Americans had a hard time getting a fill of substantive news last week. Politics created a media din as swift boat veterans threw dirt on John Kerry's war record in TV ads, President Bush denounced all such ads but didn't seem to notice the muddy footprints leading to his campaign headquarters, and Kerry didn't seem to notice the ads by independent groups supporting him that said not-so-flattering things about Bush.
Fortunately, you have the pages of this week's Modern Healthcare to tell you that much happened on the access-to-healthcare front while the politicians bickered and the pundits yelled at each other. Unfortunately, most of this news was bad as well.
Oh, there were some attempts at improving things. Maine began setting up its program to provide coverage to the uninsured. And the California Legislature tried to do something for patients by requiring hospitals to offer discounts to the uninsured, although some observers say Gov. Arnold Schwarzenegger might veto it.
But mostly, the news was downbeat. States planned to make cuts in Medicaid. The Census Bureau reported that the ranks of Americans without health insurance increased by 1.4 million last year to a total of 45 million
It's an election year, and politics surrounded this announcement, too. Democrats charged that the earlier-than-normal release of the numbers was designed to put as much distance as possible between bad news and Election Day. The administration said it wanted to release poverty numbers and uninsured statistics at one time, instead of separately. And it touted the fact that 243.3 million people had insurance, an increase of 1 million since 2003.
There were significant kernels of information in both the poverty and insurance numbers. The percentage of people covered by employer insurance fell to 60.4%, or 174 million, from 61.3%, or 175.3 million, in 2002. The increase of 1.3 million people in poverty bolsters the view that job loss is causing more people to lose insurance as the employer-based coverage system strains under a variety of economic pressures.
Neither Bush nor Kerry has offered a truly comprehensive plan to overhaul the health insurance system and deal with the economic realities of the 21st century. As the Washington Post reported last week, Bush's plan of tax credits, increased Medicaid and children's insurance, and small-business insurance pools does not seem likely to meet his target of covering 10 million people. Kerry says his agenda, which includes Medicaid expansion and a kind of medical bill reinsurance, would cover 27 million people. That is based on assumptions such as a rollback of tax breaks and savings that may never come to pass. Both men are pushing a timid form of incrementalism to solve what many believe is a macro problem. That's understandable since physicians, insurers, hospitals, pharmaceutical companies, lawyers and other special interest groups have banded together in an accidental coalition of the unwilling. They won't sacrifice a penny or a sliver of power for the greater good of the country.
Well, if we can't do anything big, here are two modest proposals. First, take the $500 billion the government was going to spend on a Medicare prescription-drug benefit and use it to finance more Medicaid coverage and community health centers. That money was earmarked in large part for giveaways to insurers, drug outfits and providers. The Medicare benefit never addressed the central problem in healthcare-the uninsured-because politicians don't have the stomach for that battle.
Second, impose a 10% tax on election-oriented ads, whether by candidates or independent groups. (Let the legal eagles iron out the First Amendment issues.) Experts say some $1.5 billion will be spent on advertising this year for control of Congress and the White House. Take that revenue and create additional small programs to cover more people.
It's only fair that the ads that are making Americans sick should be used to help us all get well.