Now that the conventions are behind us and the real fun is about to begin, let's consider what the presidential candidates say and what they understand about the role and value of information and health IT.
Here's what Sen. John McCain's (R-Ariz.) Web site has to say:
"Information Technology: Greater Use Of Information Technology To Reduce Costs. We should promote the rapid deployment of 21st century information systems and technology that allows doctors to practice across state lines."
And here's what Sen. Barack Obama's (D-Ill.) Web site says:
"Lowering Costs Through Investment in Electronic Health Information Technology Systems. Most medical records are still stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors. Processing paper claims also costs twice as much as processing electronic claims. Obama will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records. He will also phase in requirements for full implementation of health IT and commit the necessary federal resources to make it happen. Obama will ensure that these systems are developed in coordination with providers and frontline workers, including those in rural and underserved areas. Obama will ensure that patients' privacy is protected. A study by the Rand Corporation found that if most hospitals and doctors offices adopted electronic health records, up to $77 billion of savings would be realized each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary testing, more appropriate drug utilization, and other efficiencies."
So, what are we to make of this? The tone of the messages is telling. McCain, a Republican, makes no commitment. As he puts it, "We should promote..." No commitment there. By comparison, Democrat Obama's statement is replete with the word "will." "Will" invest $10 billion a year ... "Will" phase in requirements ... "Will" ensure patient privacy ... and so on.
McCain's position on health IT is linked in some way to allowing physicians to practice across state lines. It is unclear why or how health IT is important to allowing physicians to practice across state lines. It's not even clear why allowing physicians to practice across state lines is important. The issue of what states a physician can practice in is a function of state licensure.
Certainly, McCain would not permit overriding the right of states to regulate the practice of medicine within their borders. Perhaps a McCainiac can explain.
By comparison, Obama's position explicitly discusses the value of health IT in terms of cost savings, reduced hospital stays, avoidance of unnecessary testing and other efficiencies. And he notes the opportunities for care coordination, quality measurement and reduction of medical errors that health IT provides.
Comparing Overall Health Plans
The specific health IT positions of the candidates are informative. Let's look at the next level: How do their overall health plans relate to a health IT strategy?
In a section labeled "Chronic Disease: Providing Quality, Cheaper Care for Chronic Disease," McCain notes: "By emphasizing prevention, early intervention, healthy habits, new treatment models, new public health infrastructure and the use of information technology, we can reduce health care costs."
And when discussing the importance of transparency, he recognizes the value of making information on treatment options and physician performance available to consumers.
Again, by comparison, we see a more fulsome and committed use of health IT in Obama's health plan. For instance, in his discussion of his overall health strategy, Obama's plan notes that he will improve efficiency and lower costs by "adopting state-of-the-art health information technology systems," among other things. The Obama plan notes the critical role of providing information to consumers in assessing provider quality and cost, and it addresses the role of "crucial information in comparing the effectiveness of drugs, devices and procedures ... for individual patients."
As I discussed in my July 1 iHealthBeat perspective, health IT standing alone has no value. Like any tool, the value of health IT is in its use. From my way of thinking, it is the overall health care strategy and commitment that best reveals the candidates' understanding of the role and value of health IT.
'On Your Own' vs. 'In This Together'
The health care positions of the candidates are very distinct and can be summarized as follows: For McCain, you're on your own. For Obama, we're all in this together.
At its core, the McCain health plan relies on tax incentives to encourage individuals to buy coverage for themselves and their families. Health savings accounts would be offered, "leaving families in charge of what they pay for."
This is simply an extension of the Bush administration's strategy to shift health care to a defined contribution scheme where the shared-risk, social compact that has been the societal glue of our health care system is replaced by a rugged individualist, self-reliant approach to health care. McCain's strategy in containing cost increases relies exclusively on market forces. Each of us will be left to fend for ourselves in a health care market that is dysfunctional at best and non-existent at worst.
The Obama plan addresses the failures of our current system by extending coverage through a coordinated use of new and existing insurers, tax credits for small business, subsidies for the near-poor and individual mandates. There would be a coordinated effort at controlling the underlying drivers of rapid health care cost escalation, perhaps most importantly through new efforts to coordinate and integrate care, and by implementing a sophisticated comparative effectiveness program.
It is a program that reflects what I believe is the fundamental wisdom articulated by the Congressional Budget Office and addressed in my last iHealthBeat column: The country can reduce the rate of growth of federal health care spending without reducing the quality of care. The strategies to achieve that objective can only be executed through the application of Health IT.
It is this approach that tells me that under an Obama presidency, the digitization of the health care system will take place rapidly. And under a McCain presidency we'll continue to drift and dither. The main difference is Obama's commitment to a "we are all in this together" coordinated, comprehensive approach to the challenges of access, quality and cost, the success of which requires a deployed, integrated health IT system.
This was not intended to be and certainly was not a comprehensive comparison of the Obama and McCain plans. Others have done that. Henry Aaron's recent article in Health Affairs is a great example.
But in reviewing the candidates' health positions, it is clear to me, based on their direct comments regarding health IT and on how they approach the problems of health care generally, that when it comes to the role and value of health IT, Barack Obama gets it and John McCain doesn't.