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News & Events

The (next) president’s challenge

Healthcare scholars talk politics at Union League Club, where Prof. David Dranove reveals what presidential candidates are not telling public about their healthcare plans

By Aubrey Henretty

12/13/2007 - Despite what republican presidential hopeful Rudolph Giuliani has said, Harvard University School of Public Health Professor Katherine Baicker isn’t convinced he would be able to expand healthcare coverage and cut taxes at the same time.

“You can’t have a policy that says ‘Everyone is insured and we haven’t spent any more money,’” Baicker said Dec. 10 during a midday summit called “Prescription For Change: What the Presidential Candidates Are Saying — and Not Saying — About their Healthcare Plans.”

The event, sponsored by Northwestern University’s Institute for Policy Research, was held at the historic Union League Club of Chicago and moderated by Therese McGuire, the Kellogg School’s ConAgra Foods Research Professor in Strategic Management. Baicker’s presentation, the first of three, was titled, “The Republicans on Healthcare: Comparing the Candidates’ Plans.”

With small differences in strategy, said Baicker, the republican candidates are rhetorically united against “waste, fraud and abuse” in healthcare. “Pie and diners are also very popular among the candidates,” Baicker added with a smile.

Democratic frontrunners are deploying similar rhetoric at this stage of the game, said Columbia University Professor Sherry Glied in “The Democrats on Healthcare: Evaluating the Candidates’ Plans.” Though their three stated goals — for healthcare to be universal, affordable and high quality — are different from those of the republicans, they are similarly difficult to oppose.

“They’re trying to sell you on a big idea,” Glied said, noting that until anyone is actually sworn in as president, the details of a national healthcare plan are impossible to work out. For this reason, Glied advised voters to ignore projections claiming, for example, that the Clinton and Edwards “Medicaid-like” plans would cost twice as much as the Obama plan, which more closely resembles the Federal Employees Health Benefit Plan. “These numbers are completely plucked from the air,” she said. “No one is going to come up with an answer for [the exact cost of a plan] until the Congressional Budget Office forces them to.”

Another issue that voters can expect not to hear about from democratic candidates, said Glied, is how universal coverage would account for the “enormous” discrepancies in the quality of care available in different regions of the nation.

After Glied’s presentation, Kellogg Professor David Dranove took the podium to elaborate on “What the Candidates Aren’t Saying That You Need to Know.” Dranove, the Walter J. McNerney Distinguished Professor of Health Industry Management, said that whatever the strategy, the goals of a well-oiled healthcare system are always to prevent and manage disease and to do so with the least possible waste.

Of course, he added, these goals aren’t news to anyone.

“People have been talking about prevention, disease management and reducing waste since time immemorial,” he said. What they haven’t been talking about, he continued, is how they would pay for these improvements. Instead, candidates have been making elaborate, unreasonable promises to the electorate.

“No candidate would guarantee a $300,000 house to every homeless person to combat homelessness,” he said, but they don’t think twice about promising comprehensive healthcare to the uninsured — a far more expensive idea.

Dranove closed by noting that no candidate has yet taken a stand on what he sees as the defining issue of healthcare’s future: overhauling and expanding the patient-information infrastructure. Plans to improve healthcare in the three basic areas — prevention, disease management and reducing waste — “stand to fall short of their goals because they lack the proper information systems,” he said.

Following the three presentations, the speakers took questions from the audience. Illinois General Assembly 31st District Representative Mary Flowers took issue with Dranove’s $300,000-home metaphor, asserting that while no one actually needs to own a house with a yard to live well, everyone needs to be healthy.

“I can live and be homeless, but I can’t live without quality healthcare,” she said, also pointing out that the skyrocketing costs of healthcare don’t appear to be cutting into the profits of insurance companies.

Baicker countered, “That’s the ugly reality of the world we live in. We live in a world of finite resources.” She added that while some regulations may keep insurance providers honest, the faults in the nation’s healthcare system are too fundamental to fix through private-sector regulation alone. “I feel uncomfortable casting the insurers as the bad guys.”

Dranove agreed, adding, “In their zealousness to cut costs in the 1990s — which is what people wanted them to do — they stepped on a lot of toes.”

Lively debate continued throughout the Q&A session.