Debate on Health Care * Presidential Candidates

All of the 2008 presidential hopefulls have been presenting their versions of a National Health Care Plan. Many of the Universal Health Care plans promoted are similar, while others are very different. Candidates have used the state of Florida as a launching pad to unveil their health insurance plans. Many Floridians argree that a big change must be made, but they are still unsure as to which plan best suits them. Are you a Florida resident that is self employed? If so you might want to review the various health plans before voting for a candidate in 2008.

Florida is emerging as the sounding board on health care reform for leading contenders for the presidency in 2008.Mitt Romney chose an August meeting of the Florida Medical Association for the national unveiling of his new health care reform plan.Sen. Hillary Clinton dropped hints about her plan during a Sept. 10 speech in Boca Raton, then released it a week later.Their attention to the Sunshine State makes sense, and not just because of Florida's traditional role as the biggest of the electoral swing states.Florida also is a leader in a less-coveted category: the states with the most residents lacking health insurance.A recent Census Bureau report found that from 2004 to 2006, 20.3 percent of Floridians under age 65 -- more than 3.6 million people -- had no health insurance for at least one year.That gave Florida an unwelcome bronze medal. Its uninsured rate trails only Texas and New Mexico.The issue also resonates nationally.Democratic voters rank health care along with the Iraq war as the most important issue in the campaign, according to a recent poll by the Kaiser Foundation. Republican voters ranked health care second to Iraq as the top issue.Virtually all major candidates have floated plans for some overhaul to the system.Democrats like Clinton, Sen. Barack Obama and former Sen. John Edwards favor a universal "safety net" coverage coupled with changes to make existing insurance plans less expensive.Republicans, led by Romney and Rudy Giuliani, oppose new government programs, and instead propose making insurance affordable by streamlining the current system, increasing competition and allowing more tax breaks.Closer to home, the Herald-Tribune asked three people with varying stakes in health care what reforms they would like to see.The uninsured entrepreneurIn one sense, Ken Wingate could be just who Democratic candidates have in mind -- in particular, when they argue that every American needs coverage regardless of income or health.The Sarasota resident cannot get health insurance because of a pre-existing condition. An illness this summer forced an emergency room visit -- and left him with a $4,790 bill that he will have to pay out of his pocket."How am I going to come up with that?" he asked.But Wingate also makes a case for Republicans' arguments that forcing all employers to provide health insurance would be a disaster for business.Wingate recently launched a photography business, Kenneth Wingate Photography, which just landed a major retail client. He is wary of legislation that could require all businesses, even small ones like his, to provide health care coverage."Creating legislation out of both sides is the best way to go," Wingate said.Increasing health care coverage without raising costs for businesses leaves the question: Who will pay?Wingate said the government should shift money from the Iraq war and other expenses overseas."More of our taxpayer money needs to be put to taking care of our own, here in our country," he said.The hospital presidentGwen MacKenzie has seen the benefits and the consequences of universal health care coverage.When she ran a hospital system in Detroit, MacKenzie saw Canadian patients come across the border for care when government funding ran low."It was amazing to see how many people who had national health care and also had private insurance coming to Detroit," she said.But since taking the helm of Sarasota Memorial Hospital in 2005, she has seen patients leave mountains of unpaid bills -- some $140 million in just two years.Most are patients with no insurance. They are choosing between paying for groceries and paying a hospital bill -- "and you know which one they choose," she said.But even some insured people do not pay. Many chose to "roll the dice," MacKenzie said, by buying plans with low premiums but high out-of-pocket payments -- charges that they cannot afford when they get sick."Too many times, we see patients with high-deductible health plans that often fail to cover their basic health care costs," she said.So her preference for reform would include elements of both parties' approaches.MacKenzie agrees with Romney's assertion that states can develop their own innovative plans. Those plans would automatically enroll people in a basic insurance plan, allowing them to opt out for private insurance.She likes tax breaks to help small businesses buy health insurance, something the hospital is trying to do through its "Charter Plan" insurance program.Any national plan would have to be careful not to sacrifice depth of coverage just to include all people, she said. Any national plan to expand enrollment, however, must be careful not to cut back on individuals' breadth and depth of coverage."While we want more people to have insurance, we also want them to have meaningful, substantive coverage," she said.The doctorDr. Michael Patete, a Venice ear, nose and throat specialist who has lobbied in Washington, wants to see a truly free market -- meaning less control from both government and insurance companies.With insurance, patients do not know how much their care costs, and do not make informed choices, he said.For example, he said, he might recommend a patient get an MRI test, a sort of high-powered X-ray that can examine soft tissue.With insurance, a patient might only have a $25 copayment and would probably go ahead with the test.But a patient who has to pay the actual cost -- at minimum $400, and usually far more -- might wonder if the test were necessary, what hospital or lab has the best machine, and what prices they charge."Wouldn't you want to know more?" Patete said.Like MacKenzie, Patete had some experience with the Canadian system. His daughter broke an elbow during a trip there. The hospital visit cost $600.Friends of his recently took a child to a Florida emergency room for a leg injury, and X-ray, splint and crutches ran $1,500 -- without the doctor's fee.But he fears a Canadian-style system would lead to two tiers of patients, one paying for the best care, on demand, and the other waiting for safety-net care."The American people are not willing to do that," he said.He would like to see more use of health savings accounts, in which people set aside a tax-exempt portion of their pay to be used for medical expenses.While some candidates espouse that, no one plan seems complete."Nobody's got the right answer," Patete said.