Today’s anointed front-runner in the GOP is John McCain (a position he may hold longer than Sen. Obama did on the other side of the aisle). Here’s where the senator stands on health care.
Analysis
The quick take is this: McCain’s plan has some strong points and resonates with Republicans, but most GOP voters aren’t thinking about health care.
While most other candidates are talking about covering the uninsured, McCain is focused on cost. More specifically, the cost of chronic conditions such as diabetes, asthma and CAD which account for 75% of the US’ entire $2 trillion health care bill. McCain is not just pointing out the obvious, he also plans to attack these costs by altering reimbursement – paying providers for maintaining health rather than reimbursing for specific procedures.
Here’s how McCain put it:
“We should pay a single bill for high-quality health care, not an endless series of bills for presurgical tests and visits, hospitalization and surgery, and follow-up tests, drugs and office visits,”
That makes a ton of sense. It is also entirely consistent with the views of George Halvorson, CEO of Kaiser Permanente, outlined in his book Health Care Reform Now (which came out just a few days before McCain’s first major speech on health care). If McCain is reading Halvorson, that’s a good thing.
So far, so good. So far.
McCain’s plan (which is not really a plan, but a series of talking points) also calls for
— uncoupling insurance and employment by removing the favorable treatment of employer-funded insurance
–a tax credit of $2500 per individual, $5000 per family for purchase of health insurance
— he’s a fan of HSAs, repeating the tired cliches about the ability of families to decide which providers and procedures are best. “American families know quality when they see it, so their dollars should be in their hands. When families are informed about medical choices, they are more capable of making their own decisions.” I’m not sure which American families McCain is referring to; this looks to be a paean to make us feel smart.
— tort reform
— a more national approach to insurance marketing and portability and physician licensing
— some form of risk adjustment to subsidize high cost patients (at least that’s what I think he’s saying here “We should give additional help to those who face particularly expensive care. If it is done right and the additional money is there, insurance companies will compete for these patients – not turn them away…The federal government can help fund this effort … (and) develop methods to augment Medicaid and tax credits for more expensive care.”)
My take.
McCain is dead on when he talks about the need to pay for health, not reimburse for procedures. His focus on the need to aggressively improve care and outcomes for patients with chronic conditions is creditable. The risk adjustment mechanism is laudable and good policy.
What I don’t see is a requirement that insurers take all comers, a prohibition against medical underwriting. Instead, McCain appears to place his faith in risk adjustment as a substitute for limits on exclusions and underwriting.
This won’t work. Insurers are really really good at not covering folks likely to have claims; short of outlawing this behavior there’s no way to prevent insurers from playing the underwriting game.
How does this track among Republicans? Notably, McCain’s focus on cost is consistent with the majority (60%) of those in his party.
But, Republican primary voters in New Hampshire didn’t include health care among their top concerns.
