Samuel Cardona is one of hundreds of patients who visit MetroHealth system on a given day. Like many of the patients that come here, Cardona has no health insurance.
Samuel Cardona: I went and got into my own business. Just didn't work out. The economy got to me and I had to close my business down.
MetroHealth also takes in many Medicare and Medicaid patients. The hospital struggles to break even. So does Cardona's family. In terms of politics, health care policy for him is personal.
Samuel Cardona: I'm just wanting to know if they can get prescription prices down?
The candidates say they can by allowing the reimportation of drugs and accelerating the introduction of generics. But that's just a tiny part of the candidates' overall plans, about which many at Metro had lots of questions. Here's Dr. E. Harry Walker, director of Metro's Center for Community Health.
Dr. E. Harry Walker: How do you provide high quality care? How do you provide it at a cost that people or the government can afford to pay? And how do you provide access?
Both campaigns have a similar answer to those questions, at first.
Dr. Michael Burgess: Of course Senator McCain is very concerned about affordability overall.
Dr. Steve Nissen: There is an absolutely clear commitment from Senator Obama to allow the 47 million Americans that are now not covered by health insurance to be covered.
But the difference between the two plans is in the details. And it's a big difference. First lets start off with Obama's plan. Cleveland Clinic cardiologist Steve Nissen supports Obama. He says the democrat wants a mix of private and expanded public health insurance programs including a federal health care program for children and tax incentives to businesses offering insurance to workers.
Dr. Steve Nissen: And for everybody who is left, there will be a national health insurance exchange. This is a program that would provide coverage very similar to what federal employees have that people could buy into and that would have a variety of subsidies based on income level of the individuals involved.
Obama's estimated price tag: $50 to $65 billion. A lot of cash, but critics wonder if that's even enough.
Now, here's Michael Burgess, a Republican congressman from Texas, a McCain supporter and the only physician on the House medical subcomittee. Burgess says McCain wants to make the health insurance market more competitive by changing the income tax code.. McCain wants to get rid of the tax break that workers get when their employer gives them health insurance. In return, Americans would get a refundable tax credit, basically cash.
Dr. Michael Burgess: We've all heard the two figures: $2500 for individuals and $5000 for families. It could be directly used to pay for insurance coverage for an individual who's had no ability to purchase insurance previously.
Critics say an average family health plan costs over $12,000 a year …so a $5000 tax credit would pay for less than half that. Back to Metro's ER. Here's Archie May, a Cleveland dad of two. As health care costs rise, his insurance premiums and deductibles keep going up.
Archie May: How are they going to fix the prices of health care? The prices are too high.
Dr. Steve Nissen: The prices are too high.
Dr. Steve Nissen for the Obama campaign.
Dr. Steve Nissen: I think with all of these things: drug re-importation, better preventative care, health information technology, there is no question we can reduce the cost of health care.
Dr. Michael Burgess: Under the McCain plan, the control in the prices of health care will come from the ability to compete against plans that are offered in other areas and ability for consumer to become much more of a vocal component of the system.
Burgess says McCain wants Americans to be able to shop around for health insurance, even from other states. Competition, McCain says, would bring down prices.
Standing across the street from MetroHealth's emergency room entrance, Samuel Cardona says he hasn't decided how to cast his vote.
Samuel Cardona: If it's John McCain, or whoever or Barack Obama I guess - I would hope that one day everybody would be able to get health insurance and prescriptions wouldn't cost so much.
In the end though the people I talked to at MetroHealth are wondering if these health plans will just be that, plans. With the billions about to be spent to fix the financial markets, staff and patients told me they're worried that there won't be any money left to rework American healthcare. Mhari Saito, 90.3.