Healthcare Funhouse

I know I should be ashamed of myself, but I find that I just can't listen to the presidential candidates. I actually like Barack Obama and John McCain. They're not dumb, and they seem to actually speak their minds from time to time. But as soon as they open their mouths to talk about policy, it's as if these smart men fade into the distance and the pollsters take over. I want to hear what they're actually going to do, or try to do. Instead, they want to tell us what they think we want to hear. Listening to a political speech is like looking into a funhouse mirror: You think, can this really be how they see me?

When it comes to healthcare, Barack Obama and John McCain seem to see us as good-hearted folks who aren't very good at math.

Obama wants the 47 million uninsured to have insurance. Admirable. But 47 million multiplied by $5,000, the annual cost of an average health insurance plan, comes to a bit over $200 billion, roughly what we'll pay on the Iraq war this year, and about half of the total 2007 Medicare expenditures. That's not an impossible number, but it's an extremely unlikely one. Sure, we could develop cheaper plans, but the question is how much lower we can go and still solve the problem.

Patrick Clinton

McCain proposes to provide direct, refundable tax credits of $2,500 per individual or $5,000 per family to pay for health insurance. With roughly 100 million households in the country, that's an even bigger number, somewhere between $250 million and $500 million a year (compared with total federal tax revenues of $2.6 trillion). Is that really going to happen?

Both candidates, of course, expect to save tons of money by eliminating waste and inefficiency. (They also apparently both see us as not having very good memories.)

I realize the candidates aren't actually trying to be informative in their positions on healthcare. That would be politically dangerous. But it means there's no reason to listen to either one.

And what would be worth hearing? I've got a little mental list. When I hear it, I'll know that they're actually serious. So, John, Barack, if you want this inattentive voter to listen to your healthcare policies, please:

1. Tell me some things you think a national healthcare system shouldn't pay for. A big problem with getting your arms around healthcare is that there's no reason why costs shouldn't go up indefinitely. Sometimes rising standards will be the driver, sometimes fear of lawsuits, but there's no natural point at which to say "enough." That's going to be partly your job. Tell me how you plan to do it.

2. Show me a connection between your plan and making US companies more competitive by removing healthcare costs from the cost of goods sold.

3. Show me you understand the role of drugs in controlling as well as driving healthcare costs. No one would vote for a candidate who complained about the cost of motorcycle helmets if he didn't also talk about fractured skulls. It's the same deal here.

4. Talk about Alzheimer's. In just a few years it promises to be an epidemic and an economic nightmare. There's still time to plan for it. Show that you understand.

5. Finally, give up on drug importation. It's wrong, and it won't work, and you have to know that. Show some spine.

Somebody, anybody, if you hear a word from either candidate on these subjects, let me know, and I'll tune in. Until then, I'll be in the funhouse.

Patrick Clinton

Editor-in-chief

pclinton@advanstar.com