By Scott Bittle on October 23, 2008

Too often, trying to follow the presidential campaign debate is like coming in on the middle of a movie. You can get the gist of what’s going on, maybe, but you know that major plot points slipped past you – you know you could figure out who the murderer is, if you’d just been able to catch the first 15 minutes.

The basic reason is that the candidates, even when they talk about the issues, assume you already know the basics. The candidates figure they don’t have time to explain the background to you, and they figure it might bore you anyway, so they jump right into what their plan would do. That’s particularly unfair because the politicians themselves often are working off cheat sheets or talking points that give them the key points to make. Their staff has done the digging; the politician gets the bullet-point version.

Take health care, for example. The plans put forth by Sen. Barack Obama and Sen. John McCain are miles apart in ideological terms, and wickedly complicated in their details. But do the campaigns or the media spend much time stepping back and looking at what’s going on with the health care system, or why it needs fixing in the first place? Not really.

So here’s ten things you need to know about the state of the U.S. health care system. This is where we stand as a nation on this issue, and with these key facts in hand you can start to get your mind around the very complicated options the presidential candidates are putting out there. For a start:

Some 47 million Americans, 15.8% of the population, don’t have health insurance.

These are mainly people in jobs that don’t offer benefits: people between jobs, part-timers, the self-employed and lots of folks who work for small businesses. The number of uninsured may well go up over the next year because of the bad economy, as businesses lay off workers or cut back benefits.

The U.S. government spends nearly $700 billion each year on health care, mainly for Medicare (which covers nearly all older Americans), Medicaid (which helps cover those who are very poor) and care for veterans.

Meanwhile private health costs amount to about $1.1 trillion every year. About six in ten Americans get health insurance from their employer.

And just in case you hadn’t noticed, individuals shell out for health care too. It’s usually for deductibles, co-pays, premiums and drugs that aren’t covered by insurance. For an unfortunate group of Americans, it’s what they have to pay when they have a very serious illness or injury and their insurance basically runs out.

The U.S. health care system is incredibly complicated. Essentially, it’s not a ‘system’ at all – it’s a patchwork of private insurance and government programs like Medicare. There are holes in the system – and there’s duplication as well.

Health care costs have been rising faster than inflation for decades (they went up 6.7 percent in 2006). This will probably get worse. Government experts project health spending could double in 10 years

This presents a huge burden for business and it’s a budget-buster for the government, but frankly you’ll be on the line too. Business faced with spiraling health care costs sometimes cut benefits or raises or may even cut back their work force. Government needs to get the money from someone to cover health care costs. Guess who?

Most experts say expensive new treatments, procedures and drugs, along with an aging population are the major reason health care costs are shooting upward, but everyone also agrees that there’s a lot of inefficiency in the system too.

The plans of both presidential candidates are going to cost a lot of money. And given the staggering projections for the federal deficit over the next few years, money is going to be tight. So the government’s going to have to find a way to pay any reform plan.

How do we know this? Here are our sources:

Census Bureau, Health Insurance 2006; Center for Medicare and Medicaid Services, National Health Expenditures Data; Government Accountability Office, The Nation’s Long-Term Fiscal Outlook April 2008; Kaiser Family Foundation, Trends and Indicators in the Changing Health Care Marketplace; Tax Policy Center, Analysis of the Presidential Candidates’ Tax Plans,

Want to think over the options for actually fixing this problem? Have a look at Public Agenda’s Voter Survival Kit on health care, Your Money or Your Life, where we lay out different options, with potential costs and tradeoffs. And to check out the candidate plans in detail, visit the McCain and Obama web sites.

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