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…)

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…)