The Candidates on Health Care

Let's hope these two pictures don't start fighting.

I've learned some interesting things from the health care plans of each candidate, Hillary's and Barack's. Also discussed by Paul Krugman of the NY Times here.

Here's my favorite. According to Hillary's fact sheet, the average yearly health insurance premium for a family in 2006 was $11,480. Eleven thousand dollars! That's more than it costs to mortgage a house (well, a small one at least). In effect, every family in the US owns a second home--their clinic.

Is there a big difference between the two plans? Well, both mention creating something similar to congress's plan, the FEHBP. Both want to increase coverage of kids especially. Neither is advocating a true single-payer system. Both want to 'increase competition' between health insurance providers, whatever that means. Both want to replace Medicare's ability to get discounts from drug companies based on size, removed during the Bush administration. Both stress preventative health regimens and incentives for 'quality'. Both discuss electronic medical records. Otherwise, they seem similar with the exception of some differences below. In general, Hillary's plan seems much more detailed, with more references and more numbers. They kind of fit the personalities of the candidates.

Hillary plans $3 billion a year for implementation of electronic medical records, Barack $10 billion. I suppose that doesn't matter since Hillary pegs savings from EMR implementation at $77 billion a year, once up and running.

Barack mentions a new 'National Health Insurance Exchange' that will increase competition, but I'm not sure how. Hillary doesn't really address competition between health insurance companies, but does talk about restoring discounts.

Hillary talks about 'sensible' malpractice reform, basically a system by which doctors are held to 'transparent' standards with regards to error rates. Barack doesn't really talk about malpractice reform. This is a big issue in some states where caps on damage awards have recently been rescinded. I'm not totally sure it's a good idea to measure MDs on quality while ignoring the price-cap issue and the sheer cost of malpractice insurance in many states.

Hillary talks about a national research initiative to find best practices. A new 'Institute'. That sounds nice, I suppose.

Krugman and others believe that Hillary's plan will lead to universal coverage, through mandates that require people to buy coverage. But neither plan says anything about what 'affordable' or 'reasonable cost' means. Barack's plan pledges universal coverage for children, but leaves out those who don't want to buy coverage. Doesn't that leave them back at the ER again? Aren't those the very catastrophic injuries that cost so much?

In reality, there's no great way to compare these because they're both simplified and hypothetical.

The bottom line, for me? If there were a single-payer system, there would only be one place to send a bill, one place to worry about funding, and one place that, if federal, would be required by law to disclose where all the money goes. Don't we want that? Don't we think that if we spend trillions on health care we'll be able to pay our doctors, create short wait times, and still do research?

I guess in the end I don't see the appeal of the system we have now such that we aren't talking about a single-payer system. Yes, Hillary's plan seems a bit tougher. But both are incremental change to a broken system. Good luck with that, says my cynical side. Is there a better way, asks my pragmatic side. Maybe not.

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