The Politics of Healthcare

"There are a number of things in the proposals, but they are almost like wishes rather than steps," he says. "The candidates would all like a situation where IT plays a bigger role, but when it gets down to what exactly government should do to bring this out—that's where it stalls."

Elusive as it may be, an effective plan for national health information technology would have the potential to positively impact hospital cost and quality transparency, Thompson says.

"We see a need to really focus on providing the best information possible," Thompson says. "Part of this has to do with utilization of health information technology, but there is a sentiment that if you place electronic medical records in institutions it does not necessarily achieve your goal—you really need to change your processes surrounding it. It has great opportunities to save money, to reduce duplication, and to really provide better care by sharing with clinicians."

Government payers
Obama has said that if elected, he will expand both Medicaid and SCHIP. Under his plan, individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a plan.

McCain, meanwhile, says the United States must reform the payment systems in Medicaid and Medicare to compensate providers for diagnosis, prevention, and care coordination. He also argues that Medicaid and Medicare should not pay for preventable medical errors or mismanagement.

McCain would also provide the option of receiving a direct refundable tax credit of $2,500 for individuals and $5,000 for families to offset the cost of insurance. While still having the option of employer-based coverage, families will be able to choose the insurance provider that suits them best and the money would be sent directly to the insurance provider. Those obtaining insurance that costs less than the credit can deposit the remainder in expanded health savings accounts.

"What McCain has done is a very major overhaul of the tax treatment of health insurance that is going to change people's incentives for what kind of health insurance policies they buy," Ginsburg says. "And likely it is going to be a health insurance policy with a lower premium achieved either by thinner benefits or more restrictions."

Ginsburg adds that an area that also needs attention is the distortion in the current payment mechanism, which is mostly led by Medicare. Because Medicare compensates more generously for some services than others, providers will, in turn, emphasize better reimbursed services, he says.

Finding the money
"The closer we get to the election, more and more informed people are saying that doing what the candidates say is going to be tough—I think the toughest issue is how to pay for it," Ginsburg says. Obama's campaign estimates that his health plan will cost approximately $50 billion to $65 billion per year—which he says will primarily be funded by savings in the system and from discontinuing tax cuts for those with incomes of more than $250,000. McCain has been less specific on how he would fund his plan but says that cost containment measures would help.

Despite both Obama and McCain's best efforts, some remain skeptical that either will be able to step in and make sweeping, immediate changes to the nation's healthcare system.

"The two big obstacles are how to pay for it and the trend we've had toward partisan polarization," says Ginsburg. "When we get into what Democrats want to do versus what Republicans want to do, that is going to be a barrier."

Ben Cole is an associate editor with HealthLeaders Media. He can be reached at bcole@healthleadersmedia.com.