Sent to the McCain mailing list; I'll comment in the next post:

My Friends,

Today, there are 47 million uninsured individuals in the U.S., and nearly a quarter of them are children. High costs and limited access are the underlying, fundamental problems in our healthcare system.

As you know, both Senators Hillary Clinton and Barack Obama are touting outrageously expensive and unrealistic universal health care plans - a government monopoly over health care.

Unlike my opponents, I do not believe that all of our nation's problems can be solved by turning control over to our government, with all the tax increases, new mandates and government regulation that come with that idea.

Today, our campaign began running a television ad focused on health care - that you can view by following this link - to ensure all Americans hear the truth about how I plan to tackle the challenges facing our nation's health care system. To ensure this important ad is aired in as many markets as possible, I'm asking for your immediate financial assistance.

I believe the key to real reform is to restore control over our health care system to the patients themselves. Americans need new choices beyond those offered in employment-based coverage.

That's why, as president, I will seek to encourage and expand the benefits 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.

In addition, I will reform the tax code to provide every family the option of receiving a direct, refundable tax deposit - effectively $2,500 for individuals and $5,000 cash for families to offset the cost of insurance.

The reality is that both Senator Clinton and Senator Obama, in their haste to garner support for their so-called "solutions," are promising more than they can deliver. And, once again, they are simply out-of-touch with the real problems facing our health care system and how to solve them.

Here are the facts: Under the Democrats' plan, we will have all the problems, and more, of the current health care system - rigid rules, long waits and lack of choices - and we risk degrading the system's great strengths and advantages, including the innovation and life-saving technology that make American medicine the most advanced in the world.

My friends, this is not my definition of real reform. I hope you will join me in my fight to tackle the real problems facing our nation's health care system by making a contribution of $50, $100, $250, $500, $1,000, or $2,300 to help fund this important ad.

I hope to hear from you soon.

Sincerely,

John McCain

So basically, he wants to expand health savings accounts. Which means, if you are working poor (probably the majority of people who are uninsured) and you already don't pay taxes, a HSA won't help you, because you can't deduct anything anyway.

So his statement that "the key to real reform is to restore control over our health care system to the patients themselves. Americans need new choices beyond those offered in employment-based coverage." doesn't fit with his proposed solution. How exactly does given middle class and upper class Americans another tax cut to help cover double-digit yearly jumps in health care costs give patients more control over the system?

Andrew

An HSA works best for those who are actually making a decent living and have expendable cash on hand. We have looked into an HSA and unless your comfortable with a high deductable an HSA is not a real good option.

That " My Friends " thing that McCain uses is starting to make me feel a little weird. It's something that someone researched or is in response to or something. It tests well among the raisins or something. It feels so unnatural when he says it or speaks it. It's a " tell " of some kind. It alerts me to something about him that is, um, something not good.

Sorry to hijack. Carry on.

McCain is basically providing no solution for those that can't afford health insurance. More of the same we've had for the last 8 years.

I agree, he isn't providing any solution. But, what is the solution? Government hand outs?

We have another energy type issue. Two extremes. The Republicans "every man for himself" and the Democrats "get in line here, it's free". Neither approach will solve anything.

This is a situation where it's more fun to just keep pointing fingers.

The approach that's most guaranteed not to solve anything is to continue the same approach we are now doing and already know is a failure...the one Bush has used for 8 years is the same approach McCain is suggesting. Yet another example of Bush's third term.

Well I have taken much heat and some concern from many on this board for not being covered under any health insurance. We are slowly moving towards at least some kind of catastrophic coverage that will protect our assets. What that is exactly is getting clearer for us, but no slam dunk as of yet. Our situation is unique being self-employed, working from home and the type of work we do.

I say all that because if you want coverage you need to be proactive. Don't expect anyone to give you anything...period. Health insurance, in most cases, is money that just floats off into nothingness with no investment value. At least that's what I have been finding.

Also being proactive in your personal health is important. I would like to get a tax break or credit of some kind for being a non-smoker, non-drinker along with working out on a regular basis. Maybe a cut in premiums?

Since we have been paying out of pocket all these years, going with a higher deductible to lower our premiums will be no problem. Plus I have just discovered a program through the National Association for the Self-Employed that will pay me back some of my out of pocket medical expenses. Up to $20,000 in some cases.

I'm not impressed with McCain, Clinton or Obama's ideas on health insurance. They just fall way too short in my book.

