Wondering if anyone has any feedback on this; just got off a conference call
with the McCain campaign. I have a few concerns about the McCain healthcare
plan from a Federalist/free market side, but I thought a few of you might
care to tackle this on its left flank.
There's a post up at the top of my website right now about it--don't have
the permalink, but it'll be close to the top most of the day, so if you want
to read my summary, it's at:
http://attila.mu.nu
Best,
Joy
* * *
Joy Whittemore McCann
Goddess of Ink and Paper
(But pixels obey me, too.)
Copy Write Editorial Services
818/429-9806
* * *
*VIEW THE AD HERE:* <
http://www.youtube.com/watch?v=lHAAnSppMvU>
http://www.youtube.com/watch?v=m6I61-zIXOE
*Script For "Health Care Action" (:60)*
*JOHN MCCAIN:** **The problem with health care in America is not the quality
of health care, it's the availability and the affordability. And that has to
do with the dramatic increase in the cost of health care.*
*Let's give every American family a $5,000 refundable tax credit so that
they can go out across state lines and get the insurance policy that suits
them best.*
*I can characterize my approach on health care by choice and competition,
affordability and availability.*
*We need community health centers. We need walk-in clinics. We understand
that emergency room care is the most expensive in America.*
*There's many, many solutions to this problem. I think we can address them.
The fundamental problem is not the quality of health care; it's the cost of
health care. So health care must be made affordable and available.*
*I'm John McCain and I approve this message.*
__________
* *
* *
*Excerpts from remarks as prepared for delivery*
Lee Moffitt Cancer Center & Research Institute
University of South Florida
Tampa, Florida
April 29, 2008
Thank you. I appreciate the hospitality of the University of South Florida,
and this opportunity to meet with you at the Moffitt Cancer Center and
Research Institute. Speaker Moffitt, Dr. Dalton, Dean Klasko, thank you for
the invitation, and for your years of dedication that have made this campus
a center of hope for cancer victims everywhere. It's good to see some other
friends here, including your board member and my friend and former colleague
Connie Mack. And my thanks especially to the physicians, administrators,
and staff of this wonderful place.
Sometimes in our political debates, America's health-care system is
criticized as if it were just one more thing to argue about. Those of you
involved in running a research center like this, or managing the children's
hospital that I visited yesterday in Miami, might grow a little discouraged
at times listening to campaigns debate health care. But I know you never
lose sight of the fact that you are each involved in one of the great
vocations, doing some of the greatest work there is to be done in this
world.
…
In any serious discussion of health care in our nation, this should always
be our starting point – because the goal, after all, is to make the best
care available to everyone. We want a system of health care in which
everyone can afford and acquire the treatment and preventative care they
need, and the peace of mind that comes with knowing they are covered.
Health care in America should be affordable by all, not just the wealthy.
It should be available to all, and not limited by where you work or how much
you make. It should be fair to all; providing help where the need is
greatest, and protecting Americans from corporate abuses. And for all the
strengths of our health-care system, we know that right now it falls short
of this ideal.
Some 47 million individuals, nearly a quarter of them children, have no
health insurance at all. Roughly half of these families will receive
coverage again with a mother or father's next job, but that doesn't help the
other half who will remain uninsured. And it only draws attention to the
basic problem that at any given moment there are tens of millions of
Americans who lost their health insurance because they lost or left a job.
Another group is known to statisticians as the chronically uninsured. A
better description would be that they have been locked out of our health
insurance system. Some were simply denied coverage, regardless of need.
Some were never offered coverage by their employer, or couldn't afford it.
Some make too little on the job to pay for coverage, but too much to qualify
for Medicaid or other public programs. There are many different reasons for
their situation. But what they all have in common is that if they become
ill, or if their condition gets worse, they will be on their own – something
that no one wants to see in this country.
Underlying the many things that trouble our health care system are the
fundamental problems of cost and access. Rising costs hurt those who have
insurance by making it more expensive to keep. They hurt those who don't
have insurance by making it even harder to obtain. Rising health care costs
hurt employers and the self-employed alike. And in the end they threaten
serious and lasting harm to the entire American economy.
...
