I’ll say this much for the Democratic candidates for President: At least they’re trying to address the health care issue.

And to give you an idea of why the Republicans will probably lose the presidency in 2008, I perused the sites of the top 3 contenders for the nomination to ascertain what their thoughts about the health care crisis might be.

Rudy doesn’t mention it. Not. One. Word.

Neither does McCain.

Only Mitt Romney has a blurb on his issues page about health care:

The health of our nation can be improved by extending health insurance to all Americans, not through a government program or new taxes, but through market reforms.

Governor Romney: “We can’t have as a nation 40 million people—or, in my state, half a million—saying, ‘I don’t have insurance, and if I get sick, I want someone else to pay.”
(USA Today, July 5, 2005)

Governor Romney: “It’s a conservative idea,” says Romney, “insisting that individuals have responsibility for their own health care. I think it appeals to people on both sides of the aisle: insurance for everyone without a tax increase.”
(USA Today, July 5, 2005)

As for the others, Fred Thompson has no official campaign site yet and doesn’t mention his position on any issues.

Duncan Hunter apparently has no position on the health care problem.

Jim Gilmore is for “preserving traditional values” but evidently doesn’t give much thought to health care.

Those Republicans who have given the issue some thought include Senator Brownback:

Our healthcare system will thrive with increased consumer choice, consumer control and real competition. I believe it is important that we have price transparency within our health care system. This offers consumers, who are either enrolled in high deductible health plans or who pay out-of-pocket, the ability to shop around for the best prices and plan for health care expenditures. Also, the existing health insurance market forces consumers to pay for extra benefits in their premiums, such as aromatherapy and acupuncture, which tends to increase the cost of coverage. Instead, consumers should be able to choose the from health care coverage plans that are tailored to fit their families’ needs and values. Accordingly, individuals should be allowed to purchase health insurance across state lines. Finally, I believe that consumers should have control over the use of their personal health records. I have a proposal that would offer consumers a means to create a lifetime electronic medical record, while, at the same time, ensuring that the privacy of their personal health information is secured and protected.

Over time, the socialized medicine model has shown to deprive consumers of access to life-saving treatments and is downright inconsistent with the spirit of the American people to be free from unwanted government intervention. I will continue to work at the forefront to create a consumer-centered, not government-centered, healthcare model that offer both affordable coverage choices and put the consumer in the driver’s seat.

There are some sensible elements to Brownback’s position, most notably in consumers being able to choose specifics of their coverage – choice is always better than having something rammed down your throat by the state. But sadly, from what I can see, Brownback barely scratches the surface of the systemic problems in the health care industry – insurance companies and their resistance to meaningful reform.

Tommy Thompson actually has some good market solutions to the health care crisis and has given the issue a lot of thought:

Governor Thompson believes America must strengthen its health care system if it is to remain the best in the world. He would accomplish this by 1. moving the focus to preventive from curative care; 2. accelerating the adoption of health information technology to save money and lives; 3. placing the uninsured in state-by-state insurable pools, allowing private insurers to bid on their coverage; 4. strengthening the nation’s long-term care system that robs too many Americans of their life savings; and 5. strengthening the Medicare and Medicaid programs to ensure the programs are there in the future for the millions of Americans who depend on them. Details on his proposal can be found here.

And Mike Huckabee should probably have left any mention of health care off of his site. His bullet point talking points are worse than useless.

In summary, most of the Republican candidates either have no announced position yet on healthcare reform or have offered a pastiche of options that include a heavy reliance on so-called “preventive” health care.

Ezra Klein shows why that’s a chimerical idea:

First, the impacts of preventive medicine are often overstated. It’s not that cleaning up the air or putting everyone on a gym regimen would greatly improve health—but people don’t follow gym regimens, and business doesn’t let you clean air. Furthermore, not all interventions are created equal. Better parenting might be beneficial, but it’s unlikely to be more effective—either on economic or biological grounds—than the use of statins, or hypertensive drugs, or daily tablets of aspirin. There are a lot of highly effective medical interventions which are very, very cheap. But our system is very poor at incentivizing their use.

Meanwhile, the reason doctors are constantly prescribing statins along with admonitions to exercise and eat better is because using public policy to change diet and exercise habits is really, really, hard, unless you’re prepared to be very heavy-handed (i.e, outlawing trans fats in restaurants, setting portion limits, etc). Indeed, part of the problem with preventive health measures is that, rather often, they don’t work very well. Like with traditional health care, some things really succeed (stripping lead out of gasoline, giving people antibiotics), and lots of things…don’t. And that’s to sidestep the weird reality that what drives health care politics is concern over money which, in fact, is quite rational: Folks don’t want to go bankrupt, and smart politicians don’t want the government to lose all space for spending on other priorities.

To my Republican friends, let me just say that the quickest way to warm the cockles of the American voter is to address the health care crisis. Not so much coming up with ever more expensive schemes to cover the estimated 40 million Americans who don’t have coverage. People are rightly concerned that so many are uninsured. But the problem is one of under insurance or poor insurance coverage. This is what worries most Americans and addressing this problem – along with supplying coverage to those who need it – would go a long way toward improving the quality of life for ordinary Americans.

