Health Reform & the 2008 Election
Jonathan Oberlander
University of North Carolina-Chapel Hill
Russell Sage Foundation
Health Policy Hero
The U.S. Health Care System
• 46 Million Uninsured (including 8 million children)
• Average Cost of Health Insurance, 2007:
$4,500 (individual)
$12,100 (family)
• Percentage of U.S. companies providing health
insurance: 2000 69%
2007 60%
• Uneven Quality of Care (Americans get recommended
medical care only about 50% of the time)
Without Health Benefits, A Good
Life Turns Fragile
New York Times March 5, 2007
“She tried to buy a policy in the individual insurance
market, but — having had cancer — could not obtain
coverage, except at a price exceeding $27,000 a
year, which was more than she could pay.”
When Health Insurance is Not a Safeguard
New York Times, October 23, 2005
“Zachery Dorsett's parents thought their son
was an average child who was having trouble
getting over a passing illness. He was 7
months old, and it was his second case of
pneumonia… But Zachery, who was
eventually found to have an immune
system disorder, kept getting sick, and the
expense of his treatment - fees for tests,
hospitalizations, medicine - kept
mounting, eventually costing the family
$12,000 to $20,000 a year… Earlier this
year, the Dorsetts stopped making mortgage
payments on their ranch house, because they
could not afford them. In March, they filed
for bankruptcy.”
How Do John McCain and Barack
Obama Propose to Fix the Health Care
System?
Obama Plan
• Modified Employer Mandate (small business
exemption + subsidies)
• National Health Insurance Exchange (subsidized
coverage)
• Regulation of Insurance Industry
• New Public Insurance Program
• Individual Mandate for Children
• Bottom Line:
Expands Coverage, Needs Financing*
McCain Health Plan
• Eliminate Tax Exclusion for Employer-sponsored
Insurance
• Refundable Tax Credits ($2500 and $5000)
• Encourage Individual Purchase of Insurance
• Deregulate Insurance Market (Insurers Can Sell
Across State Lines)
• Guaranteed Access Plan (High Risk Pool)
• Bottom Line:
Has Financing, Doesn’t Expand Coverage Much*
*My thanks to Jon Gruber for this formulation
Political Challenges
Democrats
• Employer mandate
• Regulate insurers
• Enact new Medicarelike government plan
Republicans
• Tax health insurance
benefits
• Move away from
employer-sponsored
insurance
Obstacles to Reform
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Power of the Status Quo
Congress & 60 Votes
Budget Deficit
Limits of Consensus
Agenda Competition
What Happens After the Election?
We Have Failed at Health Reform Before:
Is Anything Different This Time?
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Ask Me After the Election
Problems Are Worse
Reformers Are Smarter
Business Role
Signs of Bipartisanship?
Ron Wyden
Bob Bennett
Steve Burd
Washington, DC: January 2009
“Mr. President. I Know It’s 3AM. But Here’s How to
Pass Health Reform.”
Memo to the Next President
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Time is not on your side
Make the economic case
Persuade the insured
Explain costs of not reforming the
health care system
• Don’t forget that improbable is not
impossible