There are those who are convinced that the solution is to move closer to a
nationalized health care system. They urge universal coverage, with all the
tax increases, new mandates, and government regulation that come along with
that idea. But in the end this will accomplish one thing only. We will
replace the inefficiency, irrationality, and uncontrolled costs of the
current system with the inefficiency, irrationality, and uncontrolled costs
of a government monopoly. We'll have all the problems, and more, of private
health care -- rigid rules, long waits and lack of choices, and risk
degrading its great strengths and advantages including the innovation and
life-saving technology that make American medicine the most advanced in the
world.
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.
Americans need new choices beyond those offered in employment-based
coverage. Americans want a system built so that wherever you go and
wherever you work, your health plan is goes with you. And there is a very
straightforward way to achieve this.
Under current law, the federal government gives a tax benefit when employers
provide health-insurance coverage to American workers and their families.
This benefit doesn't cover the total cost of the health plan, and in reality
each worker and family absorbs the rest of the cost in lower wages and
diminished benefits. But it provides essential support for insurance
coverage. Many workers are perfectly content with this arrangement, and
under my reform plan they would be able to keep that coverage. Their
employer-provided health plans would be largely untouched and unchanged.
But for every American who wanted it, another option would be available:
Every year, they would receive a tax credit directly, with the same cash
value of the credits for employees in big companies, in a small business, or
self-employed. You simply choose the insurance provider that suits you
best. By mail or online, you would then inform the government of your
selection. And the money to help pay for your health care would be sent
straight to that insurance provider. The health plan you chose would be as
good as any that an employer could choose for you. It would be yours and
your family's health-care plan, and yours to keep.
The value of that credit – 2,500 dollars for individuals, 5,000 dollars for
families – would also be enhanced by the greater competition this reform
would help create among insurance companies. Millions of Americans would be
making their own health-care choices again. Insurance companies could no
longer take your business for granted, offering narrow plans with escalating
costs. It would help change the whole dynamic of the current system,
putting individuals and families back in charge, and forcing companies to
respond with better service at lower cost.
It would help extend the advantages of staying with doctors and providers of
your choice. When Americans speak of "our doctor," it will mean something
again, because they won't have to change from one doctor or one network to
the next every time they change employers. They'll have a medical "home"
again, dealing with doctors who know and care about them.
These reforms will take time, and critics argue that when my proposed tax
credit becomes available it would encourage people to purchase health
insurance on the current individual market, while significant weaknesses in
the market remain. They worry that Americans with pre-existing conditions
could still be denied insurance. Congress took the important step of
providing some protection against the exclusion of pre-existing conditions
in the Health Insurance Portability and Accountability Act in 1996. I
supported that legislation, and nothing in my reforms will change the fact
that if you remain employed and insured you will build protection against
the cost of treating any pre-existing condition.
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.
This cooperation among states in the purchase of insurance would also be a
crucial step in ridding the market of both needless and costly regulations,
and the dominance in the market of only a few insurance companies. Right
now, there is a different health insurance market for every state. Each one
has its own rules and restrictions, and often guarantees inadequate
competition among insurance companies. Often these circumstances prevent
the best companies, with the best plans and lowest prices, from making their
product available to any American who wants it. We need to break down these
barriers to competition, innovation and excellence, with the goal of
establishing a national market to make the best practices and lowest prices
available to every person in every state.
Another source of needless cost and trouble in the health care system comes
from the trial bar. Every patient in America must have access to legal
remedies in cases of bad medical practice. But this vital principle of law
and medicine is not an invitation to endless, frivolous lawsuits from trial
lawyers who exploit both patients and physicians alike. We must pass
medical liability reform, and those reforms should eliminate lawsuits
directed at doctors who follow clinical guidelines and adhere to patient
safety protocols. If Senator Obama and Senator Clinton are sincere in their
conviction that health care coverage and quality is their first priority,
then they will put the needs of patients before the demands of trial
lawyers. They can't have it both ways.
We also know from experience that coordinated care – providers collaborating
to produce the best health outcome – offers better quality and can cost
less. We should pay a single bill for high-quality disease care, not an
endless series of bills for pre-surgical tests and visits, hospitalization
and surgery, and follow-up tests, drugs and office visits. Paying for
coordinated care means that every single provider is now united on being
responsive to the needs of a single person: the patient. Health information
technology will flourish because the market will demand it.
In the same way, clinics, hospitals, doctors, medical technology producers,
drug companies and every other provider of health care must be accountable
to their patients and their transactions transparent. Americans should have
access to information about the performance and safety records of doctors
and other health care providers and the quality measures they use.
