the plan is voluntary -- would save $1,000 annually.

''That's a big deal for the average worker," said Cutler.

Kerry's plan would cover about an additional 27 million Americans.

But Antos said the Massachusetts senator's plan relies too heavily on government, noting that the centerpiece of Kerry's plan, the catastrophic patient coverage, meant the government would have to spend hundreds of millions more on health care.

''Who makes health care decisions? In the Kerry plan, it's the same people who have been making the decision all along -- the government. But it's still not me, it's not the individual," he said. ''Kerry doesn't change the fundamental decision-making structure in health care, which caused the problems in the first place. He reinforces the problems."

Campaigning recently in St. Cloud, Minn., Bush characterized the health care debate this way: ''When it comes to health care, we have a difference of opinion -- and it's a big difference of opinion in this campaign. My opponent wants the government to dictate. I want you to decide when it comes to health care."

Bush's plan is far smaller: The price tag is about $145 billion to $160 billion. And its reach is more modest: An estimated 6.7 million to 11 million uninsured Americans would be covered. But his plan is more conceptually audacious, falling under his ''Ownership Society" mantra.

Its core principal is that most Americans should buy health care as they buy anything else, like cars, or groceries. Right now, most people don't buy health care -- they buy insurance, paid for with set monthly payments. Therefore, they don't actually feel the costs of health care -- so its nothing to order costly or unnecessary tests and procedures, which in turn inflate costs. If patients paid on their own, they would be more likely to decline extra tests and procedures and be more careful about maintaining their own health, many specialists say.

Bush's plan would try to move in that direction, at least on a small scale. He would offer tax credits of up to $2,000 for joining MSAs, where people would buy care on their own. Also, he would offer a tax credit of up to $3,000 for low-income families to buy insurance.

Critics argue the amount set aside by Bush is so small, only a fraction of the population would benefit.

Moreover, critics say the health care market is far too confusing for the average consumer to make informed choices.

The last major part of Bush's plan would be to help businesses and individuals to organize into collectives to negotiate lower health insurance prices. And he would continue to expand the rural health clinic network.

However, health care specialists say that neither candidate has proposed anything that would end the twin problems of rising costs and growing numbers of people who are uninsured.

''I don't expect either candidate to solve this problem this year," said Antos.

Earlier installments of this series appeared Sept. 29, Oct. 2, 4, and 8 and can be found at Mishra can be reached at

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