James Squires: On health care, only McCain offers serious and good reform
07 01 08 - 12:09
IT IS NO wonder that New Hampshire voters are deeply divided on how to address the manifest problems of the way Americans pay for and receive health care. John McCain offers us an opportunity to chart a course toward fundamental change with our votes tomorrow.
Or, we may listen to the siren call of simplicity and, yet again, postpone looking at reality.
Some facts are clear: Expenditures on health care in our state are rising at a faster rate than the growth of our economy. Currently, approximately 16 percent of our gross state product goes to addressing health related problems, and nothing on the horizon suggests these costs won't reach 20 percent in five to seven years.
Some will argue that this is a boon to our economy while others will counter that there will be less money available for education, transportation and workforce housing. Almost by reflex, we are driven to addressing the problems associated with the lack of health insurance.
Health coverage is not, however, health care. Witness what is happening in Coos County. The lack of obstetrical services in Colebrook and the impending closure of obstetrical care in Lancaster means that, along the Connecticut River border, the most northern locale offering this essential care is Littleton.
Currently there are over 50 vacancies in New Hampshire for primary care physicians and a vast unmet need for nurse practitioners and allied health providers. One out of five adults in New Hampshire is obese, putting New Hampshire 36th among the 50 states. No presidential candidate, except for McCain, is speaking at any length and in a serious manner about the fundamental problem of the cost of health care in the United States.
An understanding of health care costs is crucial to making health care services available to all Americans. Unfortunately, the link between health insurance to employment obscures the reality of costs. This, in turn, helps cover up a reimbursement system that handsomely rewards those who treat disease and minimizes compensation for those who care for patients at home or provide primary care.
Also left behind are those who work in community health centers and community mental health centers. Finally, at the bottom of the reimbursement scale are those who toil in obscurity by caring for patients with mental illness, substance abuse, dental disease, or carry the singular banner of public health.
While not ignoring the importance of coverage, Sen. McCain is acutely aware that our country is going into debt at the rate of $1 billion per day, making new vast commitments of federal money a risky long-term idea.
The systems that provide health services leave much to be desired in terms of transparency and measurement of quality; we physicians are very good at treating specific illnesses, but the patient with a bevy of chronic afflictions is easily lost in a maze of specialists.
Sen. McCain is well aware of the importance of community health centers and community mental health centers and is a strong supporter of the State Children's Health Insurance Program (SCHIP).
Sen. McCain's proposal to reform the tax code to eliminate the bias toward employer-sponsored health insurance, and provide individuals with a $2,500 tax credit ($5,000 for families) to increase incentives for insurance coverage begins to change the fundamental link between employment and health insurance.
Research has shown that families in New Hampshire (two parents and two children with both parents working) require $48,625 to meet their basic needs. Basic needs means: food, rent, utilities, basic telephone, clothing and household expenses, a car, child-care, health care and a small allowance for personal expenses. Below $48,625, health insurance becomes progressively more difficult. This is where Sen. McCain's proposal will have the most impact, although there will always be a certain level, tax credits not withstanding, below which public assistance will be required to provide universal coverage.
Sen. McCain offers us much to think about when approaching the No. 1 long-term domestic issue. His emphasis on fiscal reform, telehealth, transparency of physician and hospital charges, the electronic medical record and professional reimbursement reform avoids simplicity and challenges us to look deeply into ways to reduce costs, insure more people, raise quality and improve access for all Americans and for those of us in New Hampshire.
James W. Squires is a former surgeon and state senator from Hollis.