In conjunction with the September 30, 2008 broadcast of Critical Condition, POV has partnered with NewsHour to learn more about health care in America, and what presidential candidates John McCain and Barack Obama are proposing for medical coverage.
Susan Dentzer, the editor of Health Affairs journal and the host of NewsHour‘s Rx for Change,
answered some of our questions about these complicated issues.
Watch Susan talk to health care experts and campaign officials as they debate the state of the American medical system and which presidential candidate may do more to improve care on Rx for Change, tonight on NewsHour, and also available for viewing on
POV: Susan, you’ve been covering health care for over 20 years at the NewsHour, U.S. News & World Report, Newsweek and currently as editor of Health Affairs journal. Do you feel like the sides in the health care debate have evolved at all over that time, or are we still essentially debating the same policies put forth during the early ’80s? Are there any new ideas?
Susan Dentzer: We are still debating one central question: Should all Americans have reliable access to health care, and if so, what is and what should be the role of the government in assuring that access? And as has been the case for decades, Americans differ greatly on many sides of that question.
Some of the basic ideas in health reform have indeed been circulating for decades. For example, the health reform plans that Senators Clinton, Obama and Edwards put forward during the current presidential election campaign are strikingly similar to one advanced by an earlier President: Richard M. Nixon! Some ideas have been tweaked to better reflect current realities, and certainly Senator McCain is the first presidential candidate to my knowledge to advance the notion of making employer contributions to health insurance taxable to workers at the federal level and then substituting for that a system of fixed tax credits.
That said, the basic questions in health reform are much the same as always: Do we want everybody to have access to care, and by that, do we mean universal health coverage or something close to that? How do we split up the responsibilities and costs of doing that? And beyond that, do we have a health care system designed to provide optimum care at lowest possible cost, and if not, how do we get there?
POV: In a debate held earlier this month at the California Commonwealth Club, surrogates from the McCain and Obama campaigns debated the best way to cover America’s uninsured. One point that came up in the debate was that in a recent Gallup poll, a majority of Americans (57%) said that they are satisfied with their health care plans and 83% rate the quality of their health care as excellent or good. These percentages have actually remained pretty stable over the past 6 years. If that’s the case, why is it such a hotly debated election year issue? How do you explain that disconnect?
Dentzer: Very frequently, answers that people give in polls depend on how the questions are asked. If you have a health insurance plan you are, by definition, better off than about 1 in 6 Americans, so of course it is likely that you are satisfied. However, even in that Gallup poll, apparently 2 out of 5 Americans who did have a health care plan weren’t satisfied with it, so that is hardly a totally positive verdict on the status quo.
Also, most Americans who do have access to health care do feel good about the care they receive. Many people like their own doctors and value their own hospitals. However, if you asked the question differently — do you think the U.S. health care system has major problems? — many more people would say yes, and other polls reflect that.
What the Gallup poll essentially tells you is that many people who do have access to health care are happy with the access they have and happy with their health care providers. This, we know. It’s why many health reform plans don’t try to tinker much with existing arrangements that make much of the population happy. These answers in the Gallup poll don’t speak to those who are disenfranchised by the current system, or who worry that the system disenfranchises others, and there is plenty of evidence from other polls to show that there is ample dissatisfaction on these scores.
POV: Last week, Health Affairs published critiques of the McCain and Obama health care plans and a paper that proposed a compromise plan combining features from the two plans. What has been the reaction from the campaigns to these analyses? Should Americans vote in November expecting the two candidates to follow their plans to the letter, or do you think there is room for some compromise?
Dentzer: Not surprisingly, the campaigns quarrel with the analyses of their candidate’s plan and endorse the criticisms of the other candidate’s plan. We have had quite a bit of back and forth about this on our Health Affairs blog.
The reality, of course, is that presidential candidates’ health reform plans are always at best a schematic rendition of what the candidates would really do if elected president. They frequently lack critical details that would need to be fleshed out if these plans were ever to move forward as legislative proposals. They are often structured to capture the enthusiasm of a party’s base of voters or to sound certain themes that are appealing to those voters. And they rarely take into account the actual political realities that would face a President once elected.
That is the case with the current candidates’ plans, and most people who have followed these issues for years find it difficult to believe that these plans, even in broad outline, could be enacted as proposed. If you layer on our current economic difficulties and the uncertainty about the impact on the federal budget, it’s a near certainty that these plans don’t really have legs, and would have to be modified substantially to have any chance of passage.
POV: Do you think Americans can really expect to see an overhaul of the health care system some time in the next four years?
Dentzer: I don’t know, but I hope so. The problems facing us are serious, and the challenges of correcting them only grow over time.
POV: Finally, if American voters want to understand this very complicated issue, where do you think is the best place to start? Where do you think the best coverage of this issue is being offered to help American voters feel confident that they are casting an informed vote in November?
Dentzer: I’d recommend consulting some of the excellent resources now available on the Web. There’s our journal, Health Affairs. There’s the wonderful material published by the Kaiser Family Foundation at both www.kff.org and www.health08.org. There are super sites also run by the Alliance for Health Reform, the Commonwealth Fund and the Robert Wood Johnson Foundation. The Center on Budget and Policy Priorities has excellent analyses from a liberal perspective, and the Heritage Foundation and American Enterprise Institute has very important contributions from a more right-leaning perspective. I believe nobody has a corner on the truth, and one can gain immeasurably by reading as widely as possible. Fortunately, there’s plenty of analysis and information out there for the person who wants to become a serious student of the tough issues we face.