The war of words between the US presidential candidates heated up in the last week before the election with Barack Obama taking aim at John McCain’s health-care plan. “The truth is, John McCain’s health care plan is radical, it’s unaffordable, and it’s not the change we need right now”, Obama said Oct 29 at James Madison University in Virginia.He praised McCain’s top economic advisor, Douglas Holtz-Eakin, for offering “a stunning bit of straight talk–an October surprise” in his assessment of McCain’s plan to CNN. Holtz-Eakin said younger, healthier workers would not abandon their employer sponsored health plans to take up tax credits offered under McCain’s proposal. “Why would they leave?” Holtz-Eakin said “What they are getting from their employer is way better than what they could get with the credit.”

Obama said the remark confirmed that employer coverage would be better than that offered by McCain. “Now this is the point I’ve been making since Senator McCain unveiled his plan”, Obama said.

Holtz-Eakin said the quote was taken out of context and that he was arguing that the tax credit would not undermine employer sponsored care, which provides coverage for more than 60% of Americans under 65 years. Erosion of employer coverage under McCain’s plan is a major concern of some economists and health policy experts. The proposal “has the potential to reduce the incentive for many employers, particularly small employers, to continue providing health coverage to their employees”, argues the Commonwealth Fund, a Washington, DC, based think tank.

McCain is proposing elimination of the current tax exemptions offered to employers who provide coverage, replacing them with a refundable credit of $2500 for individuals and $5000 for families to purchase coverage in a proposed deregulated insurance market. (more…)

The candidates’ health-care plans are still a big issue. But just a week and a half before election day, so is the candidates’ actual health. Just a day after the New York Times ran a story exposing gaps in the candidates publicly-disclosed medical records, Senator Joe Biden responded.The Democratic vice presidential nominee gave reporters a look at his health background. Many have been wondering whether 65-year-old Biden could be at risk for another cerebral aneurism. He had his first one 20 years ago, and had to have emergency surgery to stave off some bleeding from a leaking artery. It’s also though he suffered a second, sub-clinical aneurism later.

But Biden’s physicians recorded little concern of a repeat cerebrovascular event. He’s never had a follow-up study to confirm that his arteries are clear. At the same time, Biden’s blood pressure is a relatively healthy 120/78, and he’s taking statins to control his cholesterol.

The corollary to all of this is that Governor Sarah Palin, who’s 44 and the Republican vice presidential nominee, has never disclosed any medical information to the public. She’s running to be second to a 72-year-old John McCain, who’s had two bouts of malignant melanoma (see Correspondence in the Oct 25 issue of The Lancet for more on McCain’s health). (more…)

Although funding for global health priorities like HIV/AIDS and malaria has enjoyed great support among US lawmakers in recent years, the global financial crisis—and the US Government’s US$700 billion bailout package aimed at shoring up credit markets—may change that. With the days ticking down to the presidential election, the US foreign assistance budget is increasingly being mentioned as a spending area that will have to be scaled back—and that means funding for global health priorities.Senator Barack Obama, for instance, has long pledged a doubling of foreign assistance in his first term. But campaign officials are already signaling that such a goal may be unrealistic in the face of new budget pressures, and Obama’s running mate, Joe Biden, specifically singled out foreign assistance as a funding item that may have to slow. The McCain campaign has also said foreign assistance may feel downward budget pressure.

Although the large increases of recent years may be slowed, what this ultimately means for overseas funding aimed at combating HIV/AIDS, malaria, tuberculosis, and other health issues remains unclear. (more…)

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…)