I was thrilled when Tom Brokaw asked this question, because it probes at the ideology behind each candidate's plan. I think this is important because we know that no matter who gets elected, the next president will not pass the same plan that they have proposed.
I have been able to listen to two different doctors talk about the candidate's health plans in the last couple days. The first doctor was invited to speak by Baylor's student pediatric society and gave a fairly non-partisan review of each plan. The second lecture was part of a new health policies elective that I am taking, and it clearly took sides on this issue, although it was deliberate in ignoring other political issues.
What is pretty easy to figure out is that neither plan clearly solves the biggest issues facing health care today. Fundamentally, the problem is that we continue to use more and more complex, technologically intensive therapies that cost lots of money. In addition, we continue to use more and more prescription drugs, have an aging population of baby boomers, and simply more people in this country to cover.
I personally agree with Obama's response that health care is a right. If it is a responsibility as John McCain says, then Americans have been pretty irresponsible people. As a future doctor, I don't ever want to work a hospital that has to deny care in order to turn a profit, yet that is how the system is currently set up. I don't really care how it is administered, but we are wealthy enough in this country to offer a realistic health care solution for every single person.
The hard question, which no one is really asking and the candidates would never answer anyway, is where should we draw the line on health coverage in order to make health care affordable for more people. When has western medicine done all that it can within reasonable limits to prolong a person's life? Even now, those of us with good health insurance wouldn't be covered for last ditch, experimental procedures to treat a malignant gliobastoma. How much sacrifice would the insured have to make in coming up with a plan for all people? Are there enough low yield, high cost procedures that can be cut, or would we have to accept significant reductions in our current quality of care?
At least if our president is operating under the notion that health care should be a right for all individuals, we might make some steps towards a real health care revolution.
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If more people understood McCain's health plan, no one would vote for him. It's designed to destroy the system of employer-provided health insurance along with the system of state-by-state regulation of insurance companies. The idea is that this would all improve free market competition. That may be right, or it (more likely) may be wrong, but the real point is that it is completely politically untenable.
That's why McCain's "health plan" is a red herring. It's there to appeal to independents who want their candidate to have a health plan, but don't really care to learn anything about the details. It's also there for hard-core conservatives, for whom it represents a right-wing ideological utopia. But it would never, ever be enacted into law--no Democratic Congress would touch it, and McCain clearly doesn't care enough about the issue to expend any political capital trying to get it passed.
When comparing health plans, the real comparison is "doing something" versus "doing nothing."
As far as total systemic reform and keeping down costs goes, there is always the British model. Free, public health care at a certain base line for all, with private insurance and hospitals available for those willing/able to pay for them. That's essentially what we already have for retirees with Medicare and private supplemental insurance, and I imagine that long term the general health care market will look like that too.
The real question is where we draw the line for the free public insurance. Is it to be a basic program that covers just the poor, or will it be a more fully-featured service that is intended to service most of the middle class as well?
Or at least these are my thoughts as someone who has never studied anything about health policy.
You are right Bryan, that is the question that I think will have to be addressed. Even in extending a system to all of the poor in addition to the elderly, the concept of "rationing" care will have to come into play.
Two comments here. First, one of the basic needs is having a mechanism for deciding who receives a scarce resource - is it based on who can pay for it or is it based on a third party deciding (such as the gov't or an insurance company). As Bryan points out the British system is a bit of a hybrid. Second, Scott Adams has an intriguing idea on how to encourage senior citizens to live healthier lives.
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