ANDREA SEABROOK, host:
It's All Things Considered from NPR News. I'm Andrea Seabrook. As the federal government grapples with the financial crisis, a quieter one lurks. Its name, health care. Its face, meet Carrie Staton(ph).
Ms. CARRIE STATON: It's bad when you don't think - that you can't provide for your children or you know, when your husband or someone, you know, close to you gets sick, that you can't be able to take them to a doctor and not worry about a bill coming in.
SEABROOK: Carrie Staton is one of 45 million Americans who have no health insurance. She lives in Waynesboro, Virginia. Drive an hour and a half south to Lynchburg and you might run into Ralph Smith. He owns a small business called High Peak Sports Wear, and he's another face of the health care crisis. He pays the full cost of his employees' health insurance.
Mr. RALPH SMITH (Owner, High Peak Sports Wear): I don't think a year has gone by where somebody hasn't said you can't afford to pay for a health insurance any longer. You need to consider, you know, eliminating it.
SEABROOK: In a few minutes, I'll talk to advisers to both presidential candidates about the problems Ralph and Carrie are facing. First, though, Carrie's story. She's 33 and works full-time.
Ms. STATON: I drive transportation for a nursing facility here in Waynesboro.
SEABROOK: And do you get benefits, health benefits?
Ms. STATON: They are offered to us. Yes.
SEABROOK: But you don't take them?
Ms. STATON: Well, I can't afford them at the time.
SEABROOK: How much do they cost?
Ms. STATON: I think the average for a family of four was like 80 to 100 every two weeks.
SEABROOK: So, we're talking a couple of hundred dollars a month.
Ms. STATON: Right.
SEABROOK: Tell me a little bit about your family.
Ms. STATON: I have a 13 year old daughter and a 12-year-old son, and then my husband who just recently got diagnosed with multiple sclerosis.
SEABROOK: And he had to leave his job?
Ms. STATON: Yes.
SEABROOK: And do you have any health problems?
Ms. STATON: Myself? Yeah. I'm diabetic, high blood pressure.
SEABROOK: So, you have diabetes. Your husband has MS. What do you do for health care?
Ms. STATON: I am lucky that our town has a free clinic, and the doctor sees us, and we get medicine here at a cheaper price.
SEABROOK: So, what, for you, would be an affordable health care plan?
Ms. STATON: I tell you, it's hard with just the one person working. If both of us are working, you know, I could see paying out something. But right now, I can barely make the bills that I am doing, maybe 20, 25 dollars a week.
SEABROOK: Let me turn now to Ralph Smith. Tell me about your business. What do you do?
Mr. SMITH: At High Peak Sports Wear, we do custom screen printing and embroidery, and we operate stores in the Central Virginia area.
SEABROOK: And how many people do you employ?
Mr. SMITH: Full-time employees, we've got about 40 and then there's probably an additional 20 or so that are part-time and seasonal.
SEABROOK: Now, so you are a small businessman, but you provide benefits to your employees.
Mr. SMITH: Yeah. The primary benefit we provide to the employees at High Peak is health insurance, and I pay 100 percent of the premium for the individual. So, therefore, everybody that works here full-time has zero expense for their health insurance.
SEABROOK: Why do you that?
Mr. SMITH: It's not easy. I mean, the costs are staggering and the increases every year are significant, but it was our feeling that, with as many people as we have that don't make, you know, tremendously high salaries, that if there was any contribution on their part at all, someone would be unable to pay or unwilling to pay and would be without health insurance and that was something we simply didn't want to have exist.
SEABROOK: So, how much does this cost you?
Mr. SMITH: Right now, High Peak pays about $150,000 a year for our employees for the insurance. So, after paying for the garments that we screen print and embroider, and after paying the salaries, health insurance is the next highest expense we have.
SEABROOK: Ralph Smith owns High Peak Sports Wear and joined us from his office in Lynchburg, Virginia. Carrie Staton lives in Waynesboro, Virginia. Thanks very much to both of you.
Ms. STATON: Thank you.
Mr. SMITH: Thank you, Andrea.
SEABROOK: With Ralph and Carrie in mind, we turn to the top health care advisers for the two presidential candidates. Economist Gail Wilensky joins me now in the studio. She's helped Senator John McCain craft his health care policies. Welcome.
Dr. GAIL WILENSKY (Health Care Adviser, John McCain Campaign): Thank you. It's very nice to be here.
