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Questions for Obama and McCain on health care

ASK THIS | September 12, 2008

Reporters should get down to basics with the candidates: Ask what they would do to hold down costs in the existing system and how they would promote illness prevention programs.

By Merrill Goozner

The debate over the nation's collapsing health care system has largely focused on the lamentable fact that nearly 50 million of our fellow citizens do not have health insurance. Since we are the only country in the advanced industrial world that doesn't have universal health coverage, it is appropriate that this problem be central in the debate over health care reform.

But any plan to insure the uninsured must simultaneously take into account the fact that we are also outliers in spending more than any other country on health, both on a per capita basis and as a share of our overall economy – now over 16 percent. Indeed, we spend nearly twice as much as most European nations, yet we get results, measured by the traditional benchmarks of longevity and infant mortality, that rank the U.S. near the bottom of the 30+ countries in the OECD – more like Poland or Romania than England or France.

That's why any health care reform plan that doesn't simultaneously reform the delivery system in a way that makes it more cost effective is doomed to failure. Taxpayers simply will not agree to spend another $100 billion a year on health so that everyone is included in the current, inefficient system, not when those who are insured are fearful of losing what they have, are seeing their premiums go through the roof for less and less coverage, while they're having to pay higher and higher co-pays and deductibles.

Evidence of waste is legion, and has been estimated to be as high as 30 percent of all costs. There are, of course, the high administrative costs associated with having multiple insurers – about 15 percent of the overall health care tab. But even if you got rid of the insurance companies by moving to a single payer system (not in the political cards), it would just be a one-time saving and you'd still have health care spending growing at twice the rate of inflation. The waste represented by having multiple insurers is an add-on to the underlying health care inflation.

Reporters need to look into and understand the wild disparities in health care spending across the country, as documented by the Dartmouth Atlas of Health Care. Why does a Medicare patient in Florida spend three times more than a Medicare patient in Minnesota, yet has no difference in health care outcomes? Why does the Mayo clinic spend just a fraction on a patient who's suffered a heart attack compared to what is spent on a similarly afflicted patient in Los Angeles? Why does the U.S. pay the highest prices in the world for drugs while taking far more prescriptions per person than any other country? Why does the U.S. have more MRI, CT and PET scanning machines than anyone where else on earth, yet have outcomes from the use of those imaging technologies that are certainly no better than any other country yet in many cases are worse?

The evidence is overwhelming that much of the medicine that is practiced in this country is not driven by what works best (i.e., the evidence), but what has been most heavily marketed and allows both doctors and providers (drug, device, durable equipment, imaging equipment, diagnostic test, and other manufacturers not to mention hospitals, for-profit clinics and specialty practices) to earn the most money. And each one of those players runs lobbying operations in Washington that consistently rank among the best financed.

Moreover, why is it that our health care delivery system does almost nothing to prevent disease, when over 70 percent of all health care costs are for chronic conditions like heart disease, diabetes, chronic obstructive pulmonary disorder (emphysema), chronic liver and kidney disease, and many cancers that are the result of poor diet, obesity, smoking, alcohol and drug abuse, sedentary lifestyles and other conditions susceptible to public health interventions?

So my questions for presidential candidates Obama and McCain are twofold:

  • First, what specifically would you do to hold down costs in the existing health care system, recognizing that one man's waste is another man's paycheck?
  • And second, what specifically would you do to promote public health prevention programs, which frequently do not get delivered in clinical care setting but are the products of government programs?

Posted by Angela
10/19/2008, 02:23 PM

Under Obama's health care plan, he states on his web site and in the 2nd debate that parents would be required by law to insure their children. While it would be fantastic to have them covered, the sad truth is, that the reason some parents do not have them covered is because they cannot afford it. What fines will be imposed and what happens if the parents cannot pay the fine? Jail? Have their children taken away?

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