The Democrats insist on getting in a bidding war, coming up with ever more expensive schemes to address both the uninsured and under insured while trying not to bust the bank. The latest entry in the health care sweepstakes is Barak Obama:

Democratic presidential candidate Barack Obama (news, bio, voting record) on Tuesday offered a sweeping health care plan that would provide every citizen a means for coverage and calls on government, businesses and consumers to share the costs of the program.

Obama said his plan could save the average consumer $2,500 a year and bring health care to all. Campaign aides estimated the cost of the program at $50 billion to $65 billion a year, financed largely by eliminating tax cuts for the wealthy that are scheduled to expire. President Bush wants to make those cuts permanent.

“The time has come for universal, affordable health care in America,” Obama said in a speech in Iowa City, at the University of Iowa’s medical school.

So $50-65 billion a year, financed by soaking “the rich,” would make coverage more affordable and insure those who currently have none? Good news indeed – if it were possible. The Devil, dear reader, as always, is in the details:

Obama’s plan retains the private insurance system but injects additional money to pay for expanding coverage. It would also create a National Health Insurance Exchange to monitor insurance companies in offering the coverage.

Those who can’t afford coverage would get a subsidy on a sliding scale depending on their income, and virtually all businesses would have to share in the cost of coverage for their workers. The plan is similar to the one covering members of Congress.

Obama’s package would prohibit insurance companies from refusing coverage because of pre-existing conditions…

My plan begins by covering every American. If you already have health insurance, the only thing that will change for you under this plan is that the amount of money you will spend on premiums will be less,” Obama said. “If you are one of 45 million Americans who don’t have health insurance, you will after this plan becomes law.”

Obama also called for a series of steps to overhaul the current health care system. He would spend more money boosting technology in the health industry such as electronic record-keeping, put in place better management for chronic diseases and create a reinsurance pool for catastrophic illnesses to take the burden of their costs off of other premium payers.

His plan also envisions savings from ending the expensive care for the uninsured when they get sick. That care now is often provided at emergency rooms. The plan also would put a heavy focus on preventing disease through lifestyle changes.

Obama conceded that the overall cost of the program would be high.

“To help pay for this, we will ask all but the smallest businesses who don’t make a meaningful contribution to the health coverage of their workers to do so to support this plan,” said Obama. “And we also will repeal the temporary Bush tax cut for the wealthiest taxpayers.”

There are some good ideas in this plan. I don’t know how a “National Health Insurance Exchange” would work but in theory, any expansion of coverage via private companies is a good thing – even if they would be “monitored” closely. And “subsidized” health insurance makes sense to me. We subsidize housing and families. Why not health insurance?

The biggest question I have are the uninsured and their responsibility to the rest of us. Since many of the uninsured appear to be younger, employed Americans who simply don’t want to pay for coverage, how do we include them in the insurance pool? Edwards plan would mandate that everyone have health insurance. Obama is silent on the issue and I would be interested to see how the millions of uninsured Americans who fall into that category would be forced into the system.

Unfortunately, I think the bad outweighs the good in this proposal. McQ at Q & O takes a stab at critiquing what we know of the plan so far:

So instead of really doing something which would actually make insurance more affordable and easier to get – like removing it from being provided by business and letting a real insurance market (a private insurance market) develop, Obama plans on keeping these plans under employers and making all of them share the cost. Additionally, not a word about all the mandates by various state governments on minimum coverage. And all of this will somehow make insurance cheaper.

Secondly, why not, if the purpose is simply to ensure that all uninsured have access to insurance, why not fix that problem and leave everyone else alone? Instead he wants to mess with the insurance 300 million vs. the 40 or so million purported not to have insurance. Taking care of the 40 million actually might make insurance for the remaining 260 million cheaper.

Mac has a good point, although the quality of coverage among the 260 million remaining Americans varies wildly. Simply leaving that market alone won’t fix much of anything.

But Mac hits a home run here:

Again, having government “overhaul” anything is fraught with problems, the primary being cost and efficiency. It doesn’t have a good track record with either. And someone is going to pay for this overhaul. Additionally you’re looking at a mandate when you see things like “better management for chronic illnesses” and a cost increase (despite the promise of a cost decrease) when talking about government managing a “reinsurance pool for catastrophic illness”, because again, someone has to pay for that pool.

Rather than the $50-65 billion mentioned in the article it appears that the cost would be considerably higher. But most Americans would be willing to foot the bill if they thought it would actually do some good. Health care in America is a gigantic brute of a system, a trillion dollar monster that affects every man, woman, and child in America. To confidently say that even the federal government is going to “control” it in any but the grossest sense seems to me to be a flight of fancy. The only forces to my mind that would be powerful enough to affect it in any significant way would be market forces – bringing the cost down while competition improves the choices for consumers.

Now clearly, market forces alone won’t work to insure the uninsured or bring better health care options to those whose current plans are inadequate. In this case, government can act as a combination guide, referee, and burr under the saddle. Subsidizing some people will probably be inevitable as will mandating some kind of minimum coverage by large and small business. The very nature of the problems in health care means that government will have some kind of role to play. But the challenge will be to reform the system while keeping the best of the current regime in place.

And that’s a challenge that so far, not many Republicans have risen to address.