SEABROOK: Let's start with Carrie Staton. She's the one, the mother of two. Her husband has multiple sclerosis. She's got diabetes. How would John McCain get her off the list of uninsured Americans?
Dr. WILENSKY: Well, first, what John McCain will do and, this is very helpful for someone like her who is a relatively low wage employee, she will receive, because she has a family, a 5,000 dollar credit to use for the purchase of insurance.
SEABROOK: Her husband, with the multiple sclerosis, is out of a job now. He's had to leave his work. If they're going to take this $5,000 future subsidy from the government to buy health insurance, and they went to a private insurance company and bought it, they could be turned down, yes?
Dr. WILENSKY: If they are turned down, the senator has proposed a guaranteed access plan that is meant to help people who have special health care needs that make them very expensive to insure, and there will be substantial additional subsidies available to these people, in addition to the regular help that they receive.
SEABROOK: Let's go on to Ralph Smith, the small businessman. He currently pays 100 percent of the health insurance for his full-time employees. He says his business right now can just barely afford to do that. How does John McCain's plan address the financial burden of providing health insurance to businesses?
Dr. WILENSKY: The way to help businesses is what you do to slow down the growth in health care spending. And what John McCain has been doing, in his proposal, is to have a whole series of strategies to slow down spending. Promoting generics, making disease management and prevention in chronic disease much more prominent in terms of how health care is provided. All of those strategies, allowing people to shop across state lines that are not accessing their employer's plan. What slowing health care cost will allow Ralph and any other employer to do is to provide his employees with higher wages. So, it's not helping him in terms of providing health insurance per say, it's allowing him to be able to increase the wages to his employees.
SEABROOK: Does this plan give any incentive to Ralph Smith to keep providing health insurance for his employees?
Dr. WILENSKY: No, but he understands that when you make a benefit available, that this is a benefit to attract good employees, and our expectation is employers will continue to provide this voluntary benefit.
SEABROOK: That's economist Gail Wilensky. She helped develop the McCain health care plan. And those tax credits she talked about, the 5,000 dollars per family, well, Senator McCain would pay for them by taxing employer provided health benefits. Now, to Senator Barack Obama. Economist David Cutler has been advising the campaign on health care policy. I asked him how Obama's plan would help uninsured people like Carrie Staton.
Dr. DAVID CUTLER (Health Care Adviser, Barack Obama Campaign): It would do a couple of things. First, it would reduce the cost of medical care, we estimate by about 2,500 for a typical family, through things like stressing prevention and making investments and information technology, so that we don't waste money. Second, we would give a tax credit for families like Ms. Staton so that she could afford to buy health insurance at her income.
SEABROOK: How much?
Dr. CUTLER: The tax credit would depend on her income. For people who are very poor, insurance would be free. And then as someone earned more, they would be able to pay more, but they would never have to pay so much that they couldn't afford it.
SEABROOK: Now, Senator Obama would like employers like Ralph Smith to continue providing health insurance for their employees. But let's listen to this point that is raised by Ralph Smith. His sportswear company, as we heard, pays 100 percent of his employees' health insurance. Let's listen.
Mr. SMITH: One of the things that concerns me a little bit is the level playing field. If High Peak Sports Wear is going to pay the insurance cost for our employees and other companies that we compete against don't, it gives you an inherently unlevel playing field.
SEABROOK: How would Obama's plan make Ralph Smith keep his business competitive while still providing benefits to his employees?
Dr. CUTLER: The Obama plan would do wonders for Ralph Smith and a company like his. His is an example of exactly the kind of firm that can benefit from setting up a health insurance exchange. He should be able to get access to a big group policy exactly the way that a large firm does. He should be able to give his employees a choice of policies and because there are a lot of people buying, the prices will fall enormously.
SEABROOK: One of the big criticisms of Obama's health care plans is the cost. Part of his solution, the national health plan, this is a sort of backstop for people who really can't get health insurance, is another entitlement program. It's like Medicare. There aren't a lot of specifics about how the government will pay for this and how much it'll dig the debt hole deeper in this country.
Dr. CUTLER: In the case of Senator Obama's health plan, he's actually said exactly how he will pay for it. First, by using the money that President Bush used to enact tax cuts for the wealthiest Americans, people earning over 250,000 dollars a year. Senator Obama said that a better use of that money would be making health insurance affordable for all Americans. And second, by investing in the medical system, we can reap the savings of a more efficient system. Those two sources of revenue would help to pay for everything that we've said.
SEABROOK: That's David Cutler, a health care adviser to Senator Barack Obama.