Wednesday, April 30, 2008

Taking a Look at Healthcare Policy: The McCain Campaign

In the midst of what has been quite a rollercoaster of a week, I was able to participate in a press call with the McCain campaign that focused on his healthcare proposals. Senior policy advisor Doug Holtz-Eakin and former Hewlett-Packard CEO Carly Fiorina answered questions from journalists and bloggers about his policies, which provide an interesting alternative to the talk of universal healthcare dominating the Democratic contest.

There are plenty of economic and political analyses of the McCain healthcare platform out there, so what I’m attempting to do is look at the key policies of the candidates that resonate most with my perspective: someone with multiple chronic conditions whose problem isn’t lack of insurance per se, but lack of confidence in my insurance and lack of the comprehensive coverage I used to have.

Overall, I like a lot of the central themes of the McCain campaign: we have great technology and innovation so the problem isn’t as much about quality as it is affordability of that care; patients should have more control over their own care and their choice in doctors; healthcare should focus on treatments and outcomes, not tests and procedures; and lastly, that prevention is key (no surprise there).

I can’t argue with any of those points. As always, I’m interested in the “theory into practice” aspect of things. (Who knew the basic distinction so critical in my teaching composition seminar would turn up so often in my health blogging?)

Specifically, the idea of portable health insurance that employees can take from job to job is quite appealing. Health insurance is an inordinately large deal-breaker in potential job opportunities in our world. Not being tied to a job for its health insurance or tied to sub-par health insurance because of the job that comes with it is certainly a refreshing option.

The ability to purchase health insurance outside of employer-sponsored plans through a $5000 tax credit (that this free market competition will drive down costs is a driving force of this policy) also sounds promising in theory. In practice, I worry where this leaves someone with pre-existing serious medical conditions. If I’m to go out into the national market and try to buy a plan, will the “safety net” in place for patients like me actually catch me?

Other aspects of his platform I gravitated to include publishing doctor fees and patient ratings on Internet to weed out the worst providers; encouraging telemedicine; and providing incentives for healthy lifestyle choices, though in reality I’m curious as to how this would actually play out. His team was clear that these would be incentives, not mandates, but in the push for outcome-based medicine, would that line get blurry?

One thing I’d like to know more about is how his push for pharmaceutical reimportation would impact research and innovation for orphan diseases.

In sum, McCain’s policies are an interesting alternative to universal health care—about as different as you could get—and give me a lot to think about. In coming weeks, stay tuned for a closer look at the Democrats' policies, too—we’re equal opportunity here at A Chronic Dose when it comes to evaluating healthcare platforms. In the interim, for a nonpartisan look at the different candidates’ healthcare policies, check out the Partnership to Fight Chronic Diesase.


SHOON said...

I hope you do a lot of research while vetting the candidates' health plans.

You seem likely to.

My guess is that McCain's health plans will throw millions upon millions of people into the mass of uninsured.


Because there will be no incentive for health insurers to undermine the risk management model that has made them so much money, and made out health care system the most expensive in the world.

In other words, the insurers will be able to cherry pick because so many people will tumble out of terminated job-based group insurance plans.

Girl, Dislocated said...

I get palpitations every time I consider the possibility that I won't be accepted into any graduate programs, simply because it'll mean I won't have the student health insurance coverage I've been counting on.

I also figure a graduate degree (and later a medical degree) will increase my chances of securing a job that comes with good benefits. At the same time, salary will factor into my career decisions more than I'd like it to because I have to brace myself for major out of pocket expenses, what with all of the pre-existing conditions exclusions and whatnot.

Needless to say, health insurance is a huge source of anxiety for me, and as much as I'd like to go hide (and probably cry) under a pillow whenever the subject comes up, I'm trying to stay informed. Your blog's been a great resource!

Anonymous said...

Great update... Will look forward to your thoughts on the Democrats' policies... At some point, consumerism, capitalism and competition need to be infused more into the system. Moreover, as benefits consultant, we see wellness incentives as the best of way controlling escalating costs, and studies have validated this.

I think National Healthcare would not be the panacea some think it would. Look at Canada's system and delays in care and quality of care.

Thanks, and I will stay tuned.

Unknown said...

I;m a Canadian living in the US and I used to be all for universal healthcare, but I am changing my tune. In the last 10 years I have watched Canada's system get worse and worse. My mom waited a year for a knee replacement. My dad waited 6 months for a heart test that thank god came back normal. My mom just went to the ER on the weekend and there was a man there writhing in pain..his wife said he needs cancer surgery and they have canceled it twice.
But yeah your questions about the alternative pans are very good.

Toni Brayer, MD said...

McCain's Plan takes the worst of our system now and amplifies it. It gives tax credits so people can purchase insurance, but has no price controls to ensure they can afford the coverage. It allows cherry picking and eliminates consumer protection laws in the States. It perpetuates the big business of medicine and has no solution for chronic disease or the uninsured. As dr.puck above said, it will increase the uninsured problem. For another look check out my blog at

Rick Frea said...

Excellent post. The most important thing to remember in fixing the idea of how people are going to afford healthcare is to make the system better while at the same time not making the quality of the care worse. That, I think, it the most important part of the debate.

Anonymous said...

Good Job! :)

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