Cost Estimates for Health Care Proposals of Major Presidential Candidates ‘Almost Meaningless,’ New York Times Reports

Democratic presidential nominee Sen. Barack Obama (Ill.) and Republican presidential nominee Sen. John McCain (Ariz.) both have announced cost estimates for their health care proposals during their campaigns, but the "figures they cite are invariably the roughest of estimates, often derived by health economists with ideological leanings or financial conflicts," and have become "almost meaningless" over time, the New York Times reports.

"Even the economists behind the forecasts say it makes them uncomfortable to hear candidates assert their numbers as indisputable fact," as the "transformational nature of both candidates' health care plans means that they can only guess at the future behavior of consumers, employers and insurers," according to the Times. The "campaigns acknowledge that the numbers are 'all over the map,' in the words of Jay Khosla, a McCain adviser," but "that does not keep them from selectively highlighting the most favorable ones," the Times reports.

Roger Feldman, a health economist at the University of Minnesota who conducted a study of the McCain and Obama health care proposals funded by the McCain campaign, said, "Every candidate should say that these numbers were produced by my experts and they're my best estimates but they're not exact," adding, "But the campaign trail is not the time for 'on the one hand, on the other hand.' It's a system where you paint things in black and white." In addition, Feldman said that cost estimates from economists often vary because they rely on a number of assumptions.

Uwe Reinhardt, a health economist at Princeton University, said, "It's garbage in, garbage out," adding, "Every econometric study is an effort in persuasion. I have to persuade the other guy that my assumptions are responsible. Depending on what I feed into the model, I get totally different answers" (Sack, New York Times, 10/22).

McCain Promotes Health Care Proposal
McCain on Tuesday during campaign events in Pennsylvania promoted his economic and health care proposals and criticized the Obama health care plan, the Pittsburgh Post-Gazette reports. Obama "will force them into a new huge government-run health care program," McCain said, adding, "I will bring down the skyrocketing cost of health care with competition and choice (that will) lower your premiums and make it more available to more Americans."

In response, Pennsylvania Gov. Ed Rendell (D) said that McCain plans to finance his proposal through reductions in Medicare and Medicaid benefits. He said, "It will result in higher premiums and copays and more expensive drugs" (O'Toole/Mauriello, Pittsburgh Post-Gazette, 10/21).

In related news, the Washington Post on Wednesday published an analysis of an advertisement released recently by the Obama campaign that says McCain would reduce Medicare benefits by $800 billion to finance his health care proposal (Washington Post, 10/22).

Effect of Health Care Proposals on Children
The McCain health care proposal could leave millions of U.S. children without health insurance, and the Obama plan would guarantee that all children have coverage, according to reports released on Tuesday by First Focus, United Press International reports (United Press International, 10/22).

The report on the Obama proposal said that the plan would increase access to care for children. In addition, the report said that Medicaid and SCHIP would operate more effectively under the Obama proposal. According to the report, by "extending coverage to more than eight million currently uninsured children, overall children's health can be expected to improve under the Obama plan."

The report on the McCain proposal said that the plan "places children in danger of losing coverage in the (employer-sponsored) group market, reduces their insurance protections, and will reduce public options" (Graham, "Triage," Chicago Tribune, 10/22). Under the McCain proposal, many children with pre-existing medical conditions whose families must purchase health insurance on the private market would lose coverage because of a lack of affordability, the report said. McCain also likely would reduce spending on public programs that provide health insurance for children, according to the report (United Press International, 10/22). In addition, a McCain proposal to allow the purchase of health insurance across state lines could result in a loss of coverage of autism treatment for 18 million children and loss of coverage of lead poisoning treatment for 16 million children, the report said ("Triage," Chicago Tribune, 10/22).

The reports are available online.

Examination of Health Care Proposals
Three newspapers recently examined the Obama and McCain health care proposals. Summaries appear below.

• The Bergen Record on Wednesday examined the Obama and McCain health care proposals and comments from the candidates about the plans of their opponents, as well as the health care challenges that either candidate would face as president (Groves, Bergen Record, 10/22).
  
  
• The Cleveland Plain Dealer on Tuesday examined the important differences in the Obama and McCain health care proposals (Vanac, Cleveland Plain Dealer, 10/21).
  
  
• USA Today on Wednesday examined the effect that the Obama and McCain health care proposals would have on employees at large and small companies, as well as those who purchase health insurance on the private market (Appleby, USA Today, 10/22).

Opinion Pieces
Summaries of several recent opinion pieces related to health care issues in the presidential election appear below.

• Amy Menefee, Detroit Free Press: "When it comes to health care, making the right choices for your family" determines "your family's budget, which doctors you can see, what treatments you receive," and the "choice of health insurance for your family may or may not remain in your hands" based on who wins the presidential election, Menefee, director of communications for the Galen Institute, writes in a Free Press opinion piece. According to Menefee, the McCain health care proposal would "give us more power as individuals to choose what we think is best for our families," and the Obama plan would "leave us without a choice" and have the government "determine health benefits for all of us." She concludes, "It's up to the voters to tell Washington we're still the decision makers. We have to let our leaders know we value our freedom. We can't afford to be anything but choosy" (Menefee, Detroit Free Press, 10/22).
  
  
• Ruth Marcus, Washington Post: Recent criticisms that McCain and Obama have made about the proposals of their opponents on health care and other issues are unfair in many cases, Post columnist Marcus writes. According to Marcus, McCain has criticized an Obama proposal to offer refundable tax credits to "those who pay none," although the McCain health care plan includes a similar provision. Meanwhile, "Obama has committed his share of fouls, scaring seniors about McCain's designs on their Social Security and Medicare and mischaracterizing McCain's health care program," she writes (Marcus, Washington Post, 10/22).
  
  
• Robert Samuelson, Washington Post: Voters younger than age 35 are "being played for chumps" by Obama and McCain, who have "pandered" to AARP on issues related to the increased costs of Medicare and Social Security, which "began as safety nets for the needy" but have "become subsidies for living long, regardless of need," Post columnist Samuelson writes. According to Samuelson, among the "three basic ways of reducing the costs" of the programs -- an increase in the age of eligibility, a decrease in benefits and a requirement that beneficiaries pay a large share of the cost -- Obama has "rejected all three." McCain also has "pandered" to AARP on the programs, although he "might try to curb retirement spending" as president, according to Samuelson. He adds, "There can be no 'rewriting of the social contract' without benefit cuts, because paying today's benefits inevitably involves much higher taxes, massive deficits or draconian cuts in other government programs" (Samuelson, Washington Post, 10/22).