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Want to know what may be a bigger cancer killer than smoking? Being uninsured. That’s right. Here’s what the American Cancer Society’s chief executive, John Seffrin, had to say about being uninsured:

I believe, if we don’t fix the health care system, that lack of access will be a bigger cancer killer than tobacco. The ultimate control of cancer is as much a policy issue as it is a medical and scientific issue.

In an unprecedented move, the American Cancer Society is spending all of it’s 15 million dollar advertising budget on the problem of inadequate health coverage. Go here to read about it. This decision was based on research which showed that uninsured patients with cancers of the breast, larynx, and mouth had their cancers diagnosed at a much more advanced stage. Obviously, this leads to more expensive and less effective treatment. These patients not only die early, but frequently they die broke. One in four families afflicted by cancer spends most or all of their savings battling the disease. 560,000 Americans will die of cancer this year.

Listen, politicians can dither all they want to on health care. But any politician who doesn’t make universal health coverage part of their plan needs to be reminded that they are sacrificing American lives in the process. And this wouldn’t be the Progressive Pulse if I didn’t remind readers that none of the Republican candidates for president have a plan for significantly reducing the number of uninsured Americans. How’s that for family values.

A new report “Buddy Can You Spare a Dime” produced by the NC Budget & Tax Center demonstrates, biteyet again, how shortsighted tax breaks hurt us in the long run. This time the damage is to our unemployment insurance (UI) system.

Unemployment benefits are paid from a trust fund, which is financed by employer payroll taxes. The idea is that during good economic times the trust fund balance grows so that there are adequate funds available to pay benefits during economic downturns. In the early 1990’s the trust fund balance seemed large, so state leaders revised the policies and reduced the taxes that employers were required to pay. According to the report, “the General Assembly enacted a series of 13 payroll tax changes between 1992 and 2000.” Some companies saw their payroll taxes reduced to zero. These actions coupled with a decrease in federal funding have undermined the solvency of the UI trust fund.

The unemployment insurance system is an important safety net for individuals and an economic stimulus for the state’s economy. It is important that the General Assembly acts now so the solvency problems can be fixed.

In discussing John Edwards health plan, Andrea’s post gets right to the heart of the matter. Are you an incrementalist…or a maximalist?

If you are an Incrementalist, you favor a policy of making changes by degrees; or gradualism. If you are a Maximalist, then you favor a direct and immediate approach to achieve a goal in its entirety. Of course, as a realist would argue, the political feasibility of a policy may influence which approach you support.
 
Andrea favors a maximalist approach, while Adam accepts that incremental gains are more realistic over the short-term.  Even though I’ve worked in primary care for the past 20 years, I am still on the fence as to which approach has the greater likelihood of success.  My heart tells me we ought to pursue a single payer system now.  The need is immediate, and the political climate is more favorable now than it has been in 12 years.  My head tells me that our trillion dollar healthcare system, which consumes 16% of GDP, has too many people, making too much money, with too many political connections to allow radical changes.  

Having said that, if a plan makes significant progress in any of the following three areas, I am likely to support it.

1) Immediately covers some of the 47 million uninsured. This is a crisis, now, and the longer we wait the more people will get sick, die, or go bankrupt This is not a place for purity regarding policy. We have an ethical obligation to cover as many as possible as quickly as possible. The role here of advocacy groups is critical, and we need to help them keep the pressure on our lawmakers.

2) Regulate or eliminate private, for-profit health insurance. Their profit is generated by insuring healthy people and denying coverage for sick people. It really is that simple. They are an unnecessary drain on the limited amount of healthcare dollars. Specifically, they do nothing to improve access to healthcare, improve health outcomes, or contain costs. Until they go, even incremental improvements are unlikely.

3) Minimize, or eliminate, employer-based health care. It’s bad for the employee, the employer, and the consumers who purchase their product. Scrap it now.

And just for the record, President Bush’s healthcare proposal in his State of the Union address did little to address these problems.  His modest offering was mostly a niche option for people who can afford to treat their healthcare purchasing dollars as another investment vehicle.

John Edwards proposal makes progress in all three areas. It is not the clean sweep that many of us would prefer, but as healthcare proposals go it is reasonably ambitious. Importantly, it sets the standard that the other candidates will need to meet or exceed. There’s value in that.

Now…if Obama can top that…well, I’m listening.

(If you want a fascinating, but at times mind-numbing, discussion on health care reform; go here )