John McCain is proving once again why he shouldn’t be president. His answer to the problem, medical savings accounts. The same solution George Bush has been touting for years. In the end, these medical savings accounts do absolutely nothing to control the skyrocketing costs of health care in this country.

I would love to see the free market come up with a solution to this mess, but “the free market” has done nothing short of making the crisis worse. Year after year, health care costs rise well above the rate of inflation. Rather than seeking a workable solution, they dump hundreds of millions of dollars into the campaign coffers of politicians and advocacy groups who sabotage any effort at reform.

If we are going to get real reform, then the insurance lobby, the hospital lobby, the AMA and the pharmaceutical giants all need to get onboard and take some responsibility for finding a way to help rein in costs or the current structure is going to implode. The only people left to benefit from the current structure will be government employees, the rich, poor children and the elderly.

Private industry took on the challenge of paying for its employees health care many years ago, but given the current business climate, why should they continue? Companies need to be competitive and to be forced to spend more and more on health care as their global competitors are largely immune from paying for such a benefit.

In a perfect world, I’d love to see universal coverage for all Americans. This I doubt will happen. But one thing is certain; the current structure is deeply flawed, and if not repaired soon, will collapse under its own costly weight.

Single pay, combined with solid regulation.

That's the solution, period.

This is not a "let the market fix it" problem.

"Single pay"

By who?

Free markets are about maximizing profit. Healthcare should be a non-profit industry.

Exactly.

One way is to extend Medicare / Medicaid to everybody and capture the economies of scale, and existing infrastructure. That can happen in a year, for savings right out of the gate.

Take those dollars saved and invest in solid R & D aimed at filtering out the good treatments from the not so good ones and cover those. Eg: new drug hits market, but does not offer significant improvement over existing generics. So, discourage that for all but the cases where it's highly indicated over existing means and methods of treatment.

Same thing with diagnostics and procedures.

That gives us a baseline for what is and what is not solid coverage. That will put a serious dent in the problem, leaving only chronic cases to worry about. Nice problem to have actually.

Private insurers then scale way down, offering niche and luxury coverage, for those willing and able to pay for extras.

Another way would be to offer single pay, but let the States all choose how to aggregate the dollars. They are backed by the Fed, and can then put together their own plans.

The downside of this is more overhead, but an upside is the distribution of the problem of figuring out what is and what is not baseline coverage and baseline treatments.

We may find that to be worth the effort however. Something I'm not at all sure isn't worth exploring.

In either case, there are premiums to be paid, and the pool of contributors is very large --in fact, the largest, as it ends up being a payroll deduction for everybody, period.

Also, insurance would not be tied to employment in any way. Switch jobs, still insured. Also, with this in place, the more people we have working, the better the plan pays for everybody. I would personally tie it to citizenship, with non-citizens able to buy in, but not able to tap the system for nothing, in times of need, unemployment, disability, etc...

Employers then have NO WORRIES on this stuff. They don't have to worry about pool sizes, administering the plan, cost changes, provider changes, etc... From their perspective, it's just a standard deduction and that's that.

For many small businesses, this is a HUGE plus as now those jobs are far more worth doing than they are without coverage.

The amounts can get tweaked to adjust for some factors that need it, whatever works there.

Again, those that want better, can just sign up with a private insurer, build medical savings accounts, or just pay up for those options.

The net result is the money is taken out of the business of delivering baseline health care as much as possible. From there, the money moves to value adds, which is what we want.

One value add is extra services / alternative treatments, etc... Those can be paid for, above and beyond the base-line through insurance, savings, etc...

Another value add is the strong incentive to improve efficiency, adequacy, effectivity, etc... of existing treatments, procedures, operating logic and other things. Innovators are rewarded with preferred status in coverage, driving acceptance of their products, services or knowledge easily.

Still another is in developing strong preventative options. Those can see covered status too, after being vetted for some actual thearaputic value of course.

That's a start anyway. Thinking in those kinds of big scale terms is what we need to be doing.

Some of the existing profit centers are going to get marginalized on the thing. Big deal. We really don't need them, and as far as I am concerned, they are just corporate handouts being continued because our government isn't doing the job it needs to.

Look at all the manufacturing jobs lost, so that we could take costs out of things. Nobody cared about that right? So, nobody is gonna care about the insurance companies scaling down either.

