John McCain speech on health care reform - Oct 11 2007

[w¡n9Nµ7 §£@¥€r 123]

The biggest problem with the American health care system is that it costs too much, and the way inflationary pressures are actually built into it. Businesses and families pay more and more every year to get what they often consider to be inadequate attention or poor care. And those who want to buy insurance are often unable to because of the high cost. What more compelling evidence of the problem do we need than to note that General Motors now spends more for health care of its employees and retirees than for the material required to manufacture its products - steel. The price of every GM car includes over $1500 for health care costs compared to Toyota whose total cost for healthcare per car is about $200.

...

My reforms are built on the pursuit of three goals: paying only for quality medical care, having insurance choices that are diverse and responsive to individual needs, and restoring our sense of personal responsibility.

...

The first principal of real reform is that Americans should pay only for quality. Right now, too much of the system is built on getting paid just for providing services, regardless of whether those services are necessary or produce quality care and outcomes. American families should only pay for getting the right care: care that is intended to improve their health.

American families know quality when they see it, so their dollars should be in their hands. When families are informed about medical choices, they are more capable of making their own decisions, less likely to choose the most expensive and often unnecessary options, and are more satisfied with their choices. Health Savings Accounts are tax-preferred accounts used to pay insurance premiums and other health costs. They put the family in charge of what they pay for, and should be expanded and encouraged.

...

We cannot let the search for high-quality care be derailed by frivolous lawsuits and excessive damage awards. We must pass medical liability reform, and those reforms should eliminate lawsuits for doctors that follow clinical guidelines and adhere to patient safety protocols.

...

Research shows that coordinated care - providers collaborating to produce the best health outcome - offers better quality and costs less. We should pay a single bill for high-quality heart care, not an endless series of bills for pre-surgical tests and visits, hospitalization and surgery, and follow-up tests, drugs and office visits. Paying for coordinated care means that every single provider is now united on being responsive to the needs of a single person: the patient. Health information technology will flourish because the market will demand it.

...

Families place a high value on quickly getting simple care, and have shown a willingness to pay cash to get it. If walk-in clinics in retail outlets are the most convenient, cost-effective way for families to safely meet simple needs why should government stand in their way? I will not.

If the cheapest way to get high quality care is to use advances in web technology to allow a doctor to practice across state lines, then let them. In disasters like Katrina we saw how stupid and harmful it is to refuse the services of doctors just because they had an out-of-state address. We should have a national market place, and if I'm elected President, we will.

Drugs are an important part of medicine, of course, and are often quite expensive ... If there are ways to bring greater competition to our drug markets by safe re-importation of drugs, by faster introduction of generic drugs, or by any other means we should do so. If I'm elected President, we will.

...

Government programs such as Medicare and Medicaid should lead the way in health care reforms that improve quality and lower costs. Like most of our system, Medicare reimbursement now rewards institutions and clinicians who provide more and more complex services. We need to change the way providers are paid to focus their attention more on chronic disease and managing their treatment. This is the most important care and expense for an aging population.

...

The second principle of effective reform is to have insurance choices so varied and responsive to individual needs that you could fire your insurance company if you wanted to.

...

I believe that everyone should get a tax credit of $2500, $5000 for families, if they have health insurance. It is good tax policy to take away the bias toward giving workers benefits instead of wages. It is good health policy to reward having insurance no matter where your policy comes from.

...

To use their money effectively, Americans need more choices. We should give additional help to those who face particularly expensive care. If it is done right and the additional money is there, insurance companies will compete for these patients - not turn them away. It is a challenge to develop techniques that allocate the right amount to each of these families. I propose that we try a time-honored approach and let the states work on whatever method they find most promising.

...

Family-based policies translate into broad success when they are paired with greater competition among insurers on a level playing field. You should be able to buy your insurance from any willing provider - the state bureaucracies are no better than national ones. Nationwide insurance markets that ensure broad and vigorous competition will wring out excess costs, overhead, and bloated executive compensation. Introducing competition into the health insurance market will reduce costs.

...

The final important principle of reform is to rediscover our sense of personal responsibility. We must personally do everything we can to prevent expensive, chronic diseases.

http://www.johnmccain.com/Informing/News/S...97f5287235d.htm

[Trumplestiltskin 5,791]

He's providing incentives, and those are all well and good - but as I see it doesn't really addresses the problems inherent in the healthcare system that inhibit its accessibility and affordability.

He brings up medical liability reform - which may be needed (though honestly I think medical litigation goes hand in hand with the current system) and I'm not convinced that its the biggest problem going - but without any sort of oversight of the health industry, it seems to me that all he's really doing is protecting the profits of the insurance industry while turning a blind eye to the practices by which they make their money.

