About this series:
Jerry Zremski of The News Washington bureau travels to five battleground states critical to the presidential election to talk with voters and experts about issues that matter to voters in Western New York.
At 59, Sharon Yaro has survived cancer, lupus, a painful chronic back condition and the bankruptcy that resulted from it all.
And when she turns 70, if the experts are right, she will get to witness another bankruptcy: that of the Medicare hospital trust fund that she will rely on at that time.
In other words, Yaro is the human face of an American health care system gone awry.
It's a system that the two presidential candidates have promised to fix, but only in part.
Obama wants to dramatically increase the number of insured in part by offering them federal health care, while McCain wants to replace employer-based insurance with a system based on individual responsibility.
Yet the two candidates don't offer full prescriptions for Medicare, the sick elephant in America's health care waiting room.
Nevertheless, Yaro has picked her candidate, and it's Obama, who has an average 3.2 percentage point lead in recent Florida polls.
"Barack Obama knows what it is for someone to go through what I went through," said Yaro, a former Rochester resident whose two children went to college in Buffalo. "He's been through this with his mother [who died of cancer]. . . . Improving health care is something he really believes in."
McCain supporters, though, say Obama's plan is tantamount to socialized medicine.
Meanwhile, experts wonder how either candidate will be able to reform health care with the economy ailing and a massive Medicare cash crunch looming.
"I certainly wouldn't bet a lot of money on [health care reform] happening in the next few years," said Joseph Newhouse, a Medicare expert and professor of health policy at Harvard University, who insists a major reform will have to be implemented within a decade. "The events of the last few weeks have made it more difficult."
There's no doubt, though, that voters want Washington to reform a health care system that has seen insurance costs double since 1999 while leaving 45 million Americans without any coverage. Polls in Florida and nationwide routinely rank health care as second only to the economy among the nation's most important issues.
And it's certainly important to Obama and McCain, who offer expensive but vastly different proposals for fixing the system.
Obama wants to create a new group of insurance plans, including one sponsored by the government, to offer health care to 34 million of the 45 million Americans who now go without it.
The nonpartisan Tax Policy Center estimates that Obama's program would cost $1.6 trillion in the next decade, which would be paid for in large part by eliminating the tax breaks that President Bush and Congress implemented for the wealthy.
"I will finally keep the promise of affordable, accessible health care for every single American," Obama said in an appearance in Dunedin, Fla., last month.
While Obama's plan builds on America's traditional employer-based health care program by pushing employers to offer insurance, McCain's breaks from it. His plan would tax company-provided health care benefits while giving individuals tax breaks to pay for insurance. His goal is to cut costs by making health care an individual responsibility.
The $1.3 trillion plan -- to be paid for largely by Medicare and Medicaid cuts to be named later -- would cut the number of uninsured by 2 million, the Tax Policy Center said.
"Americans need new choices beyond those offered in employment-based coverage," McCain said when unveiling his health care plan in Dunedin, Fla., last April.
Independent experts offer widely divergent views on the candidates' health care plans.
Writing in Health Affairs, a widely respected health care journal, three leading scholars recently said Obama's plan "would require new, large, and rapidly growing federal subsidies that are unlikely to be sustainable, fiscally or politically."
Meanwhile, the New England Journal of Medicine published an essay in which Dr. David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital, said McCain's plan would "profoundly threaten the current system of employer-sponsored insurance on which more than three-fifths of Americans depend."
The experts tend to agree on one thing: No matter who is elected president, finding a way to reform the American health care system will remain at least as difficult as it has been since President Harry S. Truman first proposed universal health coverage six decades ago.
Beyond the cost concerns, there's a political problem: For every Sharon Yaro, there's a Jennifer Cobb. And for every Donna Paganello, there's a Mike Binder.
"I just don't think the government can make the health care system any better than the private sector can," said Cobb, 37, who got an MBA from the University at Buffalo and who is now a restaurant operator near Orlando. "Our health care system isn't perfect, but it's the best in the world."
Paganello couldn't see things any more differently. A Buffalo native and Obama volunteer now living in Sarasota, Fla., Paganello works three jobs just to get by, and she still can't afford health care.
"If I got sick, I'd have to die; I just could not afford the care," said Paganello, 54.
But Binder, a 53-year-old physician and McCain supporter from the Tampa suburb of Lutz, Fla., worries that Obama's plan to offer a government health plan to everyone would damage the current system.
"Obama wants to socialize everything, but the government doesn't do much of any good with what they touch," Binder said.
Of course, Medicare remains one of the government's most popular programs -- and it faces a huge problem that goes unaddressed in both the Obama and McCain health plans.
