Karen Davis on the Presidential Candidates' Health Reform Plans
<p>The presidential candidates have responded to Americans' deep-seated concern about the shortcomings of the U.S. health system with two very different health reform proposals. In a <a href="/aboutus/aboutus_show.htm?doc_id=705935">new column,</a> Commonwealth Fund president Karen Davis examines a series of articles published on the Web site of the health policy journal <em>Health Affairs</em> that provides important analyses of the health plans of Senators Obama and McCain.<br><br>As Davis and the authors of the <em>Health Affairs</em> articles reveal, the candidates are far apart on the perceived root causes of system failure and on their overall strategy for fixing a broken sector that consumes 16 percent of the gross domestic product, yet leaves 46 million uninsured and another 25 million working-age adults underinsured.<br><br>Davis points out that to support their argument that Senator Obama's plan is too costly, the critique by Joseph Antos and colleagues cites the estimated costs of the Commonwealth Fund <a href="/publications/in-the-literature/2008/may/building-blocks-for-reform--achieving-universal-coverage-with-private-and-public-group-health-insura
">Building Blocks proposal,</a> which has several features in common with Senator Obama's plan; but which may differ on the extent of premium assistance to low-income families.<br><br>The <em>Health Affairs</em> authors' assertion that the Building Blocks plan would increase spending by $162 billion if it were operating in 2008 is misleading, Davis says. The actual net cost to the federal budget in the article is $82 billion in 2008, after allowing for the recapture of funds now subsidizing care of the uninsured, employer contributions to coverage of workers, and assessments on providers that offset their enhanced payments for care of the uninsured and Medicaid beneficiaries.<br><br>An accompanying <a href="/publications/issue-briefs/2008/may/the-building-blocks-of-health-reform--achieving-universal-coverage-and-health-system-savings
">issue brief</a> shows how even this cost could be reduced to $31 billion in 2008 by adopting a series of provider payment and health system reforms that have been supported, in principle, by both Senator McCain and Senator Obama. As a result, the nation could actually save $1.6 trillion over 10 years if health expansions are coupled with efforts to reform how the United States pays for health care, invest in better information systems, and adopt initiatives to improve public health.<br><br>Davis goes on to review how the <em>Health Affairs</em> articles shed light on the issues underlying the health reform debate, namely how health insurance coverage would be changed, how coverage would be made affordable, and how the delivery of health care services would be affected.<br><br>"Our hope is that, post-election, the focus will turn as quickly as possible to building concretely on the areas of agreement and work from there to achieve the health system reform that the country needs so desperately," Davis says. "We cannot afford to continue on our current course, and indeed must change direction to ensure affordable health care for all Americans."</p>