He's offering very little in the way of actual tangible "reform" with regards to the insurance industry - specifically the infamous pre-existing conditioning that goes on and which, in my view, represents the biggest barrier to people actually getting and benefitting from healthcare.

There's also this idea of health savings accounts - again this is an incentive, not a reform - but even then the savings accounts are in need of reform as many of them, as they stand, are simply poor value for money.

I'm also not convinced by this idea that increasing competition in the healthcare industry will result in better quality healthcare to consumers. I think that's wonky reasoning at its best.

I've also read (though its not mentioned on that page) that McCain wants to do away with the VHA in favor of giving veterans this same notion of "freedom of choice" that he's pushing on everyone else. Quite what that will do for the standard of healthcare veterans receive, going from an integrated system to the open public market is open to question.

[Mr. Big Dog 10,747]

We shall call him: John McSame.

[SaadBell 0]

One word - Sicko

We need something completely different, not just tweaking the same insurance ####### we have now. It is insane.

[metta 0]

The biggest problem with the American health care system is that it costs too much, and the way inflationary pressures are actually built into it. Businesses and families pay more and more every year to get what they often consider to be inadequate attention or poor care. And those who want to buy insurance are often unable to because of the high cost. What more compelling evidence of the problem do we need than to note that General Motors now spends more for health care of its employees and retirees than for the material required to manufacture its products - steel. The price of every GM car includes over $1500 for health care costs compared to Toyota whose total cost for healthcare per car is about $200.

...

My reforms are built on the pursuit of three goals: paying only for quality medical care, having insurance choices that are diverse and responsive to individual needs, and restoring our sense of personal responsibility.

...

The first principal of real reform is that Americans should pay only for quality. Right now, too much of the system is built on getting paid just for providing services, regardless of whether those services are necessary or produce quality care and outcomes. American families should only pay for getting the right care: care that is intended to improve their health.

American families know quality when they see it, so their dollars should be in their hands. When families are informed about medical choices, they are more capable of making their own decisions, less likely to choose the most expensive and often unnecessary options, and are more satisfied with their choices. Health Savings Accounts are tax-preferred accounts used to pay insurance premiums and other health costs. They put the family in charge of what they pay for, and should be expanded and encouraged.

...

We cannot let the search for high-quality care be derailed by frivolous lawsuits and excessive damage awards. We must pass medical liability reform, and those reforms should eliminate lawsuits for doctors that follow clinical guidelines and adhere to patient safety protocols.

...

Research shows that coordinated care - providers collaborating to produce the best health outcome - offers better quality and costs less. We should pay a single bill for high-quality heart care, not an endless series of bills for pre-surgical tests and visits, hospitalization and surgery, and follow-up tests, drugs and office visits. Paying for coordinated care means that every single provider is now united on being responsive to the needs of a single person: the patient. Health information technology will flourish because the market will demand it.

...

Families place a high value on quickly getting simple care, and have shown a willingness to pay cash to get it. If walk-in clinics in retail outlets are the most convenient, cost-effective way for families to safely meet simple needs why should government stand in their way? I will not.

If the cheapest way to get high quality care is to use advances in web technology to allow a doctor to practice across state lines, then let them. In disasters like Katrina we saw how stupid and harmful it is to refuse the services of doctors just because they had an out-of-state address. We should have a national market place, and if I'm elected President, we will.

Drugs are an important part of medicine, of course, and are often quite expensive ... If there are ways to bring greater competition to our drug markets by safe re-importation of drugs, by faster introduction of generic drugs, or by any other means we should do so. If I'm elected President, we will.

...

Government programs such as Medicare and Medicaid should lead the way in health care reforms that improve quality and lower costs. Like most of our system, Medicare reimbursement now rewards institutions and clinicians who provide more and more complex services. We need to change the way providers are paid to focus their attention more on chronic disease and managing their treatment. This is the most important care and expense for an aging population.

...

The second principle of effective reform is to have insurance choices so varied and responsive to individual needs that you could fire your insurance company if you wanted to.

...

I believe that everyone should get a tax credit of $2500, $5000 for families, if they have health insurance. It is good tax policy to take away the bias toward giving workers benefits instead of wages. It is good health policy to reward having insurance no matter where your policy comes from.

...

To use their money effectively, Americans need more choices. We should give additional help to those who face particularly expensive care. If it is done right and the additional money is there, insurance companies will compete for these patients - not turn them away. It is a challenge to develop techniques that allocate the right amount to each of these families. I propose that we try a time-honored approach and let the states work on whatever method they find most promising.