Medicare's trustees estimate that adding the aging baby boomers to the health care system for the elderly will increase costs by 7.4 percent a year over the next decade -- meaning the Medicare hospital trust fund will be insolvent by 2019.
Newhouse, of Harvard, said the government will have to confront that fact within the next eight years -- although neither candidate wants to do that now.
"No one wants to get out in front of this because no one knows what the answer might be," said Roger Handberg, a political scientist at the University of Central Florida in Orlando.
Both campaigns say their health plans would help stave off Medicare's day of reckoning by slowing the rate of health care inflation in the coming years. Beyond that, Obama touts his plan to allow the government to negotiate for lower Medicare drug costs, and McCain promises huge Medicare cost savings but refuses to specify them.
Neither candidate is making an appeal to Florida seniors in quite the way that past presidential candidates have done, and that could be due to the fact that the state's electorate has changed.
The state has experienced a dramatic influx of new registrations among young voters, thanks in large part to the Obama campaign's efforts to register college students, said Susan MacManus, a political scientist at the University of South Florida in Tampa.
"The issue for young people is jobs, 100 percent," MacManus said. "For the boomers, it's about the pensions."
And for the seniors, it's about competing philosophies.
"I liked McCain in the beginning, but then he changed," said Alan Schneegas, 84, a former Buffalo resident now living in Sarasota. He said he supports Obama despite concerns that his father was a Muslim.
"Now McCain is just another Bush," Schneegas said.
But Mary Meade, a 62-year-old Air Force retiree from Tampa, worries that Obama's health care plan proves he will move the country too far to the left.
"Obama is like the very establishment kind of Democrat who is all about victimization and entitlements, the kind who comes in to save the day and hand out all the money," she said.
Yaro, for one, might wish that to be the case.
After a double mastectomy and the removal of several lymph nodes, she developed a severe degenerative back condition that she said has left her unable to work.
She's been fighting for two years to try to get Social Security disability benefits, but in the meantime, the combined crunch of her medical costs and her loss of income pushed her and her husband into bankruptcy last year.
Health care might be cheaper if people had the chance to buy into a government-run health plan, as Obama proposes, said Yaro, of Margate, Fla. And like Obama and McCain, she's far more focused on improving the health care system writ large rather than facing Medicare's pending crisis.
"I'm worried about that, but I think that can be sorted out someday," she said.
Competing remedies for health care
Sen. Barack Obama , D-Ill.
* Would provide insurance to 34 million of the 45 million uninsured Americans, at a cost of $1.63 trillion over 10 years, according to the Tax Policy Center, a nonprofit group that studies health care issues. The cost would be paid for by increasing income taxes on the wealthiest Americans and by unspecified savings in Medicare.
*Those who are uninsured would be able to get insurance through a National Health Insurance Exchange, offering a series of options, including private plans and a newplan based on the one offered to federal employees.
*Employers would either have to offer health care or help pay for the new federal program.
*People who like their current health care plan would be able to keep it.
*Would bar insurers from denying coverage based on pre-existing conditions.
*All children would be required to get health insurance, either through private plans, the new insurance exchange or existing programs.
*Would allow the importation of cheaper medications from other countries.
*Would invest $10 billion a year for five years to move the medical industry to a national system of computerized records.
*Would cut subsidies to Medicare Advantage plans while allowing Medicare to negotiate for lower drug prices.
*Otherwise, proposes no major changes to Medicare.
*Would provide insurance to 2 million of the 45 million uninsured Americans, at a cost of $1.3 trillion over 10 years, according to the Tax Policy Center. The plan would be paid for largely by unspecified cuts in Medicare and Medicaid.
* Would increase coverage by providing tax credit of $2,500 for individuals and $5,000 for families to offset the cost of insurance. People could choose the health plan of their choice and the tax credit would be paid directly to the insurance provider.
* In an effort to move the responsibility for health care away from employers, employerbased benefits would be taxed as income.
*People who like their current health care plan would be able to keep it.
*Would work with states to create a "Guaranteed Access Plan" that would cover those without insurance, including those with pre-existing conditions who were previously denied insurance.
*No mandated coverage for children. *Will allow the importation of cheaper medications from other countries.
*Would encourage the expansion of electronic medical records.
*Would maintain Medicare Advantage plans while cutting drug subsidies for wealthy seniors on Medicare.
*Promises to lower Medicare premiums by cutting costs throughout the program.
Next Sunday: "New Energy?"
- Pennsylvania debates our energy future.
Nov. 3: "The Bubble Bursts" ? The economic slump hits Ohio.