Controlling Costs and Providing Quality Care

It's deja vu as politicians propose widesweeping health care fixes.


Aug. 19, 2007 — -- How big an issue will health care be in the 2008 presidential election?

Some current polling indicates it is now the No. 1 domestic issue for voters.

Though that billing could change as the campaign season wears on, right now the health care debate is reminiscent of the early '90s, when it became a very prominent issue, culminating in the ill-fated Hillary Clinton proposal.

People are talking about it, even those with some kind of health insurance. So I expect it will heat up as we head into the next election.

While some politicians still like to use the cliché that we Americans have "the best health care system in the world," most politicians are smart enough to know that many Americans are struggling with their health care even if they have insurance.

In general, and with many other issues up for debate in the election, Republican and Democratic candidates take different approaches.

Most Republicans are trying to avoid detailed proposals, and when they do speak about health care, they warn against "government involvement," which would lead to "socialized medicine."

Instead, they champion "free market" and "consumer driven" health care. They talk about a change in tax policy that would give individuals a deduction for buying their own health insurance.

In short, they seem interested in driving Americans into the individual health insurance market with policies that may cost less initially but that come with very high deductibles that they hope might encourage people to spend their own money more carefully on health care.

However, critics point out that the average person has a very hard time making informed health care choices, and that high deductibles might encourage people to avoid needed basic and preventive care.

Democrats are generally much more inclined to speak about the need for the federal government to be involved in providing "universal coverage," meaning health insurance for all citizens.

They argue that the 45-47 million uninsured in our country are mostly working people who either work for employers who don't provide insurance or cannot afford the insurance offered.

Democrats also point out that we are the only industrialized country in the world that does not have universal coverage, and that we pay a medical price for this: People without insurance are more likely to get inferior care and have a higher risk of premature death.

The Institute of Medicine estimates that 18,000 people die prematurely every year in this country because they do not have medical insurance.

Democrats do differ in how to provide universal coverage, but they all seem to agree that it is necessary and that the federal government has to play a role in making that happen.

After studying this issue for many years, my own conclusion is that no country can provide quality care while also trying to control costs without federal involvement. That involvement can vary from one country to another.

Great Britain represents true socialized medicine because the government both finances health care (pays for services from tax money) and controls the delivery of health care (owns and operates the doctors and hospitals).

Canada is half and half; the government finances health care (the government is the "single payer"), but doctors and hospitals are private -- they can practice wherever they want and patients have free choice of where to go.

We have a similar system in this country. It is called Medicare.

Some Democrats propose expanding Medicare because its overhead (administrative costs) are much lower than the private health insurance industry's (which has to pay for everything from paperwork for denying care to profits for stockholders).

Some politicians have talked about expanding the system that federal employees (including members of Congress and the president) use.

This system allows federal employees to choose annually from a list of private health insurance plans available in their area that have been vetted by the government to meet certain quality and cost standards; employees can choose the plan that best meets their financial and medical needs.

This system has the advantage of providing choice but also preserving a role for insurance companies. And since one of every six jobs in this country depends on the health care industry, there is strong motivation for politicians not to change the status quo.

But here is the one statistic that seems to me to argue strongly for significant change: We Americans spend more than twice per person on health care compared with the average cost per person that all other industrialized nations spend, yet we are the only industrialized country that does not have universal coverage.

Isn't something wrong with that picture?

Don't our politicians need to address that startling contrast between us and all other modern countries?

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