Dr. McCain

Gas tax stuff aside, I've been remiss in not really dealing with the foolhardy health care plan John McCain put out recently. To my eye, McCain's health care ad looks like a pretty good ad but unfortunately he's mantra that there's no quality problem with American health care is just false. An awful lot of the cost/access problem stems specifically from the fact that we spend a substantial amount of money on useless or counterproductive care. If you could take the resources currently expended in useless or counterproductive ways, and redirect them to useful things, then you'd have plenty of resources available to resolve access issues.

It's too bad McCain doesn't seem to understand this, because it's integral to the rationale behind the conservative notion that we need to shift costs off insurers and on to individuals. I don't agree with that prescription for resolving the quality problem, but the general idea is that if people have more personal responsibility for paying for what they're getting, they'll start holding providers more accountable and quality will rise. As I say, I don't think that's the best solution, but that's the general idea behind shifting risk onto individuals. And this just happens to be at the core of McCain's plan whose "main thrust," as Jon Cohn put it, is "to change the tax treatment of health benefits, which sounds arcane but could actually have far-reaching effects" in terms of unraveling employer-based health care in favor of individual markets.

The downside of this is that people with a history of medical problems (like, um, John McCain, except he'll be insulated from these changes by his job, age, and wealth) won't be able to get decent coverage, which is a pretty bad problem in my view. But McCain doesn't even really seem to know what the justification for this step is supposed to be. Which is too bad, because I really do think a reform-minded conservatism could contribute to improving health care by focusing on regulatory cartels and other drivers of higher costs, but to appreciate those points I think you'd need to have more of a taste for domestic policy than McCain seems able to muster.

Photo by Flickr user soggydan used under a Creative Commons licensE

Comments

"I really do think a reform-minded conservatism could contribute to improving health care by focusing on regulatory cartels and other drivers of higher costs, but to appreciate those points I think you'd need to have more of a taste for domestic policy than McCain seems able to muster."

But the candidates don't design their healthcare plans, so what does his taste for domestic policy have to do with it? Why can't he hire a cartel-busting economist?

Posted by Asher | May 2, 2008 9:37 AM

health care plan aside, mccain now officially has the most attractive person to stand behind him in pictures. (or maybe it's just relative to the two others pictured)

Posted by john b | May 2, 2008 9:37 AM

Just what I was thinking. Who's the girl?

Posted by tinisoli | May 2, 2008 9:46 AM

Phase II: Bring out the hot babes to negate the withering effects of Old Man McSame.

Posted by tinisoli | May 2, 2008 9:48 AM

Oh Matt, the idea that McCain's plan doesn't help those with preexisting conditions is a MYTH. From Sen. McCain's website:

MYTH: Some Claim That Under John McCain's Plan, Those With Pre-Existing Conditions Would Be Denied Insurance.

FACT: John McCain Supported The Health Insurance Portability And Accountability Act In 1996 That Took The Important Step Of Providing Some Protection Against Exclusion Of Pre-Existing Conditions.
FACT: Nothing In John McCain's Plan Changes The Fact That If You Are Employed And Insured You Will Build Protection Against The Cost Of Any Pre-Existing Condition.
FACT: As President, John McCain Would Work With Governors To Find The Solutions Necessary To Ensure Those With Pre-Existing Conditions Are Able To Easily Access Care.

See? There's no problem here. In fact, his plan is already in effect and already deals with preexiting conditions. And if it isn't, he's happen to ask someone else to deal with it.

Posted by Leo | May 2, 2008 9:48 AM

To my eye, McCain's health care ad looks like a pretty good ad but unfortunately he's mantra that there's no quality problem with American health care is just false. An awful lot of the cost/access problem stems specifically from the fact that we spend a substantial amount of money on useless or counterproductive care.

To my eye, Matthew doesn't understand what the word "quality" means.

McCain's "mantra" (I'm not sure Matthew understands what a "mantra" is either, come to think of it) that there's "no quality problem" is exactly right - we in America have high quality health care. We have inefficient high quality care, leading to "useless or counterproductive care", but that's not a problem of lack of "quality" - it's a problem of lack of efficiency.

Maybe somebody should teach Matthew the difference between quality and efficiency.

