Weekend America

Politics on the Spot

Politics on the Spot: Emergency Room

Mhari Saito

SEPTEMBER 27, 2008

Outside MetroHealth's emergency room

(Mhari Saito)

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For election season, we're taking you around the country to hear how some of the big issues at stake are playing out on the ground. This week we're tackling a doozy: healthcare. It's one of the most complex issues on the candidates' agendas, one that both have given serious thought. To get at it, we sent WCPN's Mhari Saito to the MetroHealth System hospital in Cleveland. It's considered the hospital of last resort for the uninsured in the county. And patients and doctors had many questions for the would-be president. So Mhari took those questions to the campaigns.

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MetroHealth System is what folks in the medical industry call a "safety net" hospital. If you want to know what a "safety net" hospital means, just hang out in front of Metro's emergency room on a Friday night. Cars, vans and taxis line up to drop off patients. And there's always people standing outside like Samuel Cardona. He's here to visit his mom who's a Medicare patient in the hospital. Cardona himself has no health insurance.

"I went and got into my own business," Cardona says. "Just didn't work out. The economy got to me and I had to close my business down."

Most of the patients who come here are poor or uninusured, and the hospital struggles to break even. So does Cardona's family. In terms of politics, health care policy for him is personal.

He has a question for the presidential candidates: "I'm just wanting to know if they can get prescription prices down?"

I put that question to both campaigns and, in a word, they both said, "Yes." Both presidential candidates say we should be able to buy drugs from abroad if they're cheaper, even when those drugs were originally made in the U.S. Prescription drug prices are just a tiny part of the candidates' overall plans, though, and many people at Metro had questions about how the larger details of the plans would affect them.

"How do you provide high quality care?" asks Dr. E. Harry Walker. Walker is the director of the Center for Community Health at MetroHealth System. "How do you provide it at a cost that people or the government can afford to pay? And how do you provide access?"

Both campaigns have a similar answer to these questions, at first.

"Of course, Senator McCain is very concerned about affordability overall," says Dr. Michael Burgess, a Republican congressman from Texas and the only physician on the House subcommittee on medical care.

And here's Dr. Steve Nissen, a prominent cardiologist from the Cleveland Clinic and a supporter of Democratic candidate Senator Barack Obama: "There is an absolutely clear commitment from Senator Obama to allow the 47 million Americans that are now not covered by health insurance to be covered."

But the difference between the two plans is in the details. And it's a big difference. First let's start off with Obama's plan. Nissen says Obama wants a mix of private and expanded public health insurance programs. Obama wants to create a federal health care program for children and tax incentives to businesses offering insurance to workers.

"And for everybody who is left," Nissen says, "there will be a national health insurance exchange. This is a program that would provide coverage very similar to what federal employees have that people could buy into and that would have a variety of subsidies based on income level of the individuals involved."

Obama's estimated price tag: $50 to $65 billion. A lot of cash, but critics wonder if that's even enough.

Congressman Michael Burgess says McCain wants to make the health insurance market more competitive, and he wants to do it by changing the income tax code. McCain wants to get rid of the tax breaks that workers get if their employer gives them health insurance. In return, Americans would get a refundable tax credit.

"We've all heard the two figures: $2500 for individuals and $5000 for families," Burgess says. "It could be directly used to pay for insurance coverage for an individual who's had no ability to purchase insurance previously."

Critics say an average family health plan costs over $12,000 a year and a $5000 tax credit would only go so far.

Back to questions from Metro's ER. Archie May, a Cleveland dad of two, says as health care costs rise, his insurance premiums and deductibles keep going up.

"How are they going to fix the prices of health care?" May asks. "The prices are too high."

Dr. Steve Nissen is confident the Obama campaign can bring prices down. "I think with all of these things--drug re-importation, better preventative care, health information technology--there is no question we can reduce the cost of health care."

"Under the McCain plan," says Dr. Michael Burgess, "the control in the prices of health care will come from the ability to compete against plans that are offered in other areas and the ability for consumers to become much more of a vocal component of the system."

Or to translate: McCain wants Americans to be able to shop around for health insurance, even from other states. Competition, McCain says, would bring down prices.

"So much of our system is designed around a 50-year-old white male having a heart attack at his kid's soccer game," says Dr. James Campbell. Campbell runs Metro's Senior Health and Wellness Center. "And everything works beautifully for that. But that's not the vast bulk of our expenses. It's the 82 year-old who has a flare up that causes three of her conditions to go out of control. That's really where people have to deal with it."

"Well, the ability of good doctors like Dr. Campbell to manage someone's illness over time is one of the powerful things that we have at our disposal now in medicine," says Burgess for the McCain campaign.

Obama supporter Dr. Nissen says comprehensive health care is what's going to make the difference to health care's bottom line. "That's where the savings are," Nissen says, "and that's why we have to emphasize prevention and we have to emphasize coverage for everybody."

Standing across the street from MetroHealth's emergency room entrance, Samuel Cardona says he hasn't decided how to cast his vote.

"If it's John McCain, or whoever, or Barack Obama," Cardona says, "I would hope that one day everybody would be able to get health insurance, and prescriptions wouldn't cost so much."

In the end, the people I talked to at MetroHealth are wondering if these health plans will be just that: plans. With anxiety rising about America's economic prosperity, staff and patients told me they're worried that there won't be any money left to rework American healthcare.

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  Artist: Jaki Liebezeit & Burnt Friedman

  CD: Secret Rhythms 3 (Nonplace)

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