Washington Matters


Details Must Be Part of Debate on Health



OK, candidates. You've had your shot at defining yourselves and each other at days-long political commercials. We've had fun with lipstick and pigs...and even more fun trying to make sense of all these polls only to conclude that all they really tell us is that things are going to remain interesting for some time to come.

How about bearing down a little now on issues? And no cheating with sweeping but rather useless policy goals. There's little argument that we want better schools, better and cheaper health care, lower taxes and a humming economy with low unemployment. Isn't it time to start talking about the means to those ends -- explaining what will and won't work and why? Let's start with health care.

Both John McCain and Barack Obama embrace sweeping reforms aimed at restraining health care costs and providing coverage to millions of uninsured Americans. However, their proposals are drastically different and neither candidate has spent much time explaining the pros and cons of their own or their opponents' approach.

What's more, what about some of the recent changes we've already tried to make to improve the system -- are they achieving what was anticipated? For example, McCain and Republicans as a whole generally favor free market approaches to health care reform. Especially popular are high-deductible, lower-cost consumer-driven health care plans (CDHPs). CDHPs, which include establishing tax-advantaged health savings accounts (HSAs) to be used for out-of-pocket costs. The idea is that if consumers are spending their own money on health care, they will demand the best price possible and make sure that proposed treatments are effective.

But there's a problem. The smaller companies that backers of the idea hoped would rely heavily on CDHPs aren't buying even though CDHPs are significantly cheaper -- up to about 20% cheaper -- than more traditional coverage. They are simply dropping or not buying health policies at all. "This is one of the leading causes of the increase in the number of uninsured over the past few years, and a troublesome finding for policymakers who were counting on these plans -- specifically HSAs -- to reverse the trend," says Blaine Bos with Mercer, which released preliminary results of an annual survey on employer-based health insurance that showed slacking interest in CDHPs.

That's just one example of the kind of detail that needs to be addressed by both candidates.

Many health organizations have looked at the plans and described them for voters, but The Obama and McCain Health Care Platforms: A Guide for Employers by Buck Consultants is an especially helpful paper with a real-world and business-world perspective. While Buck does a good job describing the candidates' proposals and the likely effects they would have on businesses, the real service they perform is to pose questions about each plan that should addressed.

If Obama and McCain mean what they say about governing in a different way and running a different kind of campaign, they could go a long way by raising and answering the types of questions Buck poses.
Here are just a few examples:

* By avoiding specific mention of CDHPs, does Obama mean to imply that he would curtail them??
* Would employers prefer to be out of the health insurance delivery business (an option supported by McCain) or is providing coverage a tax-effective way to compensate employees and a practice most employers would like to continue?
* Does an employer "pay or play" mandate as advocated by Obama make it more difficult for U.S. companies to compete globally? Is coverage expansion through mandates worth the potential cost to the U.S. economy?
* Would enhanced competition between employer plans and individual insurance, as McCain advocates, drive young, healthy employees into the individual markets, leaving the least healthy, most costly employees in employer plans?




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