Posted by Al | May 2, 2008 10:07 AM

Efforts to eliminate employer-based health insurance have the effect of putting individuals into their own individual risk pool - negating the idea of insurance, which is to create security through membership in a larger risk pool.

Republicans are generally hostile to the whole notion of insurance. The attack on Social Security was made by pretending that Social Security is something it isn't - an investment program - to destroy it for what it is - income insurance.

The best thing that could be done for healthcare finance would be to create the largest risk pool possible - a universal one involving all citizens. Doing this would eliminate the costly and counterproductive efforts on the part of private insurance companies to get rid of expensive customers (ones needing medical care) and maximize the cheapest (young ones not needing much medical care yet). IOW McCain's proposal does the completely wrong thing (pretty much par for the course on GOP policy of all stripes).

Posted by jimBOB | May 2, 2008 10:11 AM

I listened to the video, McSame gets 0 points for not offering any solution but did earn 0.5 points for recognizing that the cost of health care is a problem. Can anyone else discern if he had an actual plan or anything from that video?

"but the general idea is that if people have more personal responsibility for paying for what they're getting, they'll start holding providers more accountable and quality will rise."

Seems to me any solution that includes the major participation of the health insurance industry, is not recognizing where the problem comes from. Thats like saying the cure for the increasing obesity problems in America must include the participation of the corn syrup manufacturers and Frito-Lay....

Posted by SO | May 2, 2008 10:12 AM

I'm not sure I understand McCain's plan. Give a $5000 tax credit so we can buy our own insurance policy.

The main effect is to move this off the company books, forcing everyone to buy individual or family insurance plans.

Why?

Somehow McCain thinks that we will get a better price for a plan if we can buy it ourselves, if we can pick our own doctor.

But there is no evidence that individual plans cost less than a group plan, and overwhelming evidence of the opposite.

In fact, the point of insurance is that you pool risk so that a huge expense like surgery can be spread around. This is the same point of a group plan. Instead of an insurance company looking at the health of one person, they pool the demographics. The result is a lower exposure to the insurance company. But group rates also are easier to manage, and open to negotiation. There is more chance for a free market system with a group negotiation for insurance. If a company offers insurance as an employee benefit, they have an interest in lowering the cost of premiums by negotiating.

These things should be easy to explain in a presidential campaign, easier than the gas tax holiday. Just look at your insurance bill. The doctor charges $100 for a procedure. The insurance company pays $75. You don't pay the difference. The insurance company has negotiated a lower price for you. Sometimes you have to pay a percentage of the $75, but it is a percentage of their lower negotiated price.

McCain want to force everyone into individual plans, and 'pay for it' with a tax credit. But this means that when you lose your job, you lose both the income to pay for the plan, and the income tax which can be credited.

Those who have nothing, even what little they have will be taken away.

Posted by tomj | May 2, 2008 10:36 AM

Matt says:

An awful lot of the cost/access problem stems specifically from the fact that we spend a substantial amount of money on useless or counterproductive care. If you could take the resources currently expended in useless or counterproductive ways, and redirect them to useful things, then you'd have plenty of resources available to resolve access issues.

Well, if you are serious about reforming the health care system, then muzzle the trial lawyers, fix the tort system, and stop making health caregivers insurers of perfect outcomes in every case. Never, ever, underestimate the economic and quality costs of defensive medicine.

Posted by Eagle613 | May 2, 2008 10:40 AM

Heck, I know conservatives who support a single-payer plan. Their basic argument is that if the public is ultimately going to pick up the tab for a lot of people, it might as well do it in an efficient way.

Where these particular conservatives push back tends to be on exactly what gets covered by the single-payer plan: they want it to be relatively minimal (toward the lower bounds of what public health and our societal feelings of charity would require), giving wealthier people the ability to choose more and better healthcare than the masses will be getting through the single-payer plan.

Posted by DTM | May 2, 2008 11:06 AM

In current form, McCain's plan will leave the chronically ill holding the bag, but I'm not sure why retooling Medicaid to target these people with an EITC or direct subsidy would be substantially more costly than the current financing system. I feel certain that care would improve for these individuals under such a system.

