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As a physician and patient advocate, I know the problems with healthcare. Universal healthcare in which everyone is covered and we get rid of the middle-man (the insurance companies) is the solution. But the 2nd best solution is at least “everyone is in the system.” The 3rd best solution is “everyone has the option to be in the system.” The least optimal is what we have now. Barack chose the 3rd best solution. Edwards and Hillary chose the 2nd best.

The key question is whether to let people opt out. Scholars in the field and physicians who study the problem know that in order to do good, you cannot let people opt out. Otherwise, it increases the cost to the taxpayer via people going to the ER and we having to bail them out of bankruptcy when that happens, and those with insurance sucking up the cost of their ER visits. 

Every time an American without health insurance walks into an emergency room, we pay even more. Our family's premiums are $922 higher because of the cost of care for the uninsured. We pay $15 billion more in taxes because of the cost of care for the uninsured. And it’s trapped us in a vicious cycle. As the uninsured cause premiums to rise, more employers drop coverage. As more employers drop coverage, more people become uninsured, and premiums rise even further.

It is not in our character to sit idly by as victims of fate or circumstance, for we are a people of action and innovation, forever pushing the boundaries of what’s possible. ... The time has come for universal health care in America.

Obama says that people don’t have insurance because it is too expensive. Not true.

One study estimates that about 25% of the country’s uninsured, or roughly 11 million people, are eligible for government health care programs but unenrolled.

Research also suggests that subsidies alone are unlikely to solve the uninsured problem in the U.S. (source: Subsidies and the Demand for Individual Health Insurance in California).

In 2007, Obama said about healthcare, “We must act. And we must act boldly. ... Washington no longer has an excuse for caution. Leaders no longer have a reason to be timid.” Yet his is the wimpiest plan of the 3 top candidates and does not achieve universal healthcare/coverage. (Some estimate 9-15 million people would not be covered under his plan because they would not opt in.)

This is flip floppy... (wait until the Republicans get ahold of this!)

Here is a great article by economist Paul Krugman on the subject.

The difference between the plans could well be the difference between achieving universal health coverage — a key progressive goal — and falling far short.

... A plan without mandates, broadly resembling the Obama plan, would cover 23 million of those currently uninsured, at a taxpayer cost of $102 billion per year. An otherwise identical plan with mandates would cover 45 million of the uninsured — essentially everyone — at a taxpayer cost of $124 billion. Over all, the Obama-type plan would cost $4,400 per newly insured person, the Clinton-type plan only $2,700.

That doesn’t look like a trivial difference to me. One plan achieves more or less universal coverage; the other, although it costs more than 80 percent as much, covers only about half of those currently uninsured.

According to the Urban institute, “it is not possible to achieve universal coverage without an individual mandate.” (Source: Do Individual Mandates Matter? ).

In a recent Healthcast from the Kaiser Network, Len Nichols, Ph.D., the Director of the Health Policy Program of the New America Foundation said:

If you go pure voluntary even if you have fairly generous subsidies you are not going cover more than half of the uninsured. So basically the reason to do a mandate is not because we like it, I mean I would think the mandates are kind of like booster shots, they are vaccinations that sometimes hurt a little bit, but they protect you from the rest of us and they protect the rest of us from far worse illnesses down the road. They actually make markets work better to make sure everyone pays their fair share.

For such a brilliant man, I am shocked that Senator Obama missed such a fundamental part of the solution to the problem of healthcare or isn’t willing to take the bold changes that he advocates for. I worry that this may be indicative of his judgement regarding other issues.

— Sophia Yen MD MPH

P.S. I never dreamed of becoming an MD until my mother introduced me to her female MD friend and I realized that women could be MDs. It would be truly inspiring to young women in the US and women everywhere to see a woman lead the most powerful nation in the world.

More links

• Kaiser foundation sponsored a candidate forum on healthcare. (Interestingly, Obama refused to participate in this forum!)

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