With the presidential race at last narrowed down to two major candidates, it’s more tempting to speculate as to what the healthcare landscape may be under the next administration.
The key themes of each candidate's healthcare platform vary, as one would expect, by party outlook. Republican John McCain says he will emphasize quality and encourage personal responsibility. Democrat Barack Obama wants to provide universal healthcare through a mix of private and expanded public insurance.
Can either plan put the brakes on runaway healthcare costs, now at 16 percent of the Gross Domestic Product? And can they get these plans off the ground after the election? According to a recent poll by the Pew Center, healthcare has fallen from the top domestic concern just over a year ago to second, behind the economy. Americans certainly want to hope the next president can fix it.
As if on cue, there was no shortage of discussion on the topic of healthcare in the nation's capital last month. The Alliance for Health Reform and Robert Wood Johnson Foundation hosted a briefing June 3 to discuss not only the candidates' healthcare reform plans, but the likelihood of the plans making a dent in the problem.
Alliance Vice President Ed Howard said there are common goals shared by both candidates, including the promotion of healthcare information technology, better care for the chronically ill and reform plans for bringing down drug costs.
Yet despite the shiny hopes and promises, many experts don’t hold out much hope for U.S. healthcare reform.
Paul Ginsburg, president of the Center for Studying Health Systems Change, said many ideas proposed by the candidates have "uncertain" outcomes at best, mainly because the system is built on shaky ground. "We pay providers fee-for-service for the most part for whatever they do," he said. "No one looks at what (it costs) to serve a patient, to treat this acute episode of care, to manage chronic disease."
Uwe Reinhardt, the James Madison Professor of Political Economy and Professor of Economics at Princeton University, summed it up: "We are calling for evidence-based medicine. Has anyone ever asked for evidence-based administration?"
Reinhardt, who chaired the Governor's Reform Commission in New Jersey, was speculative about "tinkering at the margin with pay-for-performance." It hasn't worked for corporate executives, he said, so why would it for healthcare?
Mark McClellan, former administrator of the Centers for Medicare & Medicaid Services, now director of the Engelberg Center for Health Care Reform at the Brookings Institution, said the government is aware of the problem, but change is difficult. The resistance to change "is a reflection of the extreme level of detail that Congress has gotten into in setting how Medicare pays and what it pays for and how hard it is to change those kinds of systems," McClellan said.
More doom and gloom came at a June 10 Senate Finance Committee hearing, when Mark Hall, a professor of Law and Public Health at Wake Forest University, said the culprit is the relatively small group of people in the population spending the majority of the healthcare dollars. Try as we may, there’s no easy way to reduce or eliminate the effects of concentrated medical costs because the extremes are so great, he said.
Despite the naysayers, election time is a time for hope, and the candidates seem to have plenty of it. "For too long, our nation's leaders have talked about reforming health care. Now is the time to act," McCain said.
Obama adds, "We now face an opportunity — and an obligation — to turn the page on the failed politics of yesterday’s healthcare debates."