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.

Technorati Tags: Barack Obama,health care,health insurance,John McCain,Politics,presidential campaign,presidential election,uninsured,voter,Voter’s Survival Kit,voters

When we hear the line “47 million Americans go without health insurance” the image that immediately comes to mind for most people is either a sick child or a working-class family caught in the trap of making too much money for Medicare but not enough to pay for insurance premiums.  This is an inaccurate picture.  To be sure, healthcare coverage is an important issues and needs to be addressed by the next president, but often info about the problem is spun in a misleading way.

According to the 2006 Census report on Income, Poverty and Health Insurance Coverage, by far the largest population group to go without health insurance is young adults ages 18-34, making up about 2/5 of all those uninsured.  This group tends to be in good health, and generally does not stay uninsured for more than a couple of years at most.  This is most likely due to factors like since this group tends to be healthy they don’t feel they need to spend the money on insurance, or that they’re making the transition from high school and college into the work force, have not gotten a job with health care yet, and will not go uninsured for long.

Children living in poverty were the most likely group of children to be uninsured, which I find interesting since Medicare exists so that those living in poverty will not go without healthcare.  If you live below what is considered the “poverty line” and are a citizen of the US you should be eligible for Medicare, so perhaps their parents have not obtained coverage for them.  Since the State Children Health Insurance Program ( SCHIP) was made into law states are working on developing plans that cover every uninsured child in their state regardless of income (some states, like New York, even cover illegal immigrants under these plans).  The problem of uninsured children is being taken care of and soon there will be no more children that go without healthcare, even if the new president did absolutely nothing.  Neither candidate can really claim that they will save the uninsured child.  The only problem that will remain is making sure parents sign their children up for these programs.

Considering that 1/7th of the federal budget is spent on health care, health care is, indeed, expensive.  Most full time jobs (and even many part time jobs) offer employees some kind of access to healthcare.  It isn’t free, and it’s up to the employees to decide to opt-into these plans.  If the employee decides that healthcare is not a priority to them and they do not want to spend the money necessary to gain access to their employer’s plan it’s their personal decision and I’m not sure the government has any responsibility to convince them their health is worth spending money on to insure.  There’s nothing we can do to force people to have health insurance, short of making it illegal to go without, which neither candidate is suggesting.

“If you are one of the 45 million Americans who don’t have health insurance, you will have it after this plan becomes law. No one will be turned away because of a preexisting condition or illness.”

The biggest fallacy of the Obama healthcare plan is that it would cover every America.  It wouldn’t.  It would provide the option of health care, but it would still cost money and I suspect that lots of those uninsured adults between 18-34 would still rather spend the money on something else.  It wouldn’t do any more to insure children than is already being done independently of his plan. 

At the end of the day it would be the individual’s choice to obtain coverage for themselves, and short of becoming a true socialist nation there is nothing America can do to make sure that happens.

Tags: healthcare, obama healthcare, uninsured americans, socialism, socialist nation, healthcare insurance programs, medicare, healthcare plan