Health insurance is a headache for Memphis attorney BruceRalston. He runs a solo practice and says his assistant is uninsuredbecause the two haven't found a plan that's affordable and that theyboth understand.
His wife has insurance from her job teaching at a private school,and it covers Ralston and his 14-year-old daughter. But he saidpremiums cost about $10,000 a year. He's not sure what the familywould do if his wife lost her job.
'We've got a diabetic daughter,' he said. 'If we didn't have thatcoverage, it could be crippling.'
And health insurance is a frequent topic in the lawyers' e-maillists he subscribes to.
'This is a constant conversation,' he said. 'How can I get healthcare for myself, my family and my employees?'
The lawyer's concern about health insurance reflects a largertrend. Paying for health insurance and holding on to it has become aconcern for the middle and upper classes, which helps explain whypolls say health care is one of the top domestic issues in the 2008presidential race. National events will surge into Arkansas andTennessee this week when voters go to the polls for the SuperTuesday primaries. (Mississippi votes March 11.)
Health care spending keeps rising and totaled $2 trillionnationwide in 2005, according to the Kaiser Family Foundation.Reasons for the increase include an aging population and increasedspending on medical technology.
Firms around the nation are passing rising health care costs toemployees lucky enough to have coverage.
Other people, including many who work, have no insurance at alland make do with health care cobbled together from emergency rooms,out-of-pocket payments and charitable write-offs. One out of fivepeople in Mississippi had no health insurance in 2006, according tothe U.S. Census Bureau. The percentage was nearly as high inArkansas but was lower in Tennessee at 14 percent.
Some of Ralston's clients have much worse problems than he does.His specialty is bankruptcy, and he often represents people whosemedical bills have compounded other problems and forced them to turnto courts for help.
There are serious questions about the quality of the care thatthey and other Americans are paying for. A recent article in thejournal Health Affairs found that among 19 wealthy countries, theUnited States had the highest rates of death in the elderly frompreventable causes like bacterial infections and diabetes. It wasone of many studies that demonstrate that health care in the UnitedStates lags behind other developed countries.
These concerns about coverage and quality have created anxiety.
Fifty-nine percent of Democrats and 43 percent of Republicansexpressed worry that they would lose their health care coverage,according to a compilation of recent surveys published in The NewEngland Journal of Medicine.
Even the man in charge of running the nation's most importantfederal insurance programs, Medicare and Medicaid, recently told aroomful of Memphis-area health care leaders that health care inAmerica is deeply flawed.
'This is a lousy system,' said Michael O. Leavitt, secretary ofthe U.S. Department of Health and Human Services, who was in townrecently to promote a project to improve health care quality.
Leavitt said one of the biggest problems is poor communicationamong doctors, hospitals and other entities. This leads to errorsand wasted money, he said.
What's the solution? Democratic candidates Hillary Clinton andBarack Obama are calling for a bigger role for the government, whileRepublican candidates including John McCain, Mike Huckabee, Ron Pauland Mitt Romney mostly support limited solutions that rely onindividual action.
The debate over health care reflects deep beliefs, said DavidMirvis, a health policy expert at the University of Tennessee HealthScience Center.
'I think when we talk about whether we should expand health careor cover everybody, we're not talking about health,' he said. 'We'retalking about the role of government, the role of personalresponsibility, all that stuff. And that makes it much harder tosolve, because you're talking about fundamental values.'
Many of the candidates have published detailed health care plans,but any change to the current system could harm insurers and otherpowerful interests.
'You run into all the same forces of changing a trillion-dollarbusiness that you would with any other one,' Mirvis said. 'Who arethe winners and who are the losers going to be?'
Ralston, the attorney, said he hasn't followed the specifics ofthe health care debate in the current election.
'I think I have a good general idea of what they're proposing,which is some kind of compromise that's not going to be good foranybody,' he said.
He said he's not closely tied to any party but isn't pleased withPresident Bush's health policies and would prefer a government-runsystem.
He's frustrated at health insurers and believes they benefit fromcustomers' confusion about claims and coverage.
'For whatever it's worth, I'm one of the more highly educatedpeople,' he said. 'And I can't comprehend some of this stuff.'
