McCain and the quest for health insurance

it's been over a year since i've had the energy/impetus to post something on this blog. but tonight i'm fired up about john mccain's health insurance proposal, as outlined in contingencies, a magazine for actuaries.

paul krugman notes on his blog that john mccain suggested recently that we should allow health plans to compete for customers because it would work as well for the health insurance market as deregulation has worked for banks!

actually, now that i've read the article, i'm even more wigged.
mccain is proposing individual choice in health insurance products via a $2500 individual/$5000 family tax credit. which is not indexed to inflation. presumably (though he does not state this), the cost of health care should go down through an increase in government regulation of medical providers. this would happen via mandates for what he calls "patient-centered medicine," which will reward doctors by outcome rather than volume and encourage coordination of services so that a patient's care is coordinated in the optimal way, and by gutting state regulation and the right of injured patients to sue. this latter for me is troubling, especially in the way that he describes it: that doctors who practice according to standards of care should be protected from lawsuits. i believe that "practice according to standards of care" is what is discovered during litigation's "discovery" process. but i digress. my point is that he is so confident of his proposal's ability to cut costs that he assumes that the cost of a policy won't even keep pace with inflation, totally ignoring the reality that costs have been spiraling astronomically since the late 1990's.

mccain also proposes that coverage be able to follow the individual rather than the job (which i like), and that there be protections in place for folks with pre-existing conditions so that we can either buy individual coverage through private insurers or through what he calls "GAP" programs administered by the states (basically, programs for individual coverage sponsored by states to cover those who cannot get coverage anywhere else). oh, and there would be neither mandates that individuals purchase coverage nor mandates that insurance plans accept persons with pre-existing conditions. furthermore, there is no mentioned regulation stating that companies can't require whatever sort of medical screening they want before accepting an applicant to their plan. not even screenings for what are currently assumed to be risk factors (not just current physical manifestation, but also potentially family history).

unfortunately, these ideas totally undermine the advantages of what used to be understood as "social insurance": that those who are sick are protected from astronomical costs because they are covered in the same plans as those who are not (yet) sick. because what is likely to happen under mccain's plan is that some healthy people (especially the young) will opt for minimal (limiting the patient's liability if the patient gets hit by a car or something) or no coverage (many are already doing this), thereby pooling the healthy people away from the sick people. the healthy people would get to have the entirety of their health insurance premiums covered, the sick (and prudent) would not have any help if their premiums exceed the amount of the tax credit.

public health programs (medicare, medicaid, GAP) would not be guaranteed the ability to do things like negotiate with pharmaceutical companies, either.

so yeah. now the really gross part (since i've spent most of this post attacking the economics of the plan): mccain ends his article by basically scapegoating sick people. he states something about as close to the antithesis of my position that "good health is not a reward for good behavior" as possible:

The final important principle of health care reform is to rediscover our sense of personal responsibility to take better care of ourselves and our children. We must personally do everything we can to prevent expensive, chronic diseases through better health behavior. Our rights in this country are protected by our sense of personal responsibility for our own well-being. Cases of diabetes are going up, not only in the baby boom generation, but among younger Americans where obesity, diabetes, and high blood pressure are all on the rise. Parents who don't impart to their children a sense of personal responsibility for health, nutrition, and exercise -- vital quality-of-life information that political correctness has expelled from our schools -- have failed their responsibility. Also, parents have to share in the responsibility to ensure that their children are covered by health insurance if, as is often the case, options are already available to them. (Contingencies, Sept/Oct 2008).

there is so much blaming and ignorance in that passage that i can barely stand to retype it (which i did, as the article is on Contingencies in pdf form, so i couldn't cut-and-paste). first off, diabetes is a cause of diabetes? uh.... also, while those things may be "on the rise," there isn't a body of research to support holding parents accountable for all of it. focusing on "childhood obesity" seems to me to run the risk of instilling disordered thinking and behavior (that is, thinking and behavior associated with eating disorders) in our young people -- especially if the focus is on "healthy numbers" rather than "do this! it feels good!" and helping children enjoy a variety of food, etc. mccain also scapegoats diabetes in particular, which pisses me off because there are certainly problems that are more prevalent -- asthma, for instance. problem here is that it's become increasingly harder to blame the parents for this, as the number of households in which parents smoke has decreased steadily over the past 40 years, even as the percentage of children with asthma has climbed. (mccain also leaves out personal responsibility for causing your own skin cancer -- seems he can't be fussed to publicly claim culpability for his own condition).

the claim that "political correctness" has toasted nutrition and phys ed curricula in the public schools is ridiculous, as well. health curricula have largely been decimated by republican fear of sex ed, and both health and phys ed have been scratched for the same reasons art, music, and language programs have: they are expensive and draw time away from the "fundamental" skills that are measured by the standardized tests upon which schools' success rates are based. it's the most "politically correct" (read: wealthy) school districts that have retained such programs as part of the school day, and such districts also have a larger percentage of parents who are able to pay for extra-curricular sports programs. mccain also doesn't seem to remember that ronald reagan once famously suggested that ketchup could count as a vegetable in subsidized school lunches. he similarly doesn't mention the fact that coke and pepsi, as well as candy and chips, were for a long time available by vending machine in our public schools. or that free lunch programs tend toward overly fried, overly salted foods rather than fresh ones. nor does he seem to acknowledge that poor nutrition for poor people is exacerbated by the lack of choice for buying food in many poor neighborhoods -- that many of our poor people live in "food deserts." you can't put all the blame on parents here, john.

so yeah. i'm horrified by this article, because it demonstrates more ideology than understanding.

i'm almost a single-issue voter; my issue is health care. i pray that this guy doesn't get elected.