John McCain Health Care Plan
John McCain has unveiled his health care plan. The text of his speech to the Des Moines Rotary Club, at which he unveiled his plan, is here.
The highlights (all excerpted direct quotations):
- The biggest problem with the American health care system is that it costs too much, and the way inflationary pressures are actually built into it.
- We are approaching a “perfect storm” of problems that if not addressed by the next president, will cause our health care system to implode.
- The first principal of real reform is that Americans should pay only for quality. Right now, too much of the system is built on getting paid just for providing services, regardless of whether those services are necessary or produce quality care and outcomes. American families should only pay for getting the right care: care that is intended to improve their health.
- 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, less likely to choose the most expensive and often unnecessary options, and are more satisfied with their choices. Health Savings Accounts are tax-preferred accounts used to pay insurance premiums and other health costs.
- I am committed to ensuring the finest quality medical care for our veterans. . . . We can give them the option to put the means for financing their care under their control – in an electronic card or other device – so that if they want they can choose their care in another way that suits them best.
- We must pass medical liability reform, and those reforms should eliminate lawsuits for doctors that follow clinical guidelines and adhere to patient safety protocols.
- We should pay a single bill for high-quality heart care, not an endless series of bills for pre-surgical tests and visits, hospitalization and surgery, and follow-up tests, drugs and office visits.
- If the cheapest way to get high quality care is to use advances in web technology to allow a doctor to practice across state lines, then let them.
- [I]f there are ways to bring greater competition to our drug markets by safe re-importation of drugs, by faster introduction of generic drugs, or by any other means we should do so.
- Government programs such as Medicare and Medicaid should lead the way in health care reforms that improve quality and lower costs. … We need to change the way providers are paid to focus their attention more on chronic disease and managing their treatment. This is the most important care and expense for an aging population. And in a system that rewards quality, Medicare should not pay for preventable medical errors.
- The second principle of effective reform is to have insurance choices so varied and responsive to individual needs that you could fire your insurance company if you wanted to. Right now, too many of our citizens don’t have an insurance policy at all, and those who do are afraid they will lose the one they have – afraid they will get too sick, afraid to stay home and not work full-time, and afraid their benefits will disappear along with their job.
- [E]veryone should get a tax credit of $2500, $5000 for families, if they have health insurance.
- We should give additional help to those who face particularly expensive care.
- I propose that we try a time-honored approach and let the states work on whatever method they find most promising. The federal government can help fund this effort, but in exchange, states should allow Medicaid and SCHIP funds to be used for private insurance and develop methods to augment Medicaid and tax credits for more expensive care.
- You should be able to buy your insurance from any willing provider – the state bureaucracies are no better than national ones. Nationwide insurance markets that ensure broad and vigorous competition will wring out excess costs, overhead, and bloated executive compensation. Introducing competition into the health insurance market will reduce costs.
- If a church or professional organization wishes to sponsor insurance for its members, they should be able to do so.
- The final important principle of reform is to rediscover our sense of personal responsibility. We must personally do everything we can to prevent expensive, chronic diseases.
McCain held a blogger conference call to discuss that and other issues. Mostly, we talked about other issues. I asked him about the Armenian genocide resolution; my recap of that discussion was appended as an update to that post.
As to the health plan, it strikes me as rather vague but the broad principles are reasonable enough. More importantly, he’s at least talking about it. I had a BloggingHeadsTV diavlog this morning with Mike Tomasky and one of the things we debated was his notion that the Republican candidates aren’t talking about domestic issues with any specificity at all. McCain seems to be trying to move the ball, at least, on perhaps the most important social issue of our generation.
There’s broad consensus that society (aka, the taxpayer) should help take care of the poorest and sickest among us. Beyond that, we generally agree that controlling the costs of health care is key to any solution and that choice is a good thing. Figuring out a way to make health care portable, so that people with preexisting conditions aren’t tied to their current employer, is essential.
