Reflection Session 2.18.2007

Each week the volunteers of Family Help Desk get together to talk about logistics, program development, planning for finding more resources, and the 'big-picture' issues that effect our program. This semester we have RS on Mondays 8:15-9:15pm, rm 568 Lerner Hall, Columbia University.

Tonight in RS we talked about the presidential candidates' healthcare plans. The Kaiser Family Foundation has an interesting side with a side-by-side comparison of candidates' plans is here:
http://www.health08.org/sidebyside_results.cfm?c=5&c=11&c=16

--One major difference between the candidates is who is required to have healthcare. Under McCain, no one is mandated to have coverage, there are simply more incentives and stuff to get insurance cheaper. Clinton's plan mandates coverage for all Americans, and Obama's mandates coverage for all children (up to age 25).
--A big philosophical difference here is in autonomy. Obama would say that children need healthcare because they cannot make a choice, but adults do not because they have the right to make even unwise choices. On the other hand, for Clinton perhaps, these choices can often impact the entire family, including the children. For McCain, there is a stronger right to self-determination that the government cannot override unless it is very serious.
--One thing mentioned was Obama and his use of Rep. Jim Cooper as a spokesperson/surrogate, and how he may have been instrumental in derailing the [Bill] Clinton healthcare plan, but how specifically is unclear.

Dr. Emily Rothbaum, a doctor in the Pediatrics department at Columbia-Presbyterian Hospital, and our physician mentor, talked about healthcare as well:
--If people are uncovered by health insurance, they will be given care in the Emergency Dept. if they have an 'emergent' (i.e. emergency) problem. This cost is taken up in part by the hospital itself, and in part by the government, which has various 'slush funds' that cover the cost, so ultimately the taxpayer will pay for emergency treatment of people without health insurance. The difference is that once these patients leave the hospital, they cannot get treatment.
--SCHIP/Medicaid/private plans try to get people to save money by signing people up for HMOs. One effect this has is that HMOs determine which hospitals you can attend, because hospitals will only accept certain HMOs.
--People who are most affected by SCHIP (State Children's Health Insurance Program, that provides health coverage to low-income children) don't actually have time to vote/lobby and have a voice in the political process

One question that came up was why the U.S. was different from other countries with similar economic power, but universalized healthcare.
--Some reasons are our population is much higher, Americans like the idea that they can buy their health insurance (and better insurance), and their cultures except much higher tax rates that are levied in those countries in order to pay for health care
--Americans use more technologically advanced tests/treatment --> higher costs
--There is an explanation that American companies need to recoup their R&D costs
--In the U.S., we have much higher administrative costs than other countries.

We also talked about Departments of Health and competing interests that commissioners might have.
--What brings money to the city v. helping people out (commissioners are often MDs, didn't become commissioners for money)
--Two interesting special interests: Businesses (as in employer-based healthcare), AARP (American Assoc. of Retired Persons) which is actually the largest lobby in the U.S. and are very, very invested in keeping Medicare around.


--David Yin, CC '09