Forgetting Something?

As it stands now, the hot topic for the political season seems to be health care reform. No doubt Iraq and the war on terror will not go away, but it seems everyone is ramping up to present their solution to the uninsured and underinsured.

Problems include the following.

No one ever wants to admit it will require a tax increase.

No one really has a handle on how much it will cost.

And here is a biggie. No one wants to address how their plan will handle medical inflation.

Someone on the left coast is calling their hand on this. Ken Terry at the S. F. Chronicle is spot on in his analysis.

Even with the average spread of risk found among federal workers, FEHBP rates are increasing as fast as those of private plans outside the program.

Similarly, Medicare costs have been growing almost as quickly as private insurance rates for decades, when you compare benefits that are common to public and private plans. So expanding the FEHBP and adding a Medicare-like plan won't do much to control cost growth.

So all you are doing by moving folks from the private sector to the public sector is swapping one "gas guzzler" for another.

Clinton suggests other methods to curb spending. She'd require the coverage of preventive care, encourage chronic disease management, reward doctors for improving the quality of care, and kick-start the national adoption of health information technology with $3 billion in government grants. She cites an estimate that widespread use of electronic health records could eventually save $77 billion per year. But she and her advisers seriously underestimate the cost and time that will be required to get interconnected EHRs into all hospitals and doctors' offices; in fact, the RAND study she mentions assumes it would take 15 years to fully implement a national information network. Similarly, preventive care and disease management are fine ideas, but they cost money and won't save substantial amounts for years to come. And the fragmentation of our health care system will inhibit all of these initiatives. So Clinton's claim that they can save the federal government $35 billion a year right off the bat is speculative, at best.

Speculative. That's a good word.

So is ludicrous.

None of the presidential candidates - Clinton included - wants to face the fact that we can't provide comprehensive, universal health care until we find a way to control costs.

Neither the press nor the public is asking the hard questions.