Both Presidential Candidates Pursue Proactive and Preventive Approach to Health Care
23 07 08 - 11:49
America’s Future: Candidates Pursue Proactive and Preventive Approach to Health Care
by James Rosen - FOXNews.com
Though neither candidate is a physician, Sens. John McCain and Barack Obama each present strikingly similar diagnoses of the ailing American health care system: Some 47 million Americans lack health insurance at any given time; the system is too reactive, instead of proactive; and the average American’s insurance premiums are too high.
But how each candidate would address these systemic problems as the nation’s next president offers one of their sharpest philosophical clashes.
The plan put forward by McCain, the presumptive Republican presidential nominee, offers a $2,500 tax credit for individuals, and $5,000 for families, to purchase health care. However, McCain also proposes to eliminate the tax deduction Americans now enjoy on the health benefits their employers provide. This set up is designed, according to Douglas Holtz-Eakin, the trained economist and former Congressional Budget Office chief now serving as McCain’s top domestic policy adviser, to foster competition and creativity among health insurers.
“So now I’m an insurance company and the federal government has put $5,000 on the table for these families,” Holtz-Eakin told FOX News. “Once they give them that policy, it’s going to be renewable in every state; so I’m going to own that family for a long time. So I’m going to make sure I do the cheap things that are effective over the long term. Well, that’s exactly what the research literature says we should do: Let’s do some prevention, let’s pay for wellness.”
Obama, the presumptive Democratic presidential nominee, advocates a different approach. His “new national health plan” would give Americans the choice to remain with a private insurer or enter a new government-created health care plan — similar to Medicare but not limited, like that federal program is, to the poor or the elderly. Obama’s senior health care adviser, Professor David Cutler of Harvard University, also a trained economist, says the new program would be regulated by a National Health Insurance Exchange and offer Americans a benefits package roughly equal to the one members of Congress receive through the Federal Employees Health Benefits Program.
“What the national health insurance exchanges are all about is bringing the benefits of big firms to individuals and to small firms,” Cutler told FOX News. “So you take individuals and small firms, and say, ‘Look, let’s bring them together, and let’s set the rules of the road the same way that they are for big firms.’…The insurer can’t decide that they’re not going to cover something just because you happen to have been born a particular way or develop a particular illness.”
Because the candidates must specify how they plan to pay for their proposals, however, the debate over health care ultimately becomes a debate over tax policy. The McCain campaign argues that Obama, in order to cover the 47 million uninsured Americans with benefits akin to those enjoyed by members of Congress, will have to raise taxes dramatically. The Obama campaign argues that McCain, to make good on his promise to extend the tax cuts enacted by President Bush and Congress seven years ago, will leave the uninsured uncovered and do nothing to reduce premiums for those who are already covered.
“The money for the Obama health plan comes from not extending the Bush tax cuts on high-income people who are earning over $250,000 a year,” Cutler said. “The estimates are that there are between $70 to $75 billion a year in that money. What Senator Obama has said is that he believes a better use of that money, [rather] than to give [it] to people who didn’t need it and didn’t ask for it, is to use it to provide tax credits so that low- and middle-income families across the country can afford health insurance. … That’s the big difference between Senator Obama’s approach and Senator McCain’s approach.”
“Who pays the bill?” Holtz-Eakin countered. “The Obama campaign is about promising every American health insurance as good as a congressman. Now, the simple arithmetic is, at the moment, there are about 50 million people uninsured. Congressional health insurance for an individual is about $7000. So they’re saying, ‘Let’s spend $350 billion a year,’ and the response has to be: ‘Where will you get the money?’ and more importantly, ‘Once you’ve got people with insurance, and it keeps going up and up and up, how are you going to afford it?’ That’s the debate.”
Dan Magder, an independent economist not affiliated with either campaign, praised both for focusing on what health care analysts call “outcomes”: the results achieved by doctors, hospitals, and insurers on behalf of American patients. Research literature shows that although Americans spend some $2.5 trillion a year on health care — more, on a per capita basis, than any other industrialized nation — the U.S. lags behind in vital categories like infant mortality, medical recovery rates and life expectancy.
“It’s really a supply-side problem,” Magder said. “We spend more money on doctors, we spend more money on drugs, we spend more money on administration — and both of the plans are trying to address each of those [problems]. … Both of them are talking about using pay-for-performance. The idea there is to say, ‘We’re not just we’re going to pay a doctor every time he sees a patient; we’re going to pay him based on how healthy his patient is.’ Now that’s a lot easier to do in theory than it is to do in practice. But it’s shifting the focus from just, ‘What are patients doing?’ to ‘What is a doctor doing?’”
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