- Daniel Connolly: 529-5296
--------------------------
The candidates on health care
Hillary Clinton (D)
Goals:
Require all Americans to have health insurance.
They could keep existing coverage or choose other plans,including a new federal insurance program similar to Medicare.
Plans would be portable from job to job and some families wouldreceive tax breaks to help buy coverage.
Insurers couldn't deny coverage.
Small businesses would receive a tax credit so they could offerinsurance and big firms would have to coverage or contribute to thecost of the system.
Expand Medicaid and the State Children's Health Insurance Program(SCHIP).
Web site: hillaryclinton.com
------------
Barack Obama (D)
Goals:
Mandate that all children have health care coverage, but wouldnot extend mandate to adults.
Create a new public insurance coverage program similar toMedicare to assist the uninsured.
Create an agency to create rules and standards to increasecompetition among insurers.
No one would be denied coverage and plans would be portable.
Make employers contribute to the national plan or offer healthcare coverage to employees.
Provide government reinsurance to help companies in catastrophiccases.
Strengthen Medicaid and SCHIP.
Web site: barackobama.com
------------
Mike Huckabee (R)
Goals:
Improve the health-care system through free-market means.
Make health insurance portable from job to job.
Cut costs by emphasizing preventive care, giving doctors moreprotection against malpractice lawsuits and adopting electronicrecord keeping.
Allow states to experiment with health-care policy.
Web site: mikehuckabee.com
Sources: Candidate Web sites and position papers.
------------
John McCain (R)
Goals:
Foster insurance competition through market forces and avoid agovernment-run health-care system.
Give people tax credits to encourage them to buy insurance andgive veterans the chance to use Veterans Administration dollars withany provider.
Improve quality of care by publicizing information about health-care providers and rewarding them based on prevention of seriousillness.
Allow re-importation of drugs to cut costs.
Give states freedom to experiment with coverage.
Web site: johnmccain.com
------------
Ron Paul (R)
Goals:
Make all medical expenses tax deductible.
Allow doctors to negotiate collectively with insurance companiesto drive down the cost of medical care.
Make all Americans eligible for health savings accounts andexpand such accounts beyond high-deductible plans.
Save health-care dollars by letting pharmacists and nurses play abigger role in medicine.
Cut regulations to make it easier for small businesses to offercoverage.
Supports reimportation of prescription drugs.
Web site: ronpaul2008.com
------------
Mitt Romney (R)
Goals:
Use free-market methods and tax breaks to help uninsured buyprivate health insurance, avoiding a government-run system.
Make all health care expenses tax-deductible.
Place federal caps on non-economic and punitive damage awards inmedical malpractice cases to cut lawsuits and discourage doctorsfrom ordering extra tests to shield themselves from liability.
Give states more freedom to spend Medicaid dollars as they wish.
Web site: mittromney.com
--------------------------
Health-care related campaign contributions
Donations from:
// Clinton / Obama / Romney / McCain / Paul / Huckabee
Makers of drugs, medical equipment and nutritional supplements /$283,436 / $275,934 / $267,235 / $86,450 / $29,558 / $500
Doctors, nurses and other health professionals / $1,751,030 /$1,372,813 / $1,043,192 / $578,430 / $202,958 / $80,700
Hospitals and nursing homes / $386,651 / $306,386 / $169,550 /$106,135 / $29,937 / $13,700
Health services/health maintenance organizations / $266,380 /$183,943 / $134,350 / $95,400 / $4,550 / $5,300
Insurance industry (health and other types) / $525,188 / $414,863/ $656,758 / $274,724 / $42,221 / $24,550
Total of health-care and insurance / $3,212,685 / $2,553,939 /$2,271,085 / $1,141,139 / $309,224 / $124,750
Total raised / $90,935,788 / $80,256,427 / $62,829,069 /$32,124,785 / $8,268,453 / $2,345,798
Health-care and insurance as a percent of all donations / 4% / 3%/ 5% / 4% / 4% / 5%
*All data as of Sept. 30
Source: Center for Responsive Politics.
--------------------------
