The US Government's $700 billion bailout of the financial sector will cause huge damage to the country's future healthcare plans, no matter who wins the US presidential election. The issues are discussed in a Special Report News piece published early Online and in the November edition of The Lancet Oncology, written by journalist Bryant Furlow.
John McCain's plan would cut federal insurance for the poor and prioritises cost containment over health insurance expansion, while Barack Obama's plan proposes expanded coverage and relies on presumed savings from increased efficiency and health information technology to contain costs. Sherry Giled, Columbia University, New York, believes that patients with cancer would fare better under the Obama plan. She says: "The Obama plan prevents insurance firms from looking at existing conditions or to deny coverage to cancer patients", she says. "McCain's plan is generally bad for cancer patients and others with chronic diseases."
Richard Brown, UCLA Center for Health Policy Research, Los Angeles, USA, agrees: "McCain's proposal will undermine physicians' efforts to prevent cancer and detect it when it is most responsive to treatment because insurers will not have to cover cancer screening. It will burden cancer patients with potentially devastating costs because insurers will be able to exclude pre-existing conditions and cancel coverage."
"Patients with cancer and other chronic diseases have the hardest time in the individual insurance market", agrees Sara Collins, lead author of an analysis of the Obama and McCain plans, released Oct 2, 2008 by the non-partisan Commonwealth Fund (New York, NY, USA). "Under Obama's plan for a new National Health Insurance Exchange, those patients would have a place to buy insurance with standard benefits."
Furlow writes that the US government economic bailouts will almost certainly diminish prospects for health reform. Roger Feldman, University of Minnesota, Minneapolis, MN, USA, warns: "This will be the largest budget deficit in US history, and will present an immense challenge for either plan. Reform will likely be very incremental and around the edges."
The experts disagree over which plan will be more impacted by the bailout. "Obama's plan would be more impacted, but it will be very difficult to fully implement either plan", says Feldman. "Obama's plan involves more spending and proposes a new Medicare-like programme costing $140 billion a year in new spending. There's not going to be money for that", agrees Michael Cannon of the CATO Institute. "I think the bailout will be harder on McCain's plan", disagrees Glied. "It's hard to imagine Congress will want to expend political capital taking on its expense with little to show in terms of expanded coverage."
Feldman adds that the winning candidate's health-plan could end up being brought in incrementally. He says: "The easiest and most readily available option for Obama would be to simply expand the State Children's Health Insurance Program [SCHIP]." Congress expanded SCHIP coverage for uninsured American children last year, but President Bush vetoed the bill, which would have increased programme costs by $7 billion a year. Feldman continues: "The Obama plan is not like the Clinton master plan. It is a building-blocks approach, already built to be incrementalist", agrees Glied. "He could expand SCHIP as a small piece of the plan." Similarly, McCain could wait to eliminate employer health insurance subsidies, Feldman suggests, and he—or Obama—could adopt Hillary Clinton's plan of capping employer-paid insurance subsidies for upper income employees.
Collins adds: "There are other ways to offset the revenue needed", says Collins. "Allowing Medicare to negotiate better pharmaceutical prices could save the federal government $72 billion over 10 years. Tobacco taxes and savings from health information technology and other strategies could reduce the cost of an Obama-like plan from $82 billion in the first year to $31 billion."
Full Special Report: http://press.thelancet.com/TLOMcCainObamafinal.pdf
Journal
The Lancet Oncology