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The Politics of Healthcare

Ben Cole, for HealthLeaders Magazine, July 10, 2008
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Both parties’ presidential hopefuls have offered plenty of sweeping proposals for fixing the nation’s healthcare ills. But will either candidate be able to follow through?

The next president will face a colossal challenge in confronting the future of healthcare in the United States. A host of complex problems, from the growing number of uninsured to ever-rising health costs to a lack of information technology, are begging for solutions.

Despite the magnitude of such issues, however, healthcare is forced to compete with a shaky economy and the war in Iraq for voters' attention throughout the campaign. Both parties' candidates have offered plenty of ideas for addressing the country's healthcare challenges, but how significant of a role will healthcare ultimately play for voters?

"I think that while there are a number of issues the incoming administration will need to address, the public has put a very high priority on healthcare," says Ashley Thompson, director of policy for the American Hospital Association. "During 1992, everyone came to the table with their own unique reform plan and the next best option was to do nothing. And guess what? We did nothing."

So if healthcare remains a top-of-mind issue for the public, what will be the largest political battlegrounds as the campaign accelerates—and is there any way to know which solutions will really do any good?

Access, universal care
The major political parties have contrasting opinions on access and coverage for Americans. Under Democratic candidate Barack Obama's plan, healthcare coverage would be required for all children. Employers should also offer coverage, or contribute a percentage of payroll, toward the cost of a public plan, the Illinois senator contends.

Republican candidate John McCain, on the other hand, opposes universal coverage and government mandates for healthcare. The Arizona senator maintains that families should be in charge of their healthcare dollars and have more control over their care.

"To an extent, if the Democratic candidates are successful, it is more likely to lead to a bigger gain in the number of people insured. That means hospitals will be able to convert some bad debt customers to customers who pay—or at least convert them from charity care to paying customers," says Paul Ginsburg, president of the Center for Studying Health System Change. "There will also be a growth in demand for hospital care." Ginsburg adds, however, that both approaches would have an immediate impact on healthcare costs. "McCain clearly has a more consumer-oriented, market-driven approach to cost containment," Ginsburg says. "I would say McCain outlined a much clearer idea for cost containment than the Democratic candidates."

Bringing down costs
When it comes to overall cost containment, the candidates have some similarities. Both say the industry should focus on improving prevention/treatment for chronic illnesses; both candidates also are calling for increased hospital transparency to help consumers make more informed decisions.

Thompson contends that any healthcare reform needs to focus on wellness. The AHA worked with six expert advisory groups that included more than 100 organizations to develop a list of changes to laws and regulations in an effort to move toward better health and healthcare in America, and increased wellness is a huge part of the proposal, Thompson says.

"We have a sick-care system rather than healthcare system," Thompson says. "There is a personal responsibility of saying that we can't just address the healthcare system when why people are healthy or not healthy has so much to do with their own personal behaviors. It is important to manage individual's health and make sure that in this debate, people and improving their health are the focus."

Promoting IT, electronic records
Obama has promised to invest $50 billion toward electronic medical records and health information technology, while McCain promotes the "rapid deployment of 21st century information systems" and, when cost effective, using telemedicine for rural and underserved areas. But the practical application of much of the discussion surrounding technology is questionable, says Ginsburg.

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