Op-Eds Address Presidential Candidates’ Health Care Proposals

Several newspapers recently published opinion pieces addressing health care in the presidential election. Summaries of the pieces appear below.

• Jagdish Bhagwati/Sandip Madan, Wall Street Journal: Neither Sen. Hillary Rodham Clinton's (D-N.Y.) nor Sen. Barack Obama's (D-Ill.) health care proposal "addresses the need for more doctors, a problem that [former Massachusetts Gov. Mitt Romney (R)] ran into when he introduced comprehensive medical coverage in Massachusetts in 2006," Bhagwati, a Columbia University professor and senior fellow on the Council on Foreign Relations, and Madan, CEO of Global HealthNet, write in a Journal opinion piece. They add, "No presidential candidate can afford to ignore the potential of international trade in medical services to address" the issues of physician shortages and the costs associated with plans to extend health coverage to all -- or nearly all -- U.S. residents. The authors discuss "the four modes of service transactions distinguished" by the World Trade Organization's 1995 General Agreement on Trade in Services and how the modes can reduce costs. "Comprehensive coverage of the over 45 million uninsured today will require that they can access doctors and related medical personnel," and the "solution lies in allowing imports of medical personnel tied into tending to the newly insured," Bhagwati and Madan write. "It is time to expand" programs that offer extended visas to foreign physicians practicing in underserved areas, but "in order to do this, both Democratic candidates will first need to abandon their party's antipathy for foreign trade," they conclude (Bhagwati/Madan, Wall Street Journal, 5/27).
  
  
• Alex Gerber, Washington Times: "Since the top health care economists in the nation are available to the White House, we should assume our health care woes will be largely resolved upon the retirement" of President Bush, but a "careful review of the health care reforms" proposed by presidential candidates "depicts a gloomier picture," according to a Times opinion piece by Gerber, a University of Southern California clinical professor emeritus of surgery and former White House health care consultant. He writes that Clinton's plan "is a bureaucratic nightmare" that continues "to promote the main cause of health care costs nearly double that of all other countries -- the for-profit, private health insurance industry." Obama has proposed a plan "similar to Mrs. Clinton's in many respects" that costs less and "does not provide for universal health insurance -- the sin qua non of any new health care plan," Gerber states. Sen. John McCain's (R-Ariz.) market-oriented plan to "completely eliminate 'big government'" in favor of individual choice of plans and the private health insurance market is "similar to one proposed by President Bush in his 2007 State of the Union address that failed to even get a committee hearing," Gerber writes. He continues, "The quickest, easiest way to straighten our 'broken health care' system would be to adopt a modified Canadian system," or "Medicare for all age groups." He concludes that "none of the presidential hopefuls have come to grips with our skyrocketing health care costs," and if "there are not drastic changes in the health care scene, America is in for a rude awakening in 2009" (Gerber, Washington Times, 5/27).
  
  
• Alice Rivlin/Michael O'Hanlon, Washington Post: The next president will face "daunting budget problems" -- particularly "[p]romises made to the growing population of retirees as health care spending continues to soar" -- but the three major party candidates "are woefully short on fiscal prudence," according to a Post opinion piece by Rivlin, a senior Brookings Institution fellow and former director of the White House Office of Management and Budget, and O'Hanlon, a senior Brookings fellow and director of the institution's Opportunity '08 initiative. "All the candidates claim that their initiatives would not make future deficits bigger, but many of these claims are shaky at best," they write, adding that "McCain looks likely to do the most fiscal damage, but the Democrats are not far behind." The authors continue, "Worse, no candidate is facing the fiscal time bomb of health care entitlements," adding, "Even if these health spending pressures can be mitigated by reforming the health care system" they will lead to "unsustainable deficits" unless "reform is accompanied by tax increases or drastic cuts in other spending." While none of the candidates "can solve all these problems in campaign speeches and still have a chance to win," they could "promise not to make deficits worse," Rivlin and O'Hanlon write (Rivlin/O'Hanlon, Washington Post, 5/25).
  
  
• Isabel Sawhill, Salt Lake Tribune: The 2008 election "is an opportunity to begin to reshape the nation's fiscal priorities and return to a more responsible path," including a way to sustain "growing entitlement programs" such as Medicare and Medicaid, but the candidates are "avoiding the issue of the growing long-run deficit," Sawhill, a senior fellow at Brookings and former associate director at OMB, writes in a Tribune opinion piece. According to Sawhill, health care spending per capita has "been growing about one-third faster than the economy," and if the trend continues, Medicare, Medicaid and Social Security "will have absorbed all of the federal government's projected revenues" before 2050. However, she adds that the "problem is solvable" if a "deficit reduction plan" to cap discretionary spending developed by Sawhill and others is enacted. The plan would not affect Medicare, Medicaid or Social Security. These entitlements "must also be reformed over the long run," she writes, potentially through increased payroll taxes or "gradually reduced benefits promised to future generations by, for example, raising the retirement age or asking the affluent elderly to accept similar increases in their benefits." Sawhill adds, "In short, it is time for the candidates to articulate how to prevent a catastrophe that could be far worse than the recession we now fear." According to Sawhill, "Voters should expect office-seekers to state unequivocally that deficits matter, to commit to ending deficit spending and fiscally irresponsible tax cuts and to pledge bipartisan cooperation to meet this goal" (Sawhill, Salt Lake Tribune, 5/26).