Presidential candidates Obama, McCain and Clinton agree on one thing: our health care system is too expensive and getting more expensive all the time. And because they remember "Harry and Louise," all three are promising reform that delivers all of us more, better care at lower cost. You remember Harry and Louise; they were the stars of a series of TV ads paid for by the insurance industry in 1993 that helped sink the Clintons' first health care reform initiative by suggesting that the middle class would have to sacrifice in order to pay for health care for the poor and uninsured.
This year, all three candidates have proposed ways to contain health care costs; this is a slightly more critical issue for the Democrats because they, unlike John McCain, have proposed ideas — such as extending health insurance to most or all of the nation's uninsured — that will increase health care spending in the short run.
Would McCain's brand of competition really deliver better health care, cheaper? And would Obama's and Clinton's alleged cost savings come close to paying the real costs of universal — or near universal — health care coverage and other improvements? Expert opinion differs.
McCain's answer to rising costs is more competition. He proposes increased competition between providers and among alternative treatments, giving states the flexibility to experiment with Medicaid regulations, building "genuine national markets" by allowing providers to practice nationwide. Along with Obama and Clinton, Senator McCain supports conversion to electronic medical records. He believes in tort reform to reduce "frivolous lawsuits and excessive damage awards." He is a little vague on how his proposals will control rising drug costs. McCain stresses "personal responsibility" and free−market competition over the Democratic plans, which he criticizes as "big government" and "anti−choice."
Senator Clinton claims that her proposals would lower national health spending by $120 billion dollars a year and that these savings could be reinvested in the system to help cover the 45 million uninsured.
Would McCain's brand of competition really deliver better health care, cheaper? And would Obama's and Clinton's alleged cost savings come close to paying the real costs of universal — or near universal — health care coverage and other improvements? Expert opinion differs. According to Dallas L. Salisbury, president and CEO of the Employee Benefit Research Institute and a member of The Commonwealth Fund Commission on a High Performance Health System, "Presidential candidates have been long on rhetoric and short on specifics in their call for health care cost control. Republicans mainly suggest that moving to an individually based system where individuals have to pay more will bring a market solution: lower spending. Yet, if most spending is tied to chronic disease — as the data firmly show — deductibles at the levels required for health saving account tax preferences will achieve little total system savings. Democrats mainly suggest universal coverage, better information, and new payment approaches. Again, given the high proportion of total spending attributable to chronic conditions, these changes may improve efficiency and outcomes, but they will not come close to solving the health care cost spiral."
Thanks to the legacy of Harry and Louise, however, one thing is certain: no presidential candidate will openly advocate either the status quo or taking away any existing service or benefit.