Does anyone have a good estimate of the size of the chronically sick population?

All told, removing the tax preference for employer provided care is the most honest attempt at structural reform in a long time, and I applaud his courage at addressing the root of the problem.

Posted by Charlie | May 2, 2008 11:21 AM

"Does anyone have a good estimate of the size of the chronically sick population"

Yep. It's John McCain, Elizabeth Edwards, Rudy Giuliani, Fred Thompson, Ann Romney, and John McCain's first wife. It's about 75 percent of healthcare costs. Ballpark of $1.75 Trillion annually. Probably 10-12 percent of GDP. It's basically the vast majority of people who are actually using the healthcare system.

Which is why it makes no sense to treat them as an afterthought when you're ostensibly fixing the healthcare system. Any idiot can figure out how to make health insurance cheap for people we know ain't gonna need healthcare. Desgining a healthcare system around their needs is like GM trying to turn around its bottom line with luxury cars targeted to Saudi Arabian women drivers. It may look awesome on paper, but it isn't going to do what you want it to do.

This is deck chairs on the Titanic. McCain is going to cap a tax deduction and shift it from employers to employees, and that plus deregulating insurers will somehow make healthcare cheaper and available to people who need it.

It's kind of telling that his plan totally falls apart when you ask "uh, how will your brand new health care system work for the majority of people who are going to need to use it? Like, uh, yourself?"

This isn't wonks tripping McCain up on a technicality. This is pretty freaking fundamental. If your health care system doesn't work for sick people, it doesn't actually work.

Posted by Anon | May 2, 2008 12:08 PM

Here's the deal, my friends: America's "health care expenditures" are, on the flip side, INCOME to (some) Americans.

All this talk about "cutting health care costs" amounts to "let's fire a lot of people". Where are all those people going to find other work? In a manufacturing plant?? Let's get real, my friends.

We have the best health care system in the world because OUR system creates more JOBS! And more profits!! I may not know much about economics, my friends, but I know that much.

-- TP

Posted by Tony P. | May 2, 2008 12:37 PM

I'd hit it.

Posted by blah | May 2, 2008 1:01 PM

Al,

Matt is right, there is a quality issue. The problem is medical care is too ad hoc and uncoordinated, with any particular patient having multiple health care issues and providers. That's leaving aside that since hospitals don't require the use of checklists and protocols, a lot of necessary treatment steps are neglected.
http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande

The VA and military medicine are probably the best at dealing with both quality issues and perhaps coincidentally, they're examples of socialized medicine (unlike a single-payer system like in Canada or Medicare, the VA and the Pentagon own the hospitals and employ the doctors).

What's interesting about military medicine is that they overcome a shortage of doctors and nurses by dramatically increasing salaries-- just kidding-- they train enlisted personnel to take on many roles that nurses or doctors otherwise handle. Army and Air Force Medics and Navy Corpsman handle a lot of nursing duties that LPNs and RNs do in the civilian world. And the most highly trained medics, such as the Navy's Independent Duty Corpsman, will replace a doctor on an isolated base or ship. How can they do that without years of medical training? Instead of having a military doc everywhere who can remember how to treat common ailments, the military has doctors write out protocols for the medic to follow.

Here's the Air Force's list of medical and dental (shhh! don't tell the ADA) treatment protocols http://tinyurl.com/46w24x

Posted by beowulf | May 2, 2008 3:01 PM

Matt - doesn't McCain's Mom (and Rudy's Mom, when alive) enjoy socialistic Medicare?

Didn't McCain, his father, and hi grandfather - enjoy socialistic health care in the US Navy?

Didn't McCain enjoy socialistic health care as a Vet?

Isn't McCain now just full of s***?

Posted by Comment | May 3, 2008 1:19 AM

Why do people like Matt think it's appropriate to pick ridiculous looking photos of politicians they disagree with, like with John McCain here? I could scour matt's video blogging for the stupidest looking frame of him possible, but what exactly does that have to do with anything of substance? Hooray for MattY!!! You put up a photo of McCain looking like he's about to give a blowjob to a microphone!!! The problem is that it makes your site look like nothing but a ridiculous fringe site by doing that.

Posted by scottynx | May 4, 2008 5:40 AM