An adviser to Barack Obama discussed the Democratic presidential contender’s health plan this morning in a webcast produced by the Henry J Kaiser Family Foundation (a McCain adviser will be interviewed on Oct 16).

David Cutler, professor of Applied Economics at Harvard, warned that if present trends continue, US federal tax revenues will be spent entirely on Social Security and Medicare— the retirement and medical programmes for the elderly and people with certain chronic conditions.

Cutler estimated that Obama’s plan would cost the federal government US$50 billion to $65 billion annually, to be paid for largely by ending tax cuts President Bush enacted for individuals with annual incomes of $250 000 or more. All in all, a typical family of four would save about $2500 per year in medical costs under the plan, or roughly 8% of what it costs to cover that family today. At the same time, an Obama administration would lower medical costs by enlarging risk pools, and through investments in areas such as health-care infrastructure, public health, and preventive care. Doctors would be rewarded for good outcomes, and Medicare would offer incentive payments for activities such as following up with patients who miss appointments, electronic doctor-patient communication, and investing in information technology (IT). (more…)

Not that they expect to generate much response, but reproductive-health advocates are calling on the US presidential candidates to discuss the thorny issues of global family planning and women’s human rights during  a series of televised debates that began Sept 26. “I submit that if we truly want to regain international credibility and legitimacy, the US must become a collaborator with our global neighbors on a variety of issues”, writes Serra Sippel, executive director of the Center for Health and Gender Equity. “Why not start with the global crisis women face throughout the world regarding fundamental sexual and reproductive health rights.”

She points out that women havemore than half of HIV infections in some regions. In addition, 200 million women yearly have unmet need for contraceptive services and there are 80 million unintended pregnancies each year, 60% of which end in abortion. Half a million women die each year from pregnancy related complications and 68000 die from unsafe abortions.

Despite these grime statistics and widespread acknowledgement of the need to address both gender equity and the effects of demographics on development, the issue has not been a hot topic on the campaign trail, to say the least. Even development groups haven’t pushed the issue in recommendations on foreign assistance reform aimed at the next president, Sippel said.  (more…)

The US banking and economic crisis has taken centre stage. Many Americans are worried about whether they’ll be able to get a car loan next year, much less pay for health care.

But they have good reason to worry about the latter. There was some stark news this week from the Henry J Kaiser Family Foundation, which tracks the cost of employer-paid health coverage. That’s the bedrock of the American health-delivery system, which more than 160 million Americans getting their insurance through their workplace or a family member’s workplace.

The hard facts: private health coverage for the average family of four now costs US$12 680 per year. Workers’ share of that staggering costs is $3354, which Kaiser described as only a “modest” rise of 5% from last year.

It’s true, a 5% rise in premiums is relatively small compared to the double-digit rises in some years over the last decade. But the figure is more than double what workers paid in premiums in 1999. Over the same time period, wages are up 34% and inflation 29%.

Kaiser’s data shows that it’s not just consumers who are clamoring for some cost relief in the health system. Employers are buckling under the weight of rising costs, leading more and more of them to opt for high-deductible insurance plans that let them limit their financial liability when it comes to workers’ health care. (more…)

Both Presidential candidates’ health-care plans come under scrutiny in the Sept 16 issue of Health Affairs, and both are found to have serious flaws.

Right now, people who receive employer-subsidised health insurance do not have to pay taxes on it. In their analysis of John McCain’s proposals, authors Thomas Buchmueller, Sherry A. Glied, Anne Royalty, and Katherine Swartz state that this not only lowers each employee’s tax burden; it also strengthens risk pools by including younger, healthier people who take advantage of the tax break to obtain coverage. Under McCain’s plan, employer-subsidised health insurance would be considered income and become subject to federal income taxes. However, families would receive tax rebates of US $2500 to $5000 to offset the cost of those policies. 

On the assumption that, stripped of the tax benefit of employer-based coverage, many people would then buy policies on the open market, the McCain plan would eliminate current restrictions against crossing state lines when shopping for policies. Many states now require insurance companies to cover certain services, such as mammograms, even in their barest-bones policies; under the McCain programme, people in one state could buy a less-expensive policy in another state that required less generous coverage.

All in all, the authors estimate that 20 million of the 160 million Americans now covered through employer health plans would lose that insurance under the McCain plan in its current form. His proposal to deregulate the market ultimately would raise prices for consumers and leave them with fewer protections and more limited coverage. (more…)

Much has been made of the fact that the Republican Vice-Presidential candidate, Alaska Governor Sarah Palin, has a 5-month-old baby boy with Down syndrome. While a good deal of the discussion has generated far more heat than light, Palin’s personal situation does raise the question of whether she will be a disability-rights advocate if elected.

