Advisers acknowledge similarities among candidates’ healthcare plans

In sharp contrast to the harsh rhetoric the presidential candidates and their political operatives employ on the campaign trail, their healthcare advisers found much common ground at a briefing on Thursday.

One of those points of agreement was that the twin tasks of lowering costs and expanding access to healthcare will be a gargantuan task for whoever wins the White House in November.

{mosads}At the forum, sponsored by the National Federation of Independent Business (NFIB), surrogates for the candidates acknowledged that Sens. Hillary Rodham Clinton (D-N.Y.), John McCain (R-Ariz.) and Barack Obama (D-Ill.) each advocate similar measures to reduce the cost of healthcare services.

“If you look at the actual proposals that are out there to do cost-containment in our healthcare system, I think they’re very, very similar,” said Katherine Hayes, an adviser to the Clinton campaign. Hayes, a former aide to Sen. Evan Bayh (D-Ind.) and the late former Sen. John Chafee (R-R.I.), is a healthcare lobbyist with Jennings Policy Strategies.

But the campaign advisers stopped singing in unison when it came to ways to cover the uninsured — an issue of disagreement between Clinton and Obama. The main difference between the two is that Clinton would “mandate” that everyone (with limited exceptions) buy healthcare insurance, which Obama calls inessential and punitive to people with low incomes. His “mandate” only requires such coverage for children.

Though McCain has a market-based plan to expand coverage, mostly by changing the tax code, he makes no claims that his proposal would guarantee universal coverage.

Each of the three candidates has touted his or her own broad plan to ease the burden of medical costs on those who have insurance and to help get coverage for the estimated 47 million people who do not.

The Democratic candidates’ plans share many elements. The way they would combine the existing private system with an enlarged role for the federal government is right in line with their party’s principles.

McCain’s plan, on the other hand, seeks to provide new tax and market incentives to individuals, insurance companies and medical providers to achieve the goal.

Although the uninsured issue may receive more public attention, healthcare costs are a greater concern for middle-class voters, most of whom have health insurance and say they are satisfied with it. Moreover, rapid growth in the cost of medical procedures and medicines is primarily responsible for the increase in health insurance premiums, which in turn has led to the rising number of people without coverage.

On the costs side, all three of the candidates have embraced strategies such as increasing the use of information technology in the healthcare sector, linking payments to medical providers to the quality of the services they perform, conducting research to determine what treatments provide the best outcomes for a medical condition and expanding access to inexpensive generic pharmaceuticals.

The campaign advisers also called for new ways of paying medical providers for healthcare services.

Key to reducing costs is “moving away from a fee-for-service system that largely incentivizes more and more and more care” rather than better care, said Kativa Patel, a medical doctor who is an Obama adviser and a senior healthcare aide to Sen. Edward Kennedy (D-Mass.).

“All three of these plans really look at [costs] as an issue and trying to cover what works and not spend money on treatments and procedures that don’t,” Hayes, the Clinton adviser, said.

“What Sen. McCain would like to do is … change the practice of medicine so that they focus on providing good outcomes,” said Douglas Holtz-Eakin, the McCain campaign’s policy director.

A fundamental area of disagreement between the Democratic candidates and McCain was made clear when the advisers debated over whether costs could be reduced in the absence of universal coverage.

“You just can’t do one without the other,” Patel said.

“It’s really impossible to get a handle on costs without addressing coverage,” Hayes said.

From McCain’s point of view, emphasizing universal coverage is the wrong way to improve the healthcare system, Holtz-Eakin said. “The rising cost of healthcare has to be the centerpiece to any effort to reform the healthcare system,” he said.

Holtz-Eakin took issue in particular with Clinton’s mandate that individuals buy insurance.

“To the extent that you place the gold standard as a hundred percent of Americans insured and you provide for that in a way which is centered on the notion of a mandate, you run the risk of forcing people into an insurance system that covers a bill that’s too large for what we’re getting,” he said.

Hayes countered that the insurance industry cannot be expected to cooperate with a reform effort — or stay in business — without a mandate. “[Clinton] didn’t do this because she thought it would be politically popular. It’s not,” she said.

“You can’t open up the door and tell insurance companies that they have to take everybody and they have to charge everybody a reasonable premium if people wait until they’re sick to buy coverage. That business model just won’t work,” Hayes  said.

When asked in February what was the most important issue, 21 percent of voters named healthcare in a Kaiser Family Foundation Poll. Iraq, at 29 percent, and the economy, at 43 percent, were the top two issues. Sixty-nine percent of those worried about the economy named healthcare costs as a reason.