Can Our New Leaders Fix the Health Care System?

Michael Scarpitti, a 55-year-old machinist and vocational school teacher in Barberton, Ohio, desperately needs health insurance. But right now, he doesn’t have it, can’t afford it and sees no way to get it.

He’s not “Joe the Plumber” of campaign fame but “Mike the Machinist.” Millions like him, who are too young for Medicare but don’t have insurance through their employers and can’t afford it on their own, are driving what many people hope will be real fixes to the nation’s broken health system.

Indeed, there seems to be an emerging consensus among policymakers, consumers, business and health care stakeholders that, after years of little progress, now is the time to press for real change—even in the face of a recession. And in a sign of his commitment, President-elect Barack Obama has nominated former Senate Majority Leader Tom Daschle to lead the effort and invited citizens to share their ideas. During the campaign Obama pledged to help the 46 million uninsured Americans and rein in soaring costs as part of a larger effort to revive the national economy.

Congressional leaders have also identified health care as a 2009 priority, including Sens. Edward Kennedy, D-Mass., Bob Bennett, R-Utah, Ron Wyden, D-Ore., and Max Baucus, D-Mont., who opened the debate with a 98-page white paper laying a foundation for comprehensive reforms.

“Every American has a right to affordable, high-quality health care,” Baucus, chairman of the Senate Finance Committee, said in a statement. “And I believe that Americans cannot wait any longer.”

Certainly, Scarpitti can’t wait much longer. He lost his teaching job, and his health plan, when his vocational school closed in July 2007. He couldn’t afford the full cost of $857 a month to keep his insurance.

He still is uninsured because his new employer doesn’t provide it. Scarpitti spends about $550 a month on his diabetes drugs and on heart and fibromyalgia medications for his wife, Paula. He charges the drugs on his credit card. “I’m going in the hole every month,” he says.

Unlike Scarpitti, Susan Litchfield, 60, of Delray Beach, Fla., can afford health insurance now, but her premiums keep going up. She wonders if she can hold out for five years until she can qualify for Medicare and hopes she won’t get sick, since she has a $5,200 deductible.

She thinks rates are high in Florida because of the large number of retirees there. She would like national insurance pools to spread the risk. Litchfield is optimistic that “under the Obama plan, the pool would be bigger, and I would probably be able to get a lower deductible for a better price.”

The big question is how much the new leadership in Washington can do in the near future to repair a health system that’s not working for Scarpitti and Litchfield and millions of others. Here’s a look at the prospects for change:

• Covering children The push to insure more children through the State Children’s Health Insurance Program (SCHIP) is the reform that observers say is most likely to succeed in 2009. (Without action the program will expire March 31.) Congress and Obama have made expansion a priority.

• Covering the uninsured In addition to covering more people in SCHIP and Medicaid, Obama would require employers to provide coverage for workers or contribute to the cost of a public insurance program open to individuals without access to other coverage.

Baucus supports a “health insurance exchange,” a government-run program open to those without employer coverage.

Both he and Obama would provide premium subsidies for lower-income people. Baucus’ blueprint calls for allowing uninsured people ages 55 to 64 to buy into Medicare early.

Not surprisingly, the biggest obstacle is money. The president-elect has said he would pay the estimated $50 billion to $65 billion cost of covering the uninsured by allowing tax cuts for those making more than $250,000 annually to expire.

• Preexisting conditions Obama and Baucus would forbid insurers from denying coverage because of an applicant’s health status. America’s Health Insurance Plans, the industry trade group, in November announced its support of such a ban if all individuals were required to join an insurance plan.

• Controlling costs Obama has said improving health information technology could lower costs. He views this as an economic stimulus, noting that helping health providers set up electronic medical records would be a “smart” investment and could reduce medical errors. Baucus calls for investing in health IT and retraining health workers to gain access to science-based medical information. But Carol Diamond, M.D., of the Markle Foundation, an IT research group, says expanding the use of electronic information may be hindered by security concerns, legal issues and technological barriers.

Karen Davis, president of the Commonwealth Fund, a health policy research organization, estimates that improvements in health IT could save $88 billion over 10 years, though no gains would be realized in the first few years.

• Long-term and preventive care Improving long-term care is farther down the list in Washington and is more likely to get attention in the states that want to keep more people at home and out of more costly nursing homes. But Obama and Baucus have each made a case for improving preventive care by broader coverage of services such as checkups and screenings.

While no one knows what changes might be made, health experts and advocates are realizing that fixing health care is crucial to fixing the economy. Even the insurance industry, which unleashed the infamous Harry and Louise TV ads that helped sink the Clinton reforms of 1993, says that “too many people are falling through the cracks” and something needs to be done.

“I think there’s a real desire and motivation on the part of very key players in Congress to move comprehensive health reform,” says David Sloane, AARP vice president of government relations and advocacy. “Clearly the new administration is moving on this. They’re going to be aggressive.”

Indeed, Obama said in December that health care has to be “intimately woven” into an economic recovery plan. “It’s not something that we can put off because we are in an emergency. This is part of the emergency.”

Help won’t come a moment too soon for the uninsured and for those who can’t afford the high price of medical care. With a new spirit of bipartisanship in Washington—at least for now—some crucial changes seem likely.

(Photo by Gregg Segal)

Elaine S. Povich lives near Washington and writes about politics.