Prognosis-in-Brief

GOP in the Oval Office: barely break out the first aid kit
Dem in the Oval Office: a patchwork of mild reforms highly likely, with a small possibility of moderate-to-major reform

Democratic and GOP candidates aim to solve the twin problems of high
healthcare costs (16% of GDP and rising) and high numbers of un-insured
(__% of Americans) coming from almost opposite tacks. Dems want more
Uncle Sam (in terms of paying for and regulating health insurance);
Republicans want less.

But while would-be executives have ambitious – diverging – plans for
shaking up healthcare, a Republican president is sure to be stonewalled
by an unsympathetic Congress and a Democrat might find that America,
for all its healthcare groaning, is still not ready for large-scale
reform.

The full chart

GOP in Da House: With a Republican in
office, the next two years will look a lot like the last two years;
with the prez playing defense, vetoing offensive plays from a
Democratic congress hot to expand federal heath care programs.

The one ray of progress would be in shifting the nation’s health
records from filing cabinets to electronic databases, a move designed
to avoid double treatment and shed light on best medical practices –
which both parties are keen on. If McCain gets the number one spot,
Congress could also finally okay buying drugs back from Canada.

But GOP hopes to deregulate the health insurance industry (letting
plans cross state borders and choose their own standards of care) and
give families more direct purchasing power (with tax credits to buy
independent and high-deductible plans as well as health savings
accounts) won’t get very far. Republican’s fetish for capping medical
malpractice awards won’t get much more indulgement.

Dem in Da House: Depending on how sweeping of a healthcare
mandate a Democratic president rides into DC with, we could see
mild-to-medium-hot health reform.

As a no brainer, Congress will be able to push through the SCHIP bill
that President Bush has swatted down twice, adding 2-4 million low
income kids onto state health plans. Dems will also be able to give a
one-two to big pharma by telling Medicare to bargain for cheaper drugs
and letting Grandpa buy his lipitor from overseas.

But those are small fry reforms. The big question is how far a
Democratic president can bring his/her mega-plans to cover all
Americans while keeping costs down.

While there are shades of difference between the Democratic candidate’s
playbooks, they share key features: each would set up a “menu” or
“exchange” of private and public health care plans that individuals,
families and businesses could buy into; families would get tax credits
and discounts to help them buy in; and (all or many) employers who
don’t cover their workers would have to pony up to pay for the new
system. The $60 - $110 billion yearly price tag would be covered by
cutting off subsidies for families making more than $250G and by a host
of untried cost-saving initiatives.

While the candidates are aiming to avoid the pitfalls of Hillarycare –
by, for one, making “choice” key – and while US business is aching to
toss off the albatross of healthcare, one should never estimate the
power of Capitol Hill inertia and that real bogeyman, the “special
interest.” Getting the American people and the Chamber of Commerce to
swing for change is half the battle. Without Pharma, the medical
profession and HMOs on board, DC will either need a minor revolution or
another ten years before it sees solid reform.

For more on the candidate’s health plans, see Kaiser Family
Foundation’s choice breakdown.