election 2008: health care, part 2

never listen to me when i promise to post "tomorrow"...

here in the second half of health care discussion, i'll present the position of barack obama. obama goes into good detail on his site about his health care plan, and outlines it even more in this position paper. his plan was presented initially during a speech in iowa last year, a speech which is the usual cut-and-paste politician speech: start with the depressing story of a local couple, outline in detail and with lots of statistics the issue at hand, give your background and previous accomplishments with regards to the issue, outline your new plan, resurrect the ghosts of political heroes gone by, then bring back the local couple and inspire hope that your plan will save them.

obama plans to insure all americans by enrolling all those without insurance in the same insurance plan open to all federal employees. eligible citizens will receive a federal stipend to join the program. he plans to finance the plan by doing away with the bush tax cut for the wealthy, and by having businesses who don't offer a "meaningful contribution" to employee health care contribute "a percentage of payroll" (i.e. taxing business). i presume this new payroll tax is meant to stimulate businesses to participate in private insurance. he also pledges to support businesses with federal money for catastrophic coverage.

obama also feels there's money to be made by optimizing health care- he (like mccain) supports a movement toward electronic medical records, and focusing on preventative medicine. obama's plan calls for what he calls "incentives for excellence". in his speech and position paper, he speaks of how much money is wasted on suboptimal care and preventable complications. in his plan, providers will be "rewarded for achieving performance thresholds on outcome measures". this is what is usually referred to as "pay for performance" and it is a noble but miserable idea.

[a sidebar on P4P, as it is called in the industry. no payer, whether private or government, has the resources to pay extra. so while it seems nice that providers who perform well will be "rewarded", it means that there will need to be providers who will be "punished"- read: reimbursed less- for not meeting metrics. in a perfect world, we'd make everybody better, and maybe we could all achieve the benchmarks set. but because many patients are either too sick or too non-compliant to ever meet a benchmark, there will be a population of people who will never be "at goal". having too many of these folks in a practice will hurt the bottom line of the doctors who care for them. those doctors don't want to wind up in that bottom group who will be "punished", so they will weed out the "bad patients". the logical path of P4P is a selection by providers of healthy, compliant patients and a spurning of complicated, non-compliant patients who bring down performance numbers. this leaves a pool of people who need doctors the most but will not be able to find anyone to care for them. that's an improvement?]

back to the plan- lots of fluff about protecting kids from lead and pregnant women from mercury (the metal, not the planet), fighting aids, helping disabled americans, and a little blurb about "prevent(ing) insurers from overcharging physicians for their malpractice insurance". not a word about tort reform and reducing frivolous lawsuits though.

there's lots of stuff he wants to do, and even if all he puts through is his national health plan, the costs will be astronomical. i realize that before medicare was rolled out, it was probably met with much the same skepticism, but i just think that if there's a proposal for such a big policy, it should be offered with a realistic "we've all got to pitch in" financial plan rather than "we'll tax businesses and the rich, and it'll be OK" plan.

so when i try to pick a side here, while mccain's plan amounts to really nothing, at least it doesn't set us back. i think obama's plan is a bit overzealous, and the whole P4P thing really frightens me (in case you hadn't guessed). after one round then, the voting so far in the fink electoral poll is mccain 1, obama 0.

please, please follow the links to the candidate's pages and read the policies yourselves. it takes a bit to get through, and a keen eye to read between the lines, but it is well worth it.

this was fun- next topic soon- got a lot to get through before november.

election 2008: health care

i chose an issue near and dear to my heart to be the first in my election 2008 series. despite being in the trenches of the health care battlefield, i'm by no means an expert in health care policy. my attitudes towards socialized medicine sometimes change by the day, depending on the kind of day that i'm having. when i see a system struggling to keep afloat, and grow more skeptical by the day that anything can save it, it's hard for me to align with any philosophy on reform.

bookkeeping item: all information in this series about the candidates' plans and positions will come from their websites or links that they themselves provide. a few additional links may be placed just for fun or clarification. additionally, since i'm now finding these will be long posts, i'll going to do one candidate's position at a time, alternating who goes first. today, it's mccain.

mccain gives a somewhat brief outline on his health care policy, expanded upon in this speech from april. his plan to help uninsured americans involves a direct tax credit for those who either opt out of their employer's health plan or who are self-employed. he claims there will be no repercussions for those with pre-existing conditions, yet his policy abides by the HIPAA rule stating, as mccain puts it, that "if you remain employed and insured you will build protection against the cost of treating any pre-existing condition." many americans who will be using his plan will have a period where they will be either unemployed or uninsured, thus exposing them to cost liability.

he also proposes a "guaranteed access plan" for those who are the worst of the worst- people with illness who can't get coverage. it establishes a guideline system for states to provide the services with some federal support- basically, a "best of" medicaid system, taking advice and policies from states where things are working well.

to cut health care costs, he and obama both propose supporting disease management programs, with mccain pledging research dollars towards primary care, and they both pledge support of electronic medical record systems. sounds nice. mccain also plans to support "walk-in clinics in retail outlets". (ouch- that's hitting below the belt for a primary care guy like me.) lastly, he supports tort reform for medical malpractice, specifically pledging to eliminate suits against doctors who follow guidelines and "best practice" plans. how he'll do that, he doesn't say.

overall, nothing truly groundbreaking. mostly status quo, with the republican carrot of tax credits dangled as the bait for his plan. the plan moves almost all responsibility away from the federal government (a point mccain seems to celebrate in the speech above), either delegating to the states, the individuals, or the private sector. good? i'm not sure. but leaves him as president with little to blame if things don't go well.

tomorrow, obama, and my overall assessment of the issue.