The Politics of Health Care

Thomas Robey -- Blogging and politics are inexorably linked in today’s media. Bloggers whose core topics are news, health, sports, science, religion and celebrities invariably offer commentary on political issues. The Differential is at its core a blog for and about medical student life, and if you’re at an American medical school, you’ll be hard-pressed to avoid conversations about presidential politics. As a member of the medical profession, you may be called upon to offer opinions about the remaining candidates’ health care plans. Having already been asked by family, friends and fellow precinct caucus-goers which plan is best for America, I’ve done some homework on the competing proposals. Like any good medical student, I am happy to share my study guide with you here. Each of McCain's, Clinton's and Obama's plans have good ideas built into them. This post is my attempt in 700 words to provide a starting point for you to understand them. You don’t have to pick a candidate based on health plans, but considering health will be your business, health care is probably not a bad place to start. This is a ‘just-the-facts’ post. For my opinions about the candidates’ plans, you’ll have to head elsewhere.

Like just about every other issue in the 2008 campaign, there are two health plans that are more similar to each other than each is to the third. For simplicity’s sake, I’ll start with the third. John McCain’s experience as a legislator has shaped his approach to reforming health care in a way that avoids “the ‘perfect storm’ of problems that will cause our health care system to implode.” The main elements of his plan include (1) changing the way plans are purchased, (2) increasing the accessibility and use of generic drugs, (3) innovating new forms of health care delivery and (4) altering Medicare to cover more preventative care and to punish medical errors. The McCain plan leans heavily on point #1. The argument being that current health care coverage is dominated by employer-negotiated contracts and employees given more options and flexibility will force the industry to lower prices. Via tax code changes and other incentives, McCain would permit individuals to buy insurance on a national market and through groups like churches, professional associations and co-ops. His ideas for health care delivery center on a network of walk-in clinics tied together (eventually) with an electronic medical record. This is an attempt to reduce expenses incurred from costly ER visits.

When it comes to the remaining Democrats’ plans, it’s more difficult to parse the differences than to identify similarities. Let’s first consider the similarities. In TV and radio ads, both have claimed to cover all Americans. Because insurance companies still provide the bulk of reimbursement mechanisms, neither plan is fully universal health care. Both plans require insurers to offer coverage no matter the individual’s medical history. Both also allow consumers the option of purchasing government-offered insurance. Finally, both plans seek (via government subsidy) to make insurance affordable to poor Americans. The differences come down to the mandates: Clinton would require every American to be insured either by a public or a private plan, while Obama’s plan only requires children to be insured. In his plan, anyone may opt-out of insurance. He suggests that a more competitive industry faced with cheap government options will lead everyone to buy in. Some health economists have argued otherwise. Clinton would limit insurance costs to a percentage of family income, while Obama would disperse subsidies to income-qualified individuals to help pay their premiums. The main discussion surrounding these plans is how to pay for it and who is covered. Obama addresses more aspects of the practice of medicine by emphasizing a broader implementation of the electronic medical record and rewarding practitioners who keep quality of care high and costs low. Clinton also features cost-saving technologies, but speaks more of targeting insurance company excess than any incentives or punishments for health care practitioners. Interestingly, both plans have adopted elements from the no-longer-running candidate, John Edwards.

In the end, it seems like all three of the candidates are committed to improving the current American health care system. The Democrats argue for a more comprehensive overhaul than McCain, but each plan has pros and cons. As the 2008 contest for the White House intensifies, I expect health care will be argued more and more between the remaining candidates.

Will you be prepared to debate the future of medicine?