The morning after the election, I posted a speculative blog in Health Affairs on three possible scenarios for President-elect Obama’s implementing health reform: folding it into a bold, ambitious emergency legislative package (Complete the New Deal), carving funding out of the current $2.5 trillion national health spend (Braveheart), and postponing implementation until the economy recovers but taking steps now to prepare for it (Wait/Lay the Groundwork).
At the time, the Wait/Lay the Groundwork option seemed 70 percent likely. But with economic conditions worsening, I’m now convinced Obama will probably opt instead for the Complete the New Deal option, and try to implement health reform in the first 120 days of his Presidency, before the health care industry “dragon” can even stir from its cave.
Let’s call Obama’s program The Real Deal. We can already see its contours: an economic stimulus program including highway construction and other state-directed public works, a green energy spending initiative, emergency housing assistance including a foreclosure prevention measure, an auto industry bailout, labor law reform and income supports through tax credits for low income people.
Now that the results are in and the United States has officially elected Barack Obama as its next president, what does that mean to you and what will that mean for health care in America?
After nearly two years of campaigns, countless pages of material written about Obama’s health care plan and the possibility of reform, the U.S. has elected a Democrat as president and put Democratic majorities in both the House and Senate.
What do you predict the next four years will bring?
This is your space to reflect, comment and debate. Please share your thoughts, and let’s get a vigorous discussion going.
The New England Journal of Medicine and Harvard University teamed up to bring you this compelling, hour-long nail-biter of Gail Wilensky and David Cutler discussing their respective candidates’ health plans.
I wonder if the NEJM has had to buy more bandwith to support the flood of viewers?
In all seriousness, I think it’s great the NEJM is sponsoring this type
of dialogue. It probably won’t reach many people, but it might reach
and influence those who have the potential to influence others — legislative staffers,
journalists, doctors and health care leaders.
There have been calls recently for more serious coverage of the candidates’ health care issues. We need a mix of coverage. This kind of wonky dialogue and the kind that ordinary folks read and watch — yes that 800-word explainer story with a few pithy quotes.
This election is different than any other on the issue of health care because both candidates are giving us serious blueprints to reorganize America’s health care system and those blueprints are very very different.
As voters, you have a huge and critically important choice on health care.
There are dozens of details upon which they differ and for those I would point you to my comprehensive posts on the McCain Health Care Plan and the Obama Health Care Plan.
But to understand their big idea differences, I would point you to our pension system to better understand where McCain and Obama are going on health care. Back in the 1960s and 1970s, it was common for workers to have what is called a defined benefit pension plan.The worker got a promise from the employer that when retirement came he’d get a certain monthly benefit — often about 60 percent of his final average earnings. That might be $2,000 a month — every month for the rest of his life. Therefore, a defined benefit.
What do we do with people who are uninsurable because they have a pre-existing medical condition?
That is a particularly important question as both McCain and Obama propose reforming American health care by building on the private health insurance system.
One of the solutions being discussed–by McCain among others–is to use state-based risk pools. Under McCain’s plan heavily dependent on an individual platform, people who don’t have employer-based coverage and healthy enough to qualify for individual health insurance could get a private mainstream plan and people who do not qualify for a standard individual plan could buy into a state-run high risk pool for the uninsurable.
Barack Obama’s health reform proposal includes creating a center for comparative effectiveness research.
John McCain also has expressed support for this research.
And the American College of Physicians would like patients and doctors to use comparative effectiveness information when making health decisions.
What the heck are they talking about?
Policymakers, pundits and journalists have begun throwing around the term “comparative effectiveness” as if people know what it means.
I haven’t seen a formal survey, but I’m confident that the general public does not understand the concept behind this jargon nor the reasons why a national center might be needed to compare different medical treatments and procedures to find out what is most effective for different patients.
The first step to helping people understand these issues is to stop using the term comparative effectiveness. Using insider terms like this will ensure the public never engages in the issue and never buys into it. And public buy-in is important — crucial actually — says Gail Wilensky, the term’s mother of sorts.
Hal Holman is a professor of Medicine at Stanford University, and Diana Dutton is a research fellow at the London School of Economics and a former director of health services research at Stanford. The married couple supports Obama.
Many people think Hillary Clinton has a better health plan than Barack Obama. She repeatedly tells voters her plan will cover everybody, while Obama’s will leave out 15 million people. Newly emerging data tell a different story.
Since 2006, Massachusetts has been running what amounts to a pilot test of Clinton’s universal mandate plan, requiring all uninsured residents to buy private insurance or be penalized. The state regulates participating insurers and subsidizes costs for lower-income people. Yet after two years, nearly half of the uninsured still aren’t covered, despite strenuous outreach. To boost enrollment, Massachusetts has stiffened fines – up to several thousand dollars. Nevertheless, many people remain uninsured, citing more pressing needs. Clinton insists her mandate wouldn’t force people to buy insurance they can’t afford, but that’s exactly what’s happening in Massachusetts. The state has had to exempt 20 percent of the uninsured because they couldn’t afford even subsidized premiums.
Clinton’s plan would also likely fall far short of universal coverage. She hasn’t said how her mandate would be enforced, but has mentioned the possibility of garnishing wages. Without affordable insurance, a universal mandate means little.
The latest Washington Post-ABC News poll on health care should give John McCain reason to be concerned.
The early May poll asked voters, "Regardless of whom you may support, whom do you trust more to handle health care?" The answer was Obama by 55 percent and McCain by 31 percent. And this poll was done a few days after his much publicized week-long health care tour.
McCain also did poorly on the other economic issues, although not as
badly. On gas prices, it was Obama 48 percent and McCain 28 percent. On the economy
in general, it was 48 percent to 38 percent.
McCain did better on the war on terror — 55 percent to 34 percent. The two tied over who would do the best in Iraq. It is still early and polls are notoriously unreliable this far out.
But my sense is that McCain has some big work to do on health care.
As a service to our readers, we’ve compiled all the presidential candidates’ health plans in one place for you to easily access. Soon, we’ll have a section of the TCHB devoted to the presidential race and health reform.
Click on the candidate to see his or her full plan for health reform.
As the race carries on, we’ll bring you updated analysis from the candidate’s health advisers, left – and right-leaning wonks and THCB contributors.
Also here is the Kaiser Network’s side-by-side comparison of the current candidates’ plans for quick reference.
Robert Laszewski’s nonpartisan analysis of each candidate’s plan previously posted on THCB are here:
If you’re interested in seeing health reform plans of the candidates who dropped out of the race, here’s the Kaiser Network’s side-by-side comparison.