Families, insurance companies, the government – whoever is paying the bill –
must understand exactly what their care costs and the outcome they
received.
Families also place a high value on quickly getting simple care, and have
shown a willingness to pay cash to get it. If walk-in clinics in retail
outlets are the most convenient, cost-effective way for families to safely
meet simple needs, then no policies of government should stand in their
way. And if the cheapest way to get high quality care is to use advances in
Web technology to allow a doctor to practice across state lines, then let
them.
As you know better than I do, the best treatment is early treatment. The
best care is preventative care. And by far the best prescription for good
health is to steer clear of high-risk behaviors. The most obvious case of
all is smoking cigarettes, which still accounts for so much avoidable
disease. People make their own choices in this country, but we in
government have responsibilities and choices of our own. Most smokers would
love to quit but find it hard to do so. We can improve lives and reduce
chronic disease through smoking cessation programs. I will work with
business and insurance companies to promote the availability and use of
these programs.
Smoking is just one cause of chronic diseases that could be avoided or
better managed, and the national resources that could be saved by a greater
emphasis on preventative care. Chronic conditions – such as cancer, heart
disease, high blood pressure, diabetes and asthma -- account for
three-quarters of the nation's annual health-care bill. In so many cases
this suffering could be averted by early testing and screening, as in the
case of colon and breast cancers. Diabetes and heart disease rates are also
increasing today with rise of obesity in the United States, even among
children and teenagers. We need to create a "next generation" of chronic
disease prevention, early intervention, new treatment models and public
health infrastructure. We need to use technology to share information on
"best practices" in health care so every physician is up-to-date. We need
to adopt new treatment programs and financial incentives to adopt "health
habits" for those with the most common conditions such as diabetes and
obesity that will improve their quality of life and reduce the costs of
their treatment.
Watch your diet, walk thirty or so minutes a day, and take a few other
simple precautions, and you won't have to worry about these afflictions.
But many of us never quite get around to it, and the wake-up call doesn't
come until the ambulance arrives or we're facing a tough diagnosis.
We can make tremendous improvements in the cost of treating chronic disease
by using modern information technology to collect information on the
practice patterns, costs and effectiveness of physicians. By simply
documenting and disseminating information on best practices we can eliminate
those costly practices that don't yield corresponding value. By reforming
payment systems to focus on payments for best practice and quality outcomes,
we will accelerate this important change.
Government programs such as Medicare and Medicaid should lead the way in
health care reforms that improve quality and lower costs. Medicare
reimbursement now rewards institutions and clinicians who provide more and
more complex services. We need to change the way providers are paid to focus
their attention more on chronic disease and managing their treatment. This
is the most important care for an aging population.
There have been a variety of state-based experiments such as Cash and
Counseling or The Program of All-Inclusive Care for the Elderly (PACE) that
are different from the inflexible approaches for delivering care to people
in the home setting. Seniors are given a monthly allowance that they can
use to hire workers and purchase care-related services and goods. They can
get help managing their care by designating representatives, such as
relatives or friends, to help make decisions. It also offers counseling and
bookkeeping services to assist consumers in handling their programmatic
responsibilities.
In these approaches, participants were much more likely to have their needs
met and be satisfied with their care. Moreover, any concerns about
consumers' safety appear misplaced. For every age group in every state,
participants were no more likely to suffer care-related health problems.
Government can provide leadership to solve problems, of course. So often it
comes down to personal responsibility – the duty of every adult in America
to look after themselves and to safeguard the gift of life. But wise
government policy can make preventative care the standard. It can put the
best practices of preventative care in action all across our health-care
system. Over time that one standard alone, consistently applied in every
doctor's office, hospital, and insurance company in America, will save more
lives than we could ever count. And every year, it will save many billions
of dollars in the health-care economy, making medical care better and
medical coverage more affordable for every citizen in this country.
Good health is incentive enough to live well and avoid risks, as we're all
reminded now and then when good health is lost. But if anyone ever requires
further motivation, they need only visit a place like the Moffitt Center,
where all the brilliance and resourcefulness of humanity are focused on the
task of saving lives and relieving suffering. You're an inspiration, and
not only to your patients. You're a reminder of all that's good in American
health care, and we need that reminder sometimes in Washington. I thank you
for your kind attention this morning, I thank you for the heroic work you
have done here, and I wish you success in the even greater work that lies
ahead.
[Non-text portions of this message have been removed]
Received on 2008-04-29 11:59:14