WASHINGTON — Although health care has been a key issue in this year's presidential campaign, plans from both Barack Obama and John McCain are light on details when it comes to the most important aspects of the health system, including controlling costs, and improving efficiency and productivity.
The candidates have presented a wish list with very little detail on how they would accomplish the “fundamental change needed for our delivery system,” said Paul B. Ginsburg, Ph.D., president of the Center for Studying Health System Change, at a briefing sponsored by the Alliance for Health Reform. “They could have a debate over how best to do that,” he said, adding, “We aren't hearing that.”
Economists have estimated that over the next decade, U.S. health spending will double from $2.2 trillion to $4.3 trillion. Dr. Ginsburg, along with Princeton University economist Uwe Reinhardt and former Centers for Medicare and Medicaid Services Administrator Dr. Mark McClellan, said that rising costs are largely being driven by variations in practice, growth in volume, and intensity of services.
Senator Obama has said that he favors health information technology, transparency of price, promotion of quality care, chronic care coordination, payment reforms for value, malpractice reform, and promotion of generics.
Most of these are old, but not worthless, ideas, said Dr. Reinhardt, James Madison Professor of Political Economy at Princeton. “These are not to be laughed off, but they won't get us out of the box.”
Dr. Reinhardt called Senator McCain a “true radical” for his proposal to eliminate the tax exemption for employer-provided health insurance. Under Senator McCain's plan, individuals who purchase insurance on their own would instead receive a $2,500 tax credit; families would receive $5,000.
“This is almost un-American—to take away a tax preference,” said Dr. Reinhardt, adding that it is “a shocking idea and not easy to get through Congress.”
Dr. Ginsburg called the proposal “a potentially powerful idea,” saying that it could make consumers more sensitive to the cost side of insurance, and thus make them a more potent demand force.
Cost control is important because there will be no new federal money available to increase access to insurance or initiatives aimed at improving quality or productivity, said Dr. McClellan. “Next year is going to be a very tight year fiscally.”
He added that new spending will be next to impossible, especially for a Republican who, politically, would be faced with maintaining the tax cuts instituted in 2001, and continuing to fund the war in Iraq and the war on terrorism.
In fact, tax reform, the Iraq war, and the economy are likely to be higher up on the campaign agenda than health during the general election run-up this fall, said Dr. McClellan and his fellow panelists.
“I'm not personally persuaded that health care, in fact, will drive the campaign in the fall,” said Dr. Reinhardt.
But Dr. McClellan said, “My hope is it doesn't get pushed to the back burner,” noting that, “it will be a major missed opportunity if we don't have health reform next year.”