Virtually every poll finds that the economy and health care are the issues people in North Carolina and the nation are most concerned about and they are undeniably related.
People know that if they lose their job, they will lose their health care. Even if they stay employed, they may face rising premiums and co-pays they can't afford or their employer may drop their coverage altogether.
And that's for people who have insurance in the first place. More than 1.3 million North Carolinians are uninsured. Politicians of both parties are forced to talk about health care on the campaign trail, whether they want to or not. That prompts some interesting responses.
Republican W. B. Bullock from Nash County, a candidate for the State House, told the Rocky Mount Telegram recently that "people need to better prioritize their finances, which could free up extra money for them to buy health insurance." In other words, if you can't afford health insurance, figure out how to afford it. Bullock also supports a voucher program for health care, whatever that might be.
It's not just Republicans of course. Among his health care proposals, Democratic House candidate Carnell Taylor wants to remove some of the "bureaucratic" aspects of Medicaid and Medicare, programs with much smaller administrative costs that the private health care system.
Misrepresenting Medicaid is nothing new. Neither are most of the health proposals from the candidates for statewide offices. Both of the Democratic candidates for governor, State Treasurer Richard Moore and Lieutenant Governor Beverly Perdue, want to expand the state's children's health care program to cover every child in the state. Perdue has also mentioned expanding coverage for parents of children who qualify for the program.
Proposals among the Republican candidates vary some, but they all count on the purported magic of the market to solve much of the problem. Senator Fred Smith extols the virtues of health savings accounts (HSAs) and tax credits, the preferred strategy of President George W. Bush and Senator John McCain, and the approach always suggested by the market fundamentalist think tanks.
The problem with savings accounts is that many people who can't afford health insurance now won't be able to build a savings account. They can barely pay their monthly expenses as it is.
A report from the Government Accountability Office found that people currently using HSAs are disproportionately wealthy and that many are using the accounts more as a tax shelter than a health care plan, never withdrawing any money from the account.
As the Center on Budget and Policy Priorities points out, HSAs are the only savings plan in which contributions are tax deductible and withdrawals are tax free.
Both the Democratic candidates for president are proposing a version of universal health care, but the election of a Democratic president may not result in fundamental change in health care access either.
The Hill newspaper recently quoted Democratic Congressional leaders saying that there might not be the money or Congressional support for a national health care plan in the near future. That's Washington-speak for saying that the big money from the insurance companies and pharmaceutical industry still controls things in Congress, as it does in most debates in North Carolina.
That point was made even more clearly in a recent letter to the editor in the News & Observer by Dr. Assad Meymandi, a well-known Raleigh psychiatrist.
"Let us not forget the unwelcome and greedy alliance of the health-care and pharmaceutical industries….These entities, known as insurance companies, health maintenance organizations, etc., are the major culprits driving up health care costs. Their commitment is to the bottom line and to patient care. We have several CEOs of these companies who amassed 2007 compensation in the billions."
The headline of Meymandi's letter is "Universal health care needed." That's an odd prescription from a board member of the John Locke Foundation in Raleigh, but it's the right one.
Let's hope Meymandi sends a copy of his letter to the Locke staff to counter all the misleading claims about health savings accounts, and forwards the letter on to candidates for the General Assembly and members of Congress to counter the spin from the industry lobbyists.
Somewhere there must be the political will dismiss the ideological market rants of the right and to confront what Meymandi calls the medical-pharmaceutical complex and finally make helping people the priority, instead of protecting profits.