During her acceptance speech at the Republican National Convention, Palin underscored her connection to families with special-needs children. They would, she said, have “a friend and advocate in the White House”.

But Palin’s-and the Republicans’-stand on some issues could complicate her ability to advocate for the disabled. She is opposed (unlike her running mate) to embryonic stem-cell research, a position highlighted by her Democratic counterpart, Senator Joe Biden. On Sept 9, Biden asked why, if Palin plans to help parents of disabled children, she doesn’t support stem-cell research. The McCain campaign called Biden’s remarks part of “an offensive debate over who cares more about special-needs children”. Neither campaign appears to have addressed the issue of whether stem-cell research holds any promise for conditions like Down syndrome.

Like John McCain, Palin also supports a voucher system that would enable parents to choose which schools their children attend. School choice is usually appealing to voters in principle, since it gives parents the right to remove children from failing or dangerous public (ie, state-supported, free) schools, and vouchers theoretically broaden the availability of educational venues beyond the public system to private or charter (fee-supported) schools. In practice, though, US schools are basically run by state, local, and private authorities, not by the federal government. Those local policies may dictate which children can enroll in specific schools, and not all schools (in particular, private ones) will accommodate special-needs children. (more…)

If the US presidential race can be described as theatre, last week’s Democratic National Convention would have been a Broadway hit, with its star candidate Barack Obama and his adorable family in the leading role, and a supporting cast that included the veteran politician and vice-presidential pick Senator Joe Biden. The performance went off without a hitch.With his own nominating convention this week, Republican candidate John McCain hoped to capture at least some of the fanfare from the Obama Show. Instead, he has had to overcome distractions that threatened to spoil the opening act. First, McCain surprised everyone by announcing his vice presidential running mate is Sarah Palin, a previously unknown Alaska governor with little political experience. Then Hurricane Gustav took the stage, narrowly missing an evacuated New Orleans and causing Republicans to delay the start of their convention by a day.

That should have been enough drama for one convention. But the McCain-Palin ticket hit another bump in the political road. And it stems not from the merits of either candidate, but rather from a situation involving Palin’s pregnant and unmarried teenage daughter.

The story dominated the airwaves for the first two days of the convention, although both candidates and a cast of experts pointed out that such personal issues have no place in politics.

Nevertheless, the announcement of Palin’s soon-to-be grandchild is politically relevant, and here’s why: Palin is touted by Republican insiders for her socially conservative credentials, including a strong anti-abortion record. In addition to opposing abortion, on a 2006 questionnaire submitted to gubernatorial candidates, Palin refused support for “explicit sex-education programs”, according to CNN. (more…)

All eyes this week were on Denver and the glitz and glamour of the Democratic National Convention, which many commentators likened to a Hollywood production with an emphasis on personalities rather than issues.

Media coverage made a political soap opera out of Bill and Hillary Clinton supposedly vying for the limelight one last time before the party formally throws its support behind its nominee Barack Obama, who will address the convention today.

In a speech on Tuesday night, Hillary Clinton urged her backers to get behind Obama to prevent a John McCain presidency, the Chicago Sun-Times reported. “I can’t wait to watch Barack Obama sign a health-care plan into law that covers every single American”, she said, reminding the convention floor that health reform was a key issue for her supporters.

Clinton also attacked McCain, who will be formally endorsed as the Republican nominee at his party’s convention next week. “John McCain says the economy is fundamentally sound. John McCain doesn’t think that 47 million people without health insurance is a crisis.” She repeated the Democratic message that a McCain presidency would be a continuation of George W Bush’s policies. (more…)

 After the briefest of summer lulls, the presidential campaigns looked to enter their most intense stretch of politicking before November’s elections, starting with the formal endorsement of both candidates at the party conventions. Barack Obama and the Democrats meet in Denver starting on Aug 25 and John McCain and the Republicans gather in Minneapolis from Sept 1. While recent headlines have focused mostly on speculative chatter about the prospective vice-presidential candidates, health remains high on the campaign and public radar screens.

