Cheers to The Boston Globe for taking a look at John McCain’s ideas for health reform. McCain had pretty much escaped media scrutiny on this issue until last week when Elizabeth Edwards challenged a key point: whether he would require insurance companies to cover people with preexisting health conditions. Edwards pointed out that neither she nor McCain would be eligible for health insurance because they both have had cancer, causing a flurry of discussion in the blogosphere, but little in the mainstream press. The Globe, however, explored how McCain would solve that problem, which gets to the heart of whether private insurance companies can do the job of insuring everyone—whether they should be allowed to engage in a practice known in industry parlance as “risk selection.”
The story told of a journalist who asked if the senator’s skin cancer might make him sympathetic to the idea of requiring that insurance companies offer policies to those with such conditions. McCain responded: “That would be mandating what the free enterprise system does.” Indeed the free enterprise system does allow insurance companies to choose the healthiest people and refuse coverage to those who are sick. But how does that help people get care for conditions they already have? That’s what the public wants to know.
The Globe piece suggests that maybe McCain doesn’t know, either. It reported that he favors a “special provision including additional trust funds for Medicaid payments,” but noted that even his aides did not understand what he meant by that. One McCain idea, the Globe said, was to give people with preexisting conditions an extra tax credit to help pay for insurance that is funded by savings in the Medicaid program, an idea that should also leave policy makers scratching their heads. The article did point out that “extracting extra savings from Medicaid was debatable.”
Medicaid budgets are in big trouble right now, and states are thinking about cutting benefits and services like dental care. All of this raises another question for McCain: where does he think the Medicaid savings will come from? Does he mean cutting benefits to poor people who depend on Medicaid for health care, or from middle-class families who rely on Medicaid to pay for nursing home care? Without Medicaid payments, their relatives could well be on the streets. Are these groups less deserving than those with preexisting conditions? And that, in turn, brings up the equity issue, which the press needs to address as the campaign moves to its next phase.
The Globe also noted another of McCain’s suggestions for helping the sick: put them in high-risk pools, similar to the ones states set up for bad drivers. The paper could have expanded on this one. States have used high-risk pools for years. They are underfunded, premiums are sky-high, benefits limited, and sometimes waiting lists keep people from getting coverage for years.
The paper did call out what it labeled the “crux” of McCain-style health care: ending the tax break for employers who pay for most of the health insurance that people receive. McCain would replace employer-provided coverage with a $2,500 tax credit for individuals and a $5,000 credit for families to buy their own insurance. That is also the approach taken by Senator Ron Wyden, an Oregon Democrat, and Senator Bob Bennett, a Utah Republican, who are pushing the “Healthy Americans Act” that would sever the link between employment and health insurance—a truly radical fix for the nation’s health care ills.
What does the public think of that? What do businesses think? Even though the premiums businesses pay to insure their workers keep rising, many still want to be in the game. Some have a sense of obligation to their workers, while others believe they can help improve worker health and productivity through the management of chronic diseases. This, too, is ripe for investigation by the press. The Globe’s story points the way, but it is merely a start.
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.