There’s not much talk here or in the other candidate proposals, though, about the specifics of bringing down costs. In several of our OTB Radio discussions of this, for example, Dave Schuler has talked about radically expanding the number of medical and nursing school slots (currently capped by the AMA cartel) and ending the bureaucracy that attaches to buying medical supplies. Instead, we get platitudes that play into the comfortable biases on the party nominating electorate.
I guess its a start, especially for a Republican field that seems to just about deny that a problem exists. The problem, as you stated, is the broad vagueness of the whole plan. It’s good that he has a tax credit, but the Democratic plans have that. The rest doesn’t seem to have much meat on it, especially the attempts to wring costs from the system.
I’m by no means an expert, but the “consensus” Republican position that seems to highlight that people are going to the doctor unnecessarily still seems to elude me. I’m sure that there is some of that in the system, but I still see preventative measures as more cost efficient than encouraging to go to the doctor less. And with Republican plans (HSA’s), it seems that the incentives will be to not go to the doctor for preventative measures. I’m not sold on anyone’s plan just yet, but at least in the Republican field Huckabee seems to be the only one addressing that issue.
I would propose a couple of other alternatives.
1) Make employer provided health care taxable, but then provide the tax credit as he discussed. Further, the employee would have an annual option to take the money to buy his own insurance or use the corporate insurance option. This would move the health insurance out of the ‘free’ category and back to a market good. It would also make it possible to have portable insurance that follows the worker, rather than having to go into a new insurance plan with a new job (or being stuck in a job because you can’t change insurance).
2) I like the idea of lawsuit coverage based on following clinical guidelines. But I would propose that there be “good, better, best” guidelines with different costs. Let patients choose which they want weighing the costs, risks and benefits. Insurance companies could also offer coverage for “good, better, best” with patients able to ‘upgrade’ out of their own pocket.
3) Give hospitals at least the same tools as the ‘dead beat dads’ laws for going after people who use emergency room services without paying. Those who make the financial choice of going without insurance (as opposed to those who have the choice made for them by circumstances) shouldn’t be given a free ride.
4)This would probably turn the thing into a hot political hot potato, but put the HSA’s, IRA’s, 401K and social security payments into the same pot. People can then manage their accounts themselves balancing immediate medical needs against future retirement. I suspect there can be an interesting angle for insurance provided as part of the account management.
5) Require care givers to provide uninsured (or paying out of their own HSA) the same rates as their best rate given to insurance companies. Right now, doctors tend to have a high standard rate, then write off a large part when charging the insurance company. There may be some nifty tax reason for this, but doesn’t make sense for a cash paying uninsured patient.
why did you waste your time on the Armenian genocide resolution that means nothing to 99.9% of the voters and not try to ask about something important?
That the average voter doesn’t understand an issue doesn’t render it unimportant. I’m interested in his view of how to balance expressions of morality with maintaining effective diplomatic relations with key allies. I was heartened to see that he thought the latter more important in light of the genocide being long over.
LOL…If the average voter’s understanding was the screen, nothing would be important. The average voter can’t find their own state on a map.
Jim, I thought that was a great question and an even better answer by McCain.
Ohh a tax credit, lets see on 5k that amounts to a tax savings of oh about $900 or less for most of the people who don’t have health care. Should cover about one months worth of premiums.
You should be able to buy your insurance from any willing provider…
But if there are no willing providers what then?
As has been noted above, it’s a start. Unfortunately, it’s a pretty small start for a pretty urgent problem. The three largest components of healthcare costs are (in this order) insurance costs, professional salaries, and hospital costs (which probably include a substantial component of professional salaries as well). Pharmaceutical costs and legal costs are much, much smaller than these big three.
Reasonable optimization stategies suggest that the place to look for optimization are in the largest components of cost, not the smallest. I believe we’re going to need to look at serious economies in all of the major cost components to achieve the objectives that are really before us.
I’m glad that Sen. McCain mentioned telemedicine however obliquely. In addition to our problem with costs we have a persistent problem with the distribution of healthcare—there are lots of underserved areas and serious attention to the technology of telemedicine would be a step towards helping out those areas.
John will fix the health care problem just like he fixed campaign finance irregularities.