Earlier today, I wrote about the Health Affairs' critique of John McCain's health care plan. There's also a skeptical examination of Obama's proposal, and it makes a number of fair points. The main argument is cost: The Obama plan does not include much in the way of serious cost control. The authors take on the campaign's treasured data point. "According to the campaign, the average family would save up to $2,500 a year as a result of new federal subsidies and proposals intended to slow the growth of health spending...The savings estimates and the resulting impact on federal outlays from the Obama plan are controversial. Savings proposals include familiar ideas, many of which are embraced by both candidates: greater use of information technology (IT), improved disease management and care coordination, clinical effectiveness research, and better payment methods. Although many policymakers and experts agree that such policies would improve health system performance, there is little evidence that they can be implemented quickly or effectively and little proof that implementing the policies would yield net reductions in health spending." Agreed. I've never been able to make the $2,500 add up, and it's not a sum I take seriously. Health IT is hard to implement, there's contrasting evidence on whether disease management reduces costs, and effectiveness data would take years to produce and even longer to use. The authors are similarly skeptical about the National Health Plan's ability to bargain down prices. "Those advantages already exist for the Medicare program, which has not had notable success controlling its spending. Increasing the share of health spending paid for through federal programs does not automatically confer a greater ability to negotiate prices or buy smarter, as Medicare has found in its durable medical equipment spending...Most important, prices are only part of the spending equation. As Medicare has demonstrated repeatedly, increases in the quantity and mix of services can cause spending to increase even when prices remain flat."
