Goverment ss. Market reforms, Republicans, The McCain-Obama Health Care Gulf

I recently interviewed Grace Marie Turner, president of the Galen Institute, a market-based think tank, and a McCain sympathizer, and David Cutler, PhD, Harvard economist who is Senator Obama’s chief health care advisor.

The gulf between the Obama-McCain beliefs black and white (no pun intended), between government dominated and guaranteed care and market-based care with incentives to expand coverage, between government officials who think they know best and doctors and patients who believe
they know best.

Talking to their advisors was like watching two battleships
passing in the dark, with their captains dismissive, even condescending, of the other’s point of view. Grace-Marie

• Turner warns of a “government-organized, government-dominated, government-run system”.

• Dr. Cutler says consumer-driven care with HSAs and high deductible plans is simply a “fad.”

The truth, as everybody knows, lies somewhere in between.

The McCain camp believes in health care markets, with patients deciding what to do at the point of care. He thinks market competition, supplemented by tax credits for all and risk pools in states, will cut costs, allow freedom of choice, and provide affordable accessible care for most citizens. McCain, in short, espouses bottom-up innovative market solutions.

Senator Obama, on the other hand, would pour a $100 billion government money (for starters) into the system to enable doctors “to do the right thing.” To help doctors, he would create $50 billion in government subsidies and incentives to install EMRs in every physician’s office, pay bonuses to doctors who practice prevention, coordinate chronic care through medical homes, and assiduously follow pay-for-performance and “evidence-based” protocol – all in name of “quality.”

Obama would also organize consumers into government-run risk pools and plans, such as the Federal Employee Health Benefit Plan (FEHBP). In the process, he would expand Medicare and Medicaid programs, tighten their rules and regulations, and end paying for unneeded procedures. Obama, in other words, believes in stronger government programs to guide, protect, and guarantee universal coverage.

No one knows the end game.

I doubt government officials can consistently dictate the “right thing to do,” no matter how large the information database or how tight the computer guidelines. Officials
are just too far removed from the site of care and subtleties and nuances that shape physician-doctor decision-making.

Nor do I believe the American public will accept a free-wheeling market system, without protections for the poor, the sick, the frail, and the elderly.

Since the founding of the Republic, Americans have been individualistic, basically conservative and leery of big government and sweeping changes. I am counting on Americans’good sense to “do the right thing,” even if more targeted government policies are needed to do it, without sacrificing choice and freedom and quick access to the best acute care in the world.