Some 20 million people are expected to watch television coverage of the Democratic convention, which will feature speeches by “real people” on concerns close to their hearts before a live audience of about 20 000. Pamela Cash-Roper from Pittsboro, NC, will talk about how she and her husband are unemployed because of health problems and often cannot leave the house because fuel is too expensive, reports the Chicago Tribune. Kayla Whitaker, who at 20 is voting for the first time and is a Christian, won an essay contest for her slot at the convention. She would like to discuss health care with Obama. “But I will probably be too star struck to say anything,” she told the Rocky Mountain News. “I appreciate his attitude towards different faiths, his strong belief and being respectful [of different faiths],” she said.

McCain, meanwhile, used a speech before members of the Veterans of Foreign Wars in Orlando to not only reinforce his message that he would be best-placed to lead foreign policy but also to pledge to improve the veterans health-care system. He pledged to improve access to health care and improve it for the growing number of women veterans, said the Daytona Beach News Journal. Nonetheless, columnist William McKenzie said in the Dallas Morning News that McCain should strive to make health care one of his leading domestic policy issues. He wrote McCain would give tax credits to individuals to buy insurance and free those who stay in jobs mostly because of locked-in health benefits tied to their employer. He would also eliminate the tax advantage workers get because they are not taxed on company health coverage, a situation that benefits higher-income workers. “True, this stuff is complicated, but he’s basically taking an advantage from the wealthy and spreading it around to everyone else,” McKenzie wrote. “He should be shouting this from the airwaves, showing voters he’s the guy taking on the Buffetts on behalf of the average guy.” (more…)

It was a relatively quiet week on the US campaign trail, with Democratic candidate Barack Obama vacationing in his former home state of Hawaii and John McCain noticeably scaling back appearances at press conferences. With the campaigns on autopilot, the debate over the best roadmap for health-care reform continued with campaign advisors, pundits, columnists, and reporters all weighing in on the issue.           

In Pittsburgh, Democrats over the weekend refined their party’s platform by calling for guaranteed access to affordable, comprehensive health care for  “every American man, woman and child”. This move draws the health care component of the Democrat’s platform—expected to be adopted at the Democratic National Convention, which begins Aug 5 in Denver—closer to that of Obama’s former rival in the Democratic presidential race, Senator Hillary Clinton.

The move, writes The Nation’s John Nichols, appeases the party’s more progressive members and is a step beyond Obama’s proposal, which stopped short of committing to guarantees.

As both parties’ nominating conventions draw near—the Republicans will hold theirs Sept 1-4 in Minneapolis—the health-care debate broadened this week as speculation grew over who Obama and McCain would select as their vice-presidential running mates. Typically, one would not expect vice-presidential candidates to play a major role in promoting health-care policy. But, reports ZDNet’s Dana Blankenhorn, health-care reform in the USA is already taking shape through efforts by state and local governments, and three of McCain’s potential running mates have already gained insightful experience.

One of McCain’s possible picks is Minnesota Governor Tim Pawlenty. Last month, after vetoing a health care reform bill promoted by state Democratic legislators, Pawlenty unveiled his own state plan for health care reform, which promised to “put consumers in charge” by giving them access to on-line medical profiles and treatment options, as well as debit card spending accounts. The plan will be offered to some 50 000 state employees and could eventually be extended to all Minnesotans. (more…)

This week, the US Centers for Disease Control released findings that show that the incidence of HIV in the USA is 40% higher than previously thought. New survey methods show the 2006 incidence rate at 56 000. The agency put the figure at 40 000 annually for several years. “It is important to note that the new estimate does not represent an actual increase in the annual number of new HIV infections”, the agency said. “In fact, CDC’s analysis suggests that the epidemic has been roughly stable since the 1990’s though the number of new HIV infections remains unacceptably high.”

The report shows the greatest number of new infections is among men who have sex with men (53%). The rate among African Americans was seven times as high as that of whites (83.7 per 100 000 versus 11.5 per 100 000).

Even before the new figures were released, the Black AIDS Institute criticised the US for pouring billions of dollars into global AIDS efforts but “fail[ing] to mobilize the same commitment to address the large and growing epidemic within its own borders”. A report released by the group on July 29 says more black Americans are infected with HIV than the total populations of people living with the virus in seven of the 15 focus countries covered by the US President’s Emergency Plan For Aids Relief (PEPFAR).

The new CDC figures, and the report, are likely to prompt some serious soul searching among US public-health officials and politicians, including the next president. “The HIV epidemic within our own borders is even worse than we had believed”, said key congressional lawmaker Henry Waxman, a Democrat from California. “This is a stark remainder of the importance of evidence based HIV prevention programs. But under this Administration, HIV prevention has been underfunded and too often hindered by politics and ideology.” (more…)