...

Family-based policies translate into broad success when they are paired with greater competition among insurers on a level playing field. You should be able to buy your insurance from any willing provider - the state bureaucracies are no better than national ones. Nationwide insurance markets that ensure broad and vigorous competition will wring out excess costs, overhead, and bloated executive compensation. Introducing competition into the health insurance market will reduce costs.

...

The final important principle of reform is to rediscover our sense of personal responsibility. We must personally do everything we can to prevent expensive, chronic diseases.

http://www.johnmccain.com/Informing/News/S...97f5287235d.htm

I think the two core issues to helath care crisis are

1. Rising cost

2. Access.

Of the two, I think rising cost of healthcare is the tougher nut to crack.

republican always champion for the insurance wallahs and the dems the trial lawyers.

I think a serious reform plan has to have curbs for both drivers of rising health care cost.

Well, a simplified overview

[kaydee457 13]

He's providing incentives, and those are all well and good - but as I see it doesn't really addresses the problems inherent in the healthcare system that inhibit its accessibility and affordability.

He brings up medical liability reform - which may be needed (though honestly I think medical litigation goes hand in hand with the current system) and I'm not convinced that its the biggest problem going - but without any sort of oversight of the health industry, it seems to me that all he's really doing is protecting the profits of the insurance industry while turning a blind eye to the practices by which they make their money.

He's offering very little in the way of actual tangible "reform" with regards to the insurance industry - specifically the infamous pre-existing conditioning that goes on and which, in my view, represents the biggest barrier to people actually getting and benefitting from healthcare.

There's also this idea of health savings accounts - again this is an incentive, not a reform - but even then the savings accounts are in need of reform as many of them, as they stand, are simply poor value for money.

I'm also not convinced by this idea that increasing competition in the healthcare industry will result in better quality healthcare to consumers. I think that's wonky reasoning at its best.

I've also read (though its not mentioned on that page) that McCain wants to do away with the VHA in favor of giving veterans this same notion of "freedom of choice" that he's pushing on everyone else. Quite what that will do for the standard of healthcare veterans receive, going from an integrated system to the open public market is open to question.

So, you didn't criticize the tax incentives…..

Let me ask you this. Short of throwing out the system in place now and placing it all under government supervision, is there anything in his platform that you see as redeemable?

[SaadBell 0]

He's offering very little in the way of actual tangible "reform" with regards to the insurance industry - specifically the infamous pre-existing conditioning that goes on and which, in my view, represents the biggest barrier to people actually getting and benefitting from healthcare.

Wow A critical thinker, good to see someone who cares

[Trumplestiltskin 5,791]

I don't have a problem with his incentives - except that I suspect they won't amount to significant $ savings for the general public.

He isn't doing anything radical to really address the core problems. The accessibility and affordability of health insurance goes hand in hand with the way the insurance industry operates - and as usual the solution is to this is to put the onus on the individual and not on closer scrutuny and regulation of the insurance industry.

In short, he'd rather polish the ####### than flush it.

[kaydee457 13]

I don't have a problem with his incentives - except that I suspect they won't amount to significant $ savings for the general public.

He isn't doing anything radical to really address the core problems. The accessibility and affordability of health insurance goes hand in hand with the way the insurance industry operates - and as usual the solution is to this is to put the onus on the individual and not on closer scrutuny and regulation of the insurance industry.

In short, he'd rather polish the ####### than flush it.

You're speaking in generalities. Exactly who/whom do you believe is denied access and I'll somewhat agree on the affordability issue.

People with pre-existing conditions do have problems with obtaining insurance but frankly, wouldn't it be bad business to allow access? It's contrary to what insurance is all about. Access at what cost?

I don't know what the statistics are, but wouldn't this be a narrow niche of the population?

Concerning the cost, I have to be cynical in this regard because frankly, I've never seen government regulation bring costs down in any industry by regulation. In fact by adding government there's an indirect cost that's not quantifiable in the end product.

Edited April 16, 2008 by kaydee457

[Peikko 1,575]

People with pre-existing conditions do have problems with obtaining insurance but frankly, wouldn't it be bad business to allow access? It's contrary to what insurance is all about. Access at what cost?

I don't know what the statistics are, but wouldn't this be a narrow niche of the population?

Yes, it would be bad for business, which is one of the reasons it should not be a business in my opinion. What you seem to be saying, but correct me if I am wrong, is that it's ok for this % of the population to be denied health care because doing so would reduce profitablity.

