Now that the Democrats have chosen Barack Obama as their presidential nominee, we know that during the next four months the airwaves will be filled with sound and images of Obama and Republican presidential nominee John McCain sparring over the economy and the war in Iraq. I am pleased to say that they also will be talking about healthcare reform.
Both candidates have published their plans on how to provide universal access to health insurance as well as how to rein in healthcare costs. Both plans espouse keeping the current pluralistic system of public and private financing, delivery and payment mechanisms. And both plans focus on wellness, prevention and chronic-care management. Where the plans differ is the role of government in achieving these goals. McCain favors using market forces to reduce cost and expand access, while Obama favors more government involvement.
One area that receives only cursory attention by either party is how to accomplish the care-delivery restructuring that will be necessary to achieve their aims. For real and sustainable reform, the fundamental incentives within the delivery system must be changed. Most experts agree that financial incentives driven primarily through payment reform are the only way to achieve sustainable change.