I thought Hilarys plan was something along the lines of forcing people to buy a government health plan, rather than providing it free of charge. I could be wrong and I dont know the details, but I thought Obamas plan was a virtual copy except he gave you the option of opting out of the program.

Offering everybody Medicare would probably be expensive, but if people really want universal coverage that people can afford, that is probably the only way that works.

Obama, Clinton, McCain and health care reform Posted on April 21, 2008 www.sentineleffect.com/

The third session of the World Health Care Congress was begun by a talk from Rep Jim Cooper (D TN), one of Barack Obama's health policy folks. Rep Cooper primarily condemned Sen McCain's policy, while noting that both Democrats' platforms were essentially identical - with one notable exception - Obama does not mandate coverage.

(A comparison of the Clinton and Obama plans is here)

According to Cooper, the upfront problem w universal coverage is that it will result in "zero Republican votes" - a completely wrong statement. For example, Ron Wyden's (D OR) Healthy Americans Act has six (6) GOP cosponsors - and the HAA specifically calls for universal coverage.

McCain's spokesman, Thomas Miller of the American Enterprise Institute, talked a good bit about the tax implications of McCain's plan - a program that is remarkably similar to Pres. Bush's plan (that got absolutely zero traction in Congress). Miller noted that McCain's plan relies on the market and individual motivation to buy insurance, a motivation that will be enhanced by a tax credit for those how buy coverage (a tax credit that amounts to $2500 for an individual or $5000 for a family, about half of what coverage actually costs).

I'd note that Mr. Miller did not mention that Sen McCain's plan will also be quite expensive. The cost of the Senator's tax credits would be $206 billion in FY 2009 and $3.6 trillion over 10 years.

Chris Jennings spoke for Sen Clinton, and he started with the (I would argue sole) difference between the Clinton and Obama plans - she wants mandated universal coverage and he does not. Mr Jennings noted that half the cost comes from rolling back the Bush tax cuts and half from programmatic savings, but he did not add much in the way of new insights into how Sen Clinton's plan will reduce costs.

There were two commentors - George Halvorson, CEO of Kaiser Permanente, and fomer Sec of State (and other departments) George Shultz. Halvorson began with the good news, that candidates are talking at a level of detail and comprehension re health care that is unprecedented. We've moved away from sound bites and deep into the details, a transformation that is quite encouraging to Mr. Halvorson.

George Shultz noted that if people work longer there will be more GDP, and this will help pay for more health care. He also opined that the reason people are living so much longer over the last 60-80 years is due to basic research and development of technology and pharmaceuticals. This, I would note, is in direct conflict with every other expert's view on the subject - sanitation, nutrition, antibiotics and infectious disease control are overwhelmingly responsible for the improvement in lifespan, not MRI machines and new drugs (with the notable, but not overwhelmingly important, exception of antibiotics).

Finally, someone raised the question of comparative effectiveness evaluation - and all spokesmen agreed that we need to do a lot more of it. The elephant in the room is the AMA, and their likely-nuclear reaction to anything that smacks of 'telling physicians how to practice medicine'.

But here's my primary takeaway - everyone on the panel called for universal coverage even if McCain's spokesman's support was muted at best.

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{Link for the following is contained in the article above. Posted on February 25, 2008}

Which health plan controls costs, Obama's or Clinton's?

This is a two-part answer. Both have essentially identical cost containment mechanisms. But will these mechanisms have a material impact on costs?

Here's my take.

Pools - both look to reduce administrative expenses by providing insurance thru and 'managing' insurers by centralized insurance buying pools. Both would set up national mechanisms - Clinton thru the existing FEHBP and Obama via a new Health Insurance Exchance. My take - this will help cut admin costs by a few points.

Disease prevention - relatively minor policy differences - both will require coverage of preventive care and increase funding for some public health initiatives. My take - this should help reduce costs - but over the long term - by spotting disease early, thereby reducing cost of treatment. It will also improve GDP as the early detection will prolong lives of workers. Costs may well increase somewhat over the near term as the previously uninsured get lots of care for all their newly-discovered conditions.

High cost cases - Obama will reimburse employers for a portion of an individual's over a per-person threshold if the payer uses the funds to reduce premiums. Clinton's plan is silent on these. My take - no impact on costs. I don't like risk transfers, as there is no incentive for the primary risk taker to manage cases which they think will become high-cost, and no incentive once these cases have pierced the threshold.

Chronic disease management - here's where the big dollars are, and both plans miss the target by wide margins. Both set up medical homes where (I assume) patients with chronic conditions (of high acuity) could be treated.

Technology - both will drive adoption of electronic health records and data exchanges. My take - Over the long term, this should drive down costs significantly - fewer repeat test, much better coordination of care for those with multiple conditions seeing multiple providers.

Tort reform - Notably, both co-sponsored a national medical error reporting bill in 2005. Clinton will reduce potential awards for providers who comply with medical error disclosure; Obama looks to 'reform medical malpractice', but how is unclear. My take - Medical malpractice contributes much less to costs than many think; the impact of either will be minimal to unmeasurable.

Drugs - both allow reimportation, would (likely) negotiate directly with drug companies to reduce prices for federal beneficiaries; Clinton adds limits on DTC advertising while Obama would further promote generics. My take - the direct negotiation would likely significantly reduce costs for the Federal programs.

Best practices - Obama backs an 'independent institute' to research drug and device efficacy; Clinton calls for a 'best practices institute' (we sort of already have one, or rather had one in AHCPR, which ran into the physician lobby buzzsaw some time back) My take - this could have significant benefit over the long term, if it is adequately funded and assertively supported.

The net is this - I'd have to agree (mostly) with Bob Laszewski - either plan will help control costs, and there's little difference between the two.

But, and here's the 'big but', the Dems do have plans, while McCain's is not much more than more of the same.

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Another frightening look at McCains Health Plan:

healthpolicyandmarket.blogspot.com/2008/04/john-mccains-health-care-plan-and.html

single payer is the only health care plan that appeals to me. if we have a graduated approach resulting eventually in single payer i could accept that. . .but i don't want anything that locks in the hmo's and insurance companies, allowing the chance to suck off the tax dollars and drive up the costs to the taxpayers. .

the best system would have a national payment and records system and local cooperative health care services that are supported by regional plug-ins to the national and the local.