National Nurses United

NewsBriefs:FINAL 3 (No Notice) 8/21/08 8:59 PM Page 5 New Deal or No Deal? other domestic programs. The national public plan The differences between Sen. McCain and Sen. Obama are would be modeled on the covparticularly pronounced on Social Security. erage available to members of McCain supported President Bush's privatization scheme, Congress. Obama has also and voted to raid the Social Security fund to pay down the offered tax credits to small national debt, which he says he'd do again as President. On businesses which provide the campaign trail, McCain has said he wants to allow workemployee health benefits. ers to invest their Social Security investments "privately," Parents would be mandatexposing their retirement security to the huge risk and ed to buy insurance for their vagaries of Wall Street while underfunding the Social Security children if they are not system. He also says "all options are on the table," such as insured in some other fashincreasing the retirement age and reducing benefits. ion. Obama has opposed MasIn 2005, Obama opposed the Bush plan for privatization sachusetts-style mandates on and he calls Social Security "the cornerstone of the social all individuals to buy insurcompact in this country." In the Senate, he also voted to force ance, the key difference in his companies to properly fund their pension plan, according to debate with Sen. Hillary Clinhis website statement on retirement. ton in the primaries. Obama has proposed putting more money into the sysObama intends to step up tem through new Social Security payroll taxes on employers pressure on insurance and and individuals with incomes above $250,000 a year. In late drug companies. For drug August, he said that plan could be delayed for 10 years, a companies, Obama would almove welcomed by a number of economic analysts who have low Americans to buy cheapsaid the rhetoric about the fund's shortfall, the pretext cited er medications from other by Bush for privatization, is far overstated. —C.I. countries and repeal the Bush administration ban on the government using its bulk purchasing power to negotiate lower prices has no proposal to pay for a federal expansion. McCain's attitude toward regulating from drug companies. For insurers, Obama has criticized their insurers was amply illustrated by his bafflement at a reporter's question about the dis- monopolistic practices, says he wants to proparity between insurance plans which pay hibit their denials of coverage, and require for Viagra but don't cover prescription con- them to spend a higher percentage of their traceptives. McCain twice voted against fed- profits on direct care. How Obama would get there apparently eral legislation that would require insurance companies covering Viagra to also cover pre- is through a National Health Insurance Exchange to help individuals who want to scription birth control. purchase private insurance. Participating insurers would have to sell policies to people Sen. Barack Obama while falling short in several key areas, with preexisting conditions, and would have Sen. Obama's health plan has a very different to offer benefits and pricing equal to the frame, with an emphasis on increased cover- national public plan. Overall, Obama has pledged to "bring age, a tougher critique of insurance and pharmaceutical corporations, and a more down premiums by $2,500 for the typical family" through the various components of active role for government. First, he proposes to extend access through his plan. There is considerable doubt subsidies for uninsured low- and middle- whether his plan can achieve this goal. The Exchange, for example, is apparently income people to buy private insurance or buy into a newly established national public plan modeled on the Massachusetts Connector, which has failed to curtail price gouging by available to both individuals and employers. Public subsidies would be funded through private insurers or assure middle-income fees on employers who don't provide health residents have access to comprehensive covbenefits, and by reversing the Bush adminis- erage. And, of course, the insurance compatration's tax cuts for the wealthy. Additional- nies don't have to participate. Don't expect the public plan option to ly, Obama also advocates diverting some of the $10 to $12 billion wasted in the war in result in lower premiums either. The private Iraq every month to healthcare, as well as insurance giants will be able to undercut the J U LY | A U G U S T 2 0 0 8 W W W. C A L N U R S E S . O R G public plan, and cherry pick the healthier and wealthier patients through massive advertising and other marketing techniques that the public plan will not be able to match. The public plan would likely end up saddled with the sickest and poorest patients, destroying the notion of a secure risk pool and potentially bankrupting the plan. Obama's other cost-cutting ideas are also suspect. They include more investment in medical technology (McCain favors this too). However, a May Congressional Budget Office report questioned how much could be saved from computerized health systems. Obama also advocates more transparency on costs and quality, including requiring hospitals to publicly report nursing ratios, disparities in care, and other quality data. But disclosure without enforcement and penalties is ineffective. When employers select your insurance options and insurers restrict going out of network, choosing which insurance company or hospital will get your business has nothing in common with picking which supermarket or department store to patronize based on their daily sales. Finally, like McCain, Obama is silent on insurance company denials of needed care, though Obama does not share McCain's antagonism to the concept of more regulation. Single-Payer and the Role of Government perhaps the biggest difference between McCain and Obama on healthcare is their vision of the role of government and public oversight. Vilifying Obama for supposedly advocating "government-run" healthcare and "inserting government bureaucracy into your medicine cabinet" has been a regular sound bite for McCain's stump speeches (ignoring the fact that private insurance is far more bureaucratic and wasteful than the publicly run Medicare and Medicaid programs). Nothing better symbolizes McCain's hostility to a government role in healthcare than his proposal to limit Veterans Administration healthcare benefits to veterans whose care needs "are a direct result of combat," a position that builds upon and extends the Bush administration policy of reducing eligibility for VA services, underfunding VA healthcare, and promoting privatization. By contrast, though Obama has shied away from single-payer and proposes instead a private-public mix, he is far more comfortable with an expanded role for government in REGISTERED NURSE 5

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