Eventually what will happen is non-value add services, means, methods and products will disappear, leaving only those proven effective and low overhead. From there, the innovation pressure will be on those things that do add value and again, that's what we need.

We don't need for-profit middle companies at all. They are a leech on our increasingly limited resources and they do not add any value to health care AT ALL.

If they were re purposed as luxury offerings, that would add value. Market would be smaller, but that's ok. Having it exist would not be a net loss for us like the current system is.

The problem with that idea is that medicare/medicaid really doesn't offer great coverage. Also, many people would argue (and I wouldn't disagree) that, being a government entity, they are inherently less efficient than a private corporation.

So, why not fold all private insurance into a single, well-regulated, NON-PROFIT corporation? And maybe throw in the big pharma companies too? Surely there's some economies of scale to be had there.

I doubt it would ever happen since the legislators are in the very deep pockets of said industries, but it seems like the best solution to me.

HSAs are a joke. Our (previously very good) health insurance has just been switched over to an HSA-based plan, and it's been the worst coverage I've ever had, with countless hours spent on the phone dealing with clueless people.

Missing, for the most part you and I agree on the medical issues. A couple of things I might point out.

Medicaid is extremely wasteful. Hospitals provide Medicaid services like there is no tomorrow. Medicare has many of the same problems.

Medicare and Medicaid are very different from each other in what they cover and what they don't, so you can't lump them. Medicare has limits on hospital stays and many other things. Medicaid is unlimited.

When I hear of government programs to extend Medicaid to illegals and/or the poor, I cringe. They suddenly have better coverage than anyone on commercial insurance. And you and I are paying for it.

I also think HDAs, MSAs and HMOs are a joke.

"I also think HDAs, MSAs and HMOs are a joke."

Thank the Republicans, Deane.


Although the concept of HMO's dates to the 1920's, the term "HMO" was developed in the early 1970s as part of a Nixon Administration strategy to promote the growth of prepaid plans as a way of improving the capacity and efficiency of the nation's health system. New federal legislation, the 1973 Health Maintenance Organization Act, recognized the promise of HMOs and encouraged their growth nationwide by removing legal impediments to their development. By the end of 1978, there were more than 200 HMOs spread over 37 states.

During the early 1990s, think tanks such as the National Center for Policy Analysis and insurance companies such Golden Rule Insurance Company began to promote passage of a law that would allow for tax-free contributions to a medical savings account. Even though the US Congress was under Republican control and the MSA concept was central to the Republican Party's health care agenda, a federal MSA law failed to materialize during the 1990s. However, Congress did pass an MSA pilot as a part of the Health Insurance Portability and Accountability Act (HIPAA) in 1996.

What is HDA?

Tadc writes:
The problem with that idea is that medicare/medicaid really doesn't offer great coverage. Also, many people would argue (and I wouldn't disagree) that, being a government entity, they are inherently less efficient than a private corporation.

On the contrary, Medicare is known to be extremely efficient, far moreso than private insurance companies. Medicare's cost overhead is only about 2% whereas private insurance companies typically have an overhead of about 20%. You have to pay dividends to stockholders, bonuses to CEOs, advertise to get business, pay commissions to salespeople, etc. That money has to come from somewhere.

What benefit does a private insurance company really have for an individual? Insurance companies seem to do whatever they can to make life as difficult as possible for their customers, making it hard to collect on policies, limiting coverage, etc. Could a government-run insurance company really be worse?

Andrew

"Thank the Republicans, Deane."

That's where Republicans and I differ significantly.

What is HDA?

Someone up above referred to HDA in the form of an MSA. I believe they referred to it as an HSA and I did a typo. I believe they have changed it now, but I suspect we only have MSAs.

Andrew, I'm not talking about administration efficiency. I'm talking about hospitals using it as a cash cow since they don't have to account for anything. They order tests like they cost about a penny a piece.

I've heard nurses talking about the waste. One told me a lady had $100,000 worth of workup because she had Medicaid. The nurse said if she had commercial insurance, she wouldn't have gotten $20,000 worth of work up for what her symptoms were.

This is exactly why I said we also couple the plan with evaluations of treatments and procedures.

That will cut the waste enough to matter.

Without this, I agree with you BTW.

I wrote both of them together as models for how things could go. Maybe everybody gets baseline Medicare. Some could opt for Medicaid, for example.

No absolutes there, just trying to work through options and learn stuff