The two remaining presidential debates will feature arguments over the candidates' healthcare plans, centering on access to care and the merits and shortcomings of the new Medicare drug benefit. Unless lightning strikes, the problem underlying those issues-health cost inflation-will get short shrift.
Both candidates have previously broached this subject. Each claims he would wring the inefficiencies out of the care delivery system and link everyone through electronic medical records. Neither, however, has said how this will be paid for. John Kerry wants to reduce employers' costs and expand access to care but will shift those costs to the federal government, though employers that participate in his catastrophic-coverage plan would have to provide employees with disease-management and preventive care. President Bush believes that only through tort reform will we see lower costs, though I'm not sure savings from capping noneconomic damages in malpractice cases would make enough of a dent in a $1.8 trillion-and-growing industry.
We shouldn't single out these men for failing to address the factors that cause the health-cost spiral. Congress has similarly devoted significant rhetoric to the problem, while making it worse through a series of actions, most recently the drug benefit law's lack of cost control. The healthcare community similarly bemoans the cost problem, but everyone is acting like it doesn't exist when it comes to improving their bottom lines.
As study after study has shown, health costs are continuing a rapid rise, fed by utilization increases, technology and profits. Though the rate of growth abated somewhat last year, it was still twice general inflation. A recent survey found that HMOs would hit large employers in 2005 with a 10% premium increase. In the near future demographic changes will cause a more rapid rise. The Medicare drug benefit alone may cost as much as $2.5 trillion between now and 2016.
What the candidates should be talking about is how they intend to take the lead on solving this problem, even as they are helping to expand coverage. The two issues are inextricably linked, because you can't expand access without a plan to reduce spiraling costs.
We need a 10- to 20-year plan to reform the healthcare system from top to bottom. That will start with higher costs in the short term to pay for clinical research that can lead to new standards of care and the information technology to reduce such inefficiencies as needlessly repeated tests, incorrect medications and lost records. New medical devices and drugs are often lifesavers, but we can't keep disseminating this technology without assessing what is best and most cost-effective.
Medicare, Medicaid and private payers should reimburse only for quality care. It is unacceptable that as many as half of all medical encounters involve substandard care.
Every health plan should provide incentives for patients to participate in preventive care and disease-management programs. Patients should be encouraged to take an active role in their own health through exercise, diet and smoking cessation.
Yes, reform of the legal system would help, but not through eliminating the rights of those who are injured by poor medical care. Instead we need a system whereby lawsuits are subjected to a screening process by medical and legal professionals-as is already done in some states-while the medical community agrees to report all adverse events.
It is notable that healthcare is playing as big a role as it is in this election. But Bush and Kerry are ignoring a current problem and future fiscal catastrophe by not promising to take the lead on defusing one of our more pressing economic and social problems-the healthcare cost time bomb.
What do you think?
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