Uninsured try to untangle health proposals
KEENE, N.H. -- Julie Voigts, a 22-year-old worker at Prime Roast Coffee Co. who has no health insurance, waited on customers the other day as supporters of various presidential campaigns marched on Main Street. With just days to go before the primary vote, Voigts was still trying to figure out which Democratic candidate is most likely to help her get health coverage.
"I don't know what I would do" if a major health problem occurred, Voigts said. "It's a big issue for me."
As one of the 125,000 New Hampshire residents without health insurance, out of a population of 1.2 million, Voigts represents a voting bloc that could be one of the most important of the presidential campaign. At nearly every campaign event, groups of New Hampshire residents show up in purple T-shirts that indicate they are health care voters. A labor-financed organization, New Hampshire for Health Care, has signed up 50,000 people who say they will pick a candidate today based on his health care stance.
But it is far from clear whether any candidate has drawn significant support because of his health care proposal. While all of the candidates tout their plans, most of the programs they are proposing would involve incremental steps.
"The problem is that every candidate has a health care plan and every candidate has difficulties drawing contrasts [of] why their plan is better than all the rest," said Richard Killion, director of the Marlin Fitzwater Center for Communications at Franklin Pierce College in Rindge. The center has surveyed residents on health care issues.
The irony, he said, is that the war in Iraq overshadowed health care for much of the campaign, only to have health care emerge now as the top concern. It is likely to be a major issue of contrast in the general election, he said.
Indeed, a survey conducted for The Boston Globe last week suggested that health care is the top concern among this state's voters, with 32 percent of those surveyed saying it is the issue they most want to hear candidates discuss. In comparison, 12 percent cited terrorism, national security, and Iraq as the top concern.
Interviews with business owners, workers, pharmacists, and physicians in this small New Hampshire city indicate widespread agreement that the health care system is broken, although there is much disagreement about the solution.
At The Apothecary, pharmacist Susan Harris hears about the problems daily -- from customers who want to get less expensive drugs from Canada or who can't afford the painkillers prescribed for them. At The Pub, a restaurant owned by Keene's mayor, Michael Blastos, the "perk" of free health insurance has long since vanished because of the high cost.
But perhaps the biggest lesson about health insurance in Keene can be found at the city's largest medical facility, Cheshire Medical Center. Here, the administrators have vowed to do what the candidates can only talk about so far: provide free care to anyone who needs it and can prove they are local residents living at no more than three times the local poverty level. Last year, the facility provided $2.2 million of such care, out of budget with revenues of $95 million, with the expense borne largely by costs imposed on other patients, administrators said.
"We have never turned anyone away, never have, never will," said Dr. William B. Toms, chief medical officer of Cheshire Medical Center, which is affiliated with Dartmouth-Hitchcock Medical Center. But, he said: "It is far from adequate. It is a burden upon our patients, our community, and our local employers."
The center's chief financial officer, Arthur Nichols, has wrestled with the problem for years. Back in 1993 when President Clinton was proposing a universal health-care system partly run by the government, Nichols didn't support it. But a decade later, Nichols has watched the number of uninsured and underinsured rise so much that he now says some kind of universal system is a necessity.
But the plans put forward by the leading presidential candidates do not provide a realistic solution, Nichols said.
"I think that of the so-called solutions that I have read, they are very simplistic and don't really address the issues. . . . To really solve the problem, you are going to have to go back to Bill and Hillary's solution," Nichols said.
The plans from the leading Democratic candidates are complicated and typically offer health insurance to children and young adults, with various government-assistance programs and tax incentives to help individuals obtain and businesses to provide insurance.
The proposals of former governor Howard Dean of Vermont and Senator John F. Kerry of Massachusetts provide an illustration.
Dean has long hoped that his work on health care would boost his candidacy. Dean, a physician, boasts that he instituted programs in his state that made 99 percent of its children eligible for health insurance. But even Dean isn't proposing a Canadian-style single-payer government plan that would insure everyone. Instead, he would insure people 25 years old and younger and lower-income Americans, and he would offer incentives to help businesses provide insurance to their employees.
Kerry's website says he will make health insurance "affordable for all Americans." A key part of Kerry's plan is to have the government pick up the tab on the most expensive claims. "The government will pick up most of the tab . . . and the premiums for middle-class families will go down," Kerry has said.
Back at the coffee shop, Voigts was weighing her options. "Everybody wants universal health care, but the question is, how do you get there?" Voigts said.
Michael Kranish can be reached at kranish@globe.com.
