Health care is a mess, candidates agree

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - Barack Obama and John McCain agree that the U.S. health care system is a mess. They agree Americans spend too much and get too little for it, and they agree that 47 million Americans without health insurance need coverage.

The prominent health economists enlisted by each presidential candidate laid out clear differences between the campaigns that reflect the relative importance each candidate places on health care reform, in exclusive interviews with Reuters reporters and editors.

Obama, the Democratic candidate, hopes to get government, employers and industry to lead the way. McCain, the Republican candidate, is counting on patients themselves to do it.

McCain adviser Gail Wilensky noted that opinion polls indicate that health care reform is a more important issue among Democratic voters than Republican voters.

On Monday, McCain referred to "some of the minor items like health care plans." Wilensky winces when she reads the statement.

"I wouldn't have chosen that particular phrasing," said Wilensky, a senior fellow at Project HOPE, an international health education foundation, and former administrator of the Health Care Financing Administration, directing the Medicare and Medicaid programs under the first President George Bush.

Obama has said health care reform leads his agenda, second only to Iraq, said David Cutler, a Harvard economist who has been working for health-system change for 15 years and now is advising Obama.

FALLING APART

"It is really bad and getting worse. It is dysfunctional and falling apart," Cutler said.

Studies show that Americans spend double what people in other industrialized countries do on health care, but often have more trouble seeing doctors, are the victims of more errors and go without treatment more often.

The nonprofit Commonwealth Fund found last year that Americans spent $6,697 per capita on health care in 2005, or 16 percent of gross domestic product, compared to $3,326 in Canada, or 9.8 percent of GDP, for example.

"You basically need three things," Cutler said. "One, is you need to cover everybody. Second, you need to improve the value of what you're getting for what you spend. And third, you need to have a public health system that actually works."

One key approach would be rewarding good behavior, in part by compensating doctors who spend time with patients to counsel them on healthier lifestyles and who help patients stay on medications such as diabetes and blood pressure drugs, said Cutler.

Wilensky believes patients can figure this out.

"Most people don't know how much their employers spend on their behalf for health insurance," Wilensky said.