nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Wednesday, September 17, 2008

Healthcare Platforms

Analyses question McCain, Obama health plans.

CQ (9/17, Jha) reports, "Twenty million people will lose coverage provided through their employers under Sen. John McCain's (R-Ariz.) healthcare plan, while Sen. Barack Obama's (D-Ill.) proposal will add $100 billion in new spending every year, according to two separate analyses published Tuesday in the journal Health Affairs." McCain proposes a shift away from employer-sponsored coverage, but that may result in the "same number of uninsured Americans," because approximately 20 million "would use the tax credits to buy cheaper, but less-generous, non-group coverage," according to researchers Thomas Buchmueller of the University of Michigan, Sherry Glied of Columbia University, Anne Royalty of Indiana University-Purdue University at Indianapolis, and Katherine Swartz of Harvard University. Obama's private/public plan would "reduce the number of uninsured by imposing a mandate for employers to offer health insurance to their workers, or else pay a payroll tax that would help fund a new public program." Joseph Antos, of the American Enterprise Institute, Gail Wilensky of Project Hope and Hanns Kuttner, formerly of the University of Michigan, said this employer mandate "conceals who actually pays for the required benefit," warning that the mandate could "undermine their chances for economic success."

Doc D: I’ve written about the candidates’ plans before, talking about these issues and others, so I’m feeling like a pretty smart guy today. Once again, though, the media goes for the conflict: I subscribe to Health Affairs and have read the articles…it’s actually about combining the good elements of both parties’ plans (note the title: “Blending Better Ingredients for Health Reform”). By the way, the media likes to refer to the candidates’ policies as “theirs,” but the plans are all written by policy wonks that work for the campaigns: I believe the candidates themselves have little understanding of the healthcare system. I don’t agree with some of the analysis in this article, but it would take 20 pages to say why, and bore you to tears.

I did a fun experiment. I went to the health plan comparison website at and asked the computer to search for two words in the side-by-side comparison: “choice(s)” and “require(d)(ment)”. Here’s the result: the McCain plan uses “choice” twice; the Obama plan, not at all. The McCain plan uses “require” three times; the Obama plan, eleven times. This is not scientific and shouldn’t be given more than a moment’s consideration [for instance, in the Obama plan, most of the time, “require” is used toward the industry (insurance, employers, doctors, hospitals, and such), but saying “require all children to have health coverage” doesn’t tell you how that’s going to happen—it’s probable that the details are in the platform somewhere]. However, I do think that there is a fundamental ideological difference in the parties. If having a say in who, what, when, where, and how is most important to you, then you like “choice”. If ensuring that everybody gets a share by contributing according to ability, then you like “require”. Said differently, do we want to make sure people don’t obtain (choose) less coverage using their tax credit, or do we want to mandate (require) coverage and pay for the increased cost in government spending each year? The above article greatly oversimplifies things, admittedly. For you Poli Sci majors, this is old stuff between the Left and the Right.

It took me a long time to write that paragraph: it’s almost impossible to choose language that is balanced, and I probably didn’t succeed. The problem I have is that neither plan will solve the nation’s need for high quality, accessible, affordable coverage. The parties just want to pander to the public’s demand to get people into the “insured” column.

Doc D

Opinions are entirely my own. Quotations from AMA Morning Rounds (© U S News Custom Briefings)

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