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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Thursday, August 07, 2003

    Dr. Dean's Medicine Show: Jim Miller also has an excellent post that dissects Howard Dean's Vermont heatlhcare record. Dean summarizes his achievements on his website as follows:

    In Vermont, where I served as governor for the last 11 years, nearly 92% of adults now have coverage. Most importantly, 99% of all Vermont children are eligible for health insurance and 96% have it.

    But that's not it. We coupled our success in insuring kids with a new early childhood initiative that we call "Success by Six." As a result, nine out of 10 parents with a newborn baby -- regardless of income -- get a home visit from a community outreach worker who's there to help them with parenting skills and to put those parents in touch with the services they may need or want. Thanks to Success by Six, we've cut our state's child abuse rate nearly in half, and child sexual abuse of kids under 6 is down by 70%.

    If Vermont -- a small, rural state that ranks 26th in income in the United States -- can achieve this, surely the country that ranks No. 1 in the history of the world can do so as well.

    I'm not so certain that lower child abuse and sexual abuse rates can be completely credited to the Success by Six program. There could also be tougher reporting laws that account for it, or stiffer penalties for abusers. And as Miller points out, Vermont actually lags behind other New England states with lower taxes in indicators of children's health such as infant mortality and vaccination rates. Vermonters just must not be using the services they've been handed.

    But here's Dean's plan for the nation:

    1. He'll expand Medicaid to cover everyone, rich and poor, under 25 years of age:

    First, and most important, in order to extend health coverage to every uninsured child and young adult up to age 25, we'll redefine and expand two essential federal and state programs -- Medicaid and the State Children's Health Insurance Program. Right now, they only offer coverage to children from lower-income families. Under my plan, we cover all kids and young adults up to age 25 -- middle income as well as lower income. This aspect of my plan will give 11.5 million more kids and young adults access to the healthcare they need.

    2. He'll also expand it to cover everyone making up to 185% of the federal poverty level:

    Second, we'll give a leg up to working families struggling to afford health insurance. Adults earning up to 185% of the poverty level -- $16,613 -- will be eligible for coverage through the already existing Children Health Insurance Program. By doing this, an additional 11.8 million people will have access to the care they need.

    3. He'll also establish another federal health insurance program:

    Many working families have incomes that put them beyond the help offered by government programs. But this doesn't mean they have viable options for healthcare. We'll establish an affordable health insurance plan people can buy into, providing coverage nearly identical to what members of Congress and federal employees receive.

    And subsidize the premiums with a tax credit:

    To cushion the costs, we'll also offer a significant tax credit to those with high premium costs. By offering this help, another 5.5 million adults will have access to care.

    4. The government insurance program will be offered to employers at a discounted rate, and it will cover COBRA premiums for the recently unemployed:

    With the plan I've put forth to the American people, we'll organize a system nearly identical to the one federal workers and members of Congress enjoy. And we'll enable all employers with less than 50 workers to join it at rates lower than are currently available to these companies -- provided they insure their work force. I'll also offer employers a deal: The federal government will pick up 70% of COBRA premiums for employees transitioning out of their jobs, but we'll expect employers to pay the cost of extending coverage for an additional two months.

    5. And finally, he'd require all employers to provide health insurance to their employees:

    The final element of this plan is a clear, strong message to corporate America that providing health coverage is fundamental to being a good corporate citizen. I look at business tax deductions as part of a compact between American taxpayers and corporate America. We give businesses certain benefits, and expect them to live up to certain responsibilities.

    Those are, in many ways, laudable goals, but they're also very expensive ones. At a time when national defense is of utmost importance, it's hard to justify spending so much on so many who don't really need the help. Then, too, how do you make all of that new federal health insurance program "affordable"? You could ration care, and only pay for a limited number of services. But everyone cries foul whenever an insurance company - be it private or Medicare - takes that approach. The only alternative is then also an inevitable one - pay for everything but control the prices. Which means that doctors and hospitals, already pinched by inadequate reimbursement, would be driven into further economic losses.

    But the biggest drawback to his healthcare plan is that it insists on maintaining the status quo of having a third party bear the brunt of healthcare costs. The actual consumer and his provider continues to be divorced from the financial reality of their healthcare decisions - which aren't always matters of life and death. In this day and age of expensive cosmetic pharmacology and minimally beneficial, but expensive preventive drugs and procedures, that's just asking for trouble.


    posted by Sydney on 8/07/2003 01:21:00 PM 0 comments


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