[kaydee457 13]

People with pre-existing conditions do have problems with obtaining insurance but frankly, wouldn't it be bad business to allow access? It's contrary to what insurance is all about. Access at what cost?

I don't know what the statistics are, but wouldn't this be a narrow niche of the population?

Yes, it would be bad for business, which is one of the reasons it should not be a business in my opinion. What you seem to be saying, but correct me if I am wrong, is that it's ok for this % of the population to be denied health care because doing so would reduce profitablity.

Not at all, I just don't buy the notion that you have to throw the baby out with the bath water, and in effect start all over.

If there are people that are unable to acquire health benefits through insurers, then how about an "assigned risk pool" whereby insurers would be required to take on these people on a random basis, mandated by law.

That's pretty much the system in use in states that have mandatory automobile insurance, and a population of high risk drivers. Insurers would rather not take these drivers on but in order to business in the state, as a condition, they must insure these risky drivers.

I'm sure there are other ideas but to completely overhaul the system is a bit much. The point is to minimize government involvement.

Edited April 16, 2008 by kaydee457

[w¡n9Nµ7 §£@¥€r 123]

That's pretty much the system in use in states that have mandatory insurance, and a population of high risk drivers.

yup - nj and the auto insurance industry is a good example.

[Trumplestiltskin 5,791]

I don't have a problem with his incentives - except that I suspect they won't amount to significant $ savings for the general public.

He isn't doing anything radical to really address the core problems. The accessibility and affordability of health insurance goes hand in hand with the way the insurance industry operates - and as usual the solution is to this is to put the onus on the individual and not on closer scrutuny and regulation of the insurance industry.

In short, he'd rather polish the ####### than flush it.

You're speaking in generalities. Exactly who/whom do you believe is denied access and I'll somewhat agree on the affordability issue.

People with pre-existing conditions do have problems with obtaining insurance but frankly, wouldn't it be bad business to allow access? It's contrary to what insurance is all about. Access at what cost?

I don't know what the statistics are, but wouldn't this be a narrow niche of the population?

Concerning the cost, I have to be cynical in this regard because frankly, I've never seen government regulation bring costs down in any industry by regulation. In fact by adding government there's an indirect cost that's not quantifiable in the end product.

Well obviously the people with the chronic conditions are the ones most in need of healthcare. That may not be "good business", but the idea that a person's health should come distant second to a company's bottom line is simply offensive - in a first world country.

Both my sister-in-law, father-in-law and a friend of mine back in CA have had problems with variously: lack of insurance, pre-existing conditions and being priced out of the system entirely. My FIL was almost killed because insurance workers interfered in the management of his care and decided that since his angina hadn't flared up in a while that he didn't need to see his cardiologist. My friend had perfect health up until he had a sudden stroke a couple of years ago. Luckily no permanent damage resulted for him - but he did find himself in the position of facing gigantic premiums that he can't afford. All because the cholesterol lowering drugs they put him on are a "high risk" flag to the insurer.

System works great until you get sick.

If you don't scrutinise what the industry is doing and how this is affecting the public's access to healthcare you're not doing anything to really address the problem. As I say - all that's left is papering over the cracks.

[Trumplestiltskin 5,791]

I should point out that this opposition to all any regulation extends to McCain's economic policies as well. In a speech he made a couple of weeks ago - in relation to the current credit crunch / sub-prime mortgage crisis - McCain indicated that he wouldn't impose any sort of regulatory measures on the financial services industry: essentially ignoring the issue of irresponsible lending practices.

A rather strange attitude to take - IMO.

[kaydee457 13]

I should point out that this opposition to all any regulation extends to McCain's economic policies as well. In a speech he made a couple of weeks ago - in relation to the current credit crunch / sub-prime mortgage crisis - McCain indicated that he wouldn't impose any sort of regulatory measures on the financial services industry: essentially ignoring the issue of irresponsible lending practices.

A rather strange attitude to take - IMO.

Well, that's what separates the liberals from the conservatives as conservatives don't believe it's incumbent on themselves to regulate, into minutia, every industry based on short term and anomalous problems. The government could never have foreseen this problem, and instituting regulation in hindsight does nothing but add cost to home ownership in the future in compliance measures that won’t ever be needed again.

I can guarantee you that these kinds of sub-prime loans will never be marketed again as the markets themselves, particularly those banks and brokerages that manage Hedge Funds, won't invest in bundled mortgages without guarantees of quality.

The problem corrects itself and government interference isn't necessary.

Edited April 16, 2008 by kaydee457