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"Obama May Have Edge Among Disabled" -- No Kidding

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Conventional wisdom holds that Barack Obama is a charismatic newcomer who holds less appeal to regular people. Tell that to anyone with a serious health problem. With a flair for the self-evident, the Politico website just ran a story titled: "Obama may have edge with disabled." Well, yeah. Differences between the two parties are stark; I am only surprised the vote isn't unanimous here.

Let's run down a few obvious differences. The Democratic platform states that the party is "united behind a commitment that every American man, woman and child be guaranteed to have affordable, comprehensive health care... with everyone in and no one left out." Democrats would forbid health insurers from cancelling or raising premiums on account of preexisting health conditions. For anyone with a serious physical or mental health condition, these provisions are crucial. How do we know Democrats are serious about this stuff? They spent the past year in dozens of primaries arguing the specifics of rival health plans aspiring to expanded health coverage.

Republicans pursue virtually the opposite course. They profess no aspiration to universal coverage. The McCain plan seeks to place greater responsibilities and risks on individual patients who would be encouraged to join high-deductible plans. He explicitly wishes to move individuals from employer-based coverage to a nongroup marketplace dominated by medical underwriting and other practices designed to protect insurers from bearing the high costs of chronic illness and disability.

The McCain campaign presents vaguely defined, under-funded provisions to provide coverage for people with preexisting conditions, disabled or otherwise. Senator McCain promises to "work with states to establish a guaranteed access plan" for high-cost patients. I'm not sure what this means, but he'd better work hard. The most prominent analysis of such things includes such confidence-boosting items as:

Although thirty states operate high-risk pools, only a few have found success.

and

Inadequate funding leads most states to compromise the high-risk pool's benefits and affordability, and in myriad ways, to curtail access.

Democrats call for everyone to have the option of joining a public plan modeled after the coverage provided to federal employees. They support mental health parity and other provisions to ensure that policies truly cover patients' major expenses. Democrats would subsidize coverage for low-income citizens--an important consideration for hundreds of thousands of people whose employment prospects are limited by disability. Republicans, in the name of deregulation and cost control, again choose a different course.

Differences go beyond the standard issues of universal coverage. Last month, Democrats and Republicans both spoke at disability forums convened to celebrate the Americans with Disabilities Act. ADA draws bipartisan support. Measures that require significant public investment are another story. Consider a current hot issue, the Community Choice Act (CCA). If you're not confined to a wheelchair or caring for a loved one, you've probably never heard of it. CCA is a proposed law that would provide Medicaid recipients who are eligible for nursing home or institutional care access to personal assistance services in their homes.

CCA seeks to redress the "institutional bias" of many state governments, which will pay for services to people living in institutions, but will not cover personal assistance services to people in otherwise identical circumstances who live in the family home. As you might imagine, CCA is a critical piece of legislation to the disability community.

I can't claim to be unbiased. When my wife and I assumed the responsibility for her medically fragile, cognitively disabled brother Vincent, he was a classic case of someone who needed such help. He needed multiple hospital stays, round-the-clock IV treatments, and many other medical interventions on top of his need for custodial care. The only reason we could care for him at home is that I have a good job, and my wife happens to be an experienced clinical nurse specialist who could stay home and care for him. (For more on our particular story, you can listen to it here)

We are unusually well-equipped. This was still no easy thing. Vincent's now happily in a group home. Should his health deteriorate, we might someday require the personal assistance services that CCA mandates and that are difficult to get where we live.

John McCain and many Republicans oppose CCA. The reason is clear. It would cost several billion dollars annually. You might think that keeping Vincent out of a state institution or nursing home would save money. Sometimes it does, but these savings are outweighed by something else. Patients might seek personal assistance services at home even when there is no prospect that they would enter institutional care. This "woodwork effect" is a source of real anxiety to states and to the federal government.

CCA is supported by Barack Obama, Tom Harkin, and pretty much every other Democrat you know. They don't like to run up the deficit, any more than Republicans do. (Obama's platform is far more fiscally responsible than McCain's.) Democrats are willing to pay for CCA, because they know families need the help. Democrats would tax the affluent a bit more--say at the rates America imposed fifteen years ago--to finance these things. Republicans have a different sense of collective provision, and are less willing to make this investment.

As Labor Day approaches, many Democrats are getting nervous. Republicans caricature Senator Obama as a celebrity who can rock a stadium but can't hit the meat-and-potatoes issues that matter to real folk. For me and many others who care for a disabled loved one, Senator Obama has met this test. I might add: So did many other Democrats. I happen to have supported Obama in the primaries, but I would just as happily go the mat for Hillary Clinton, John Edwards, and many others.

A Democratic victory in November would help millions of families cope with steep medical bills. It would move us towards universal health coverage. It would help persons with disabilities live with greater security, dignity, and comfort in their own homes.

John McCain, despite his admirable military record, would not accomplish any of these goals. He hasn't earned our votes. Things don't get much simpler than that.