John McCain's selection of Alaska Gov. Sarah Palin offers a vivid glimpse of the philosophical leanings of a Presidential candidate who bears little resemblance to the media's rapturous portrait of an independent maverick, and provides a window into the policies that a McCain presidency would promote.
While probably most evident on the issue of women's reproductive rights and the possibility that the next President could have up to three Supreme Court appointments, it is perhaps even more striking in the realm of healthcare, one of the most critical issues facing voters in November.
Gov. Palin's portfolio on healthcare, as in other areas, is thin. But her ideological orientation is abundantly clear. She is a vocal proponent of market medical care and deregulation, the path that has led to the current grave healthcare crisis. It also happens to perfectly match McCain's own prescription on healthcare.
This past January, Palin proposed and stumped for legislation to repeal Alaska's certificate of need (CON) program requiring hospitals and other healthcare providers to obtain state approval prior to expansion of certain new facilities or expanded services.
CON's were mandated by the federal government in the 1970s, as Palin herself noted in a commentary in the Anchorage Daily News in February, "to make sure healthcare facilities matched community need and provided access and quality care." Due to vociferous opposition from the free market crowd, the federal mandate was repealed in the Reagan years, and many states subsequently dropped their state programs.
In her Anchorage commentary, Palin made her views crystal clear as well, writing that eliminating her state's CON program "will allow free-market competition and reduce onerous government regulation."
But CON programs, where they still exist, have proven useful in protecting public and community-based independent hospitals by limiting cutthroat competition by wealthier corporate chains or speculators who are focused on profits not on providing care.
In Alaska, for example, attacks on the CON program are led by private boutique, specialty care clinics and surgery centers that want to cherry pick higher paying patients without having to meet federal rules to provide emergency care to all patients regardless of their ability to pay.
Like her free market fundamentalist running mate, Palin argues that increased market competition and deregulation would reduce costs, increase access, and improve quality.
However, an unleashed market, especially during the Bush years, has had the exact opposite effect on healthcare. Costs are so high that employers are dropping coverage like hotcakes and four in 10 Americans have trouble paying medical bills.
More than 70 million Americans are uninsured or underinsured; the number of uninsured dipped slightly in the most recent report, but only because the escalating economic crisis pushed millions more impoverished people into the government Medicaid program.
As for quality, the U.S. now ranks last among 19 industrialized countries in preventable deaths and has a dismal ranking in many other patient indicators.
As former Senate Majority Leader Tom Daschle said bluntly -- and accurately -- at a healthcare forum during the Democratic convention in Denver, it's time "to destroy the myths about healthcare" starting with the one "that we have the best healthcare system in the world."
McCain's program promises more of the same, and worse. His plan includes allowing insurance companies to evade and undermine current state regulatory standards and public protections.
He'd also tax employer-sponsored healthcare benefits. That's intended to push workers to fend for themselves in the private market, with the dubious claim that the lure of more individual customers will somehow encourage insurance giants to reduce costs through increased competition.
The combined consequences will be to shift more of the healthcare cost and health risk away from insurers and employers on to the already over loaded backs of individuals and families.
As Sen. Barack Obama put it in his acceptance speech in Denver, "in Washington, they call this the "Ownership Society," but what it really means is that you're on your own. Out of work? Tough luck, you're on your own. No health care? The market will fix it. You're on your own. Born into poverty? Pull yourself up by your own bootstraps, even if you don't have boots. You are on your own."
That's the brutal reality of the McCain-Palin approach to healthcare.
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