Candidate health plans: can they walk, chew gum?

My dog and just about every candidate for governor, U.S. senator or congressman anywhere in America have plans for solving our health care problems; the question is whether any of those plans are smart enough to walk and chew gum at the same time. You can tell my dog’s plan is not going to cut it, based as it is on the Tennis Ball Workout and the Dunkin’ Munchkin Diet. But how does a voter know whether a political candidate’s plan is worth spit? Look for the following, at a minimum:

1. Is the plan comprehensive? Any good plan has to include proposals for reining in rapidly increasing health care costs, getting everyone insured, improving the quality of our health care so we waste less money on unnecessary care and avoidable complications, and improving the health of our population so we spend less money on disease. If the plan does not have those basics covered it is missing wheels and is not ready for the road. A candidate with an incomplete plan has probably not thought enough about health care or is trying to avoid commitment to controversial choices.

2. Does the plan have specifics, about how to insure people, how to improve the health of our people and how to rein in the rate of cost increases? If it is not long on specifics it is more of a marketing plan designed for votes than a proposed health plan designed for real improvements.

3. Does the plan cost money? Any plan worth anything probably costs more money up front, for virtually all of its components. Even initiatives that will save money in the long term will probably cost additional money initially. Any plan for universal insurance, for example, will require a subsidy paid by someone. Any proposal to promote a healthier population has to have real money put into it or might as well tell us to eat more veggies, then be spread on the garden to help grow them. If the plan does not cost more money, sniff twice, and if it costs more money, it should also come with proposals for where that money will come from.

4. Does the plan include some pain for everyone, from patients to insurers, from doctors to hospitals, from employers to government? If not, your BS meter should be in the red when you hear of the plan. Solutions to tough problems are like promises to love you in the morning; they all sound good because they are designed to get the whisperer something they want (in this case, your vote). Any real solutions to any of our problems have to tick someone off, and most good solutions will tick everyone off. There are no easy choices on the fundamental challenges confronting us in health care, there is no bloodless surgery and there is no candidate worth supporting who is afraid to stand for something others will not like.

5. Have the candidate’s proposed solutions to any of the problems in health care been tried somewhere else, and if so, where was that and what – specifically – were the results? Most bright ideas in health care policy have been tried already, so the candidate proposing the bright idea should be able to talk about the results of that trial. If the candidate says all the results were good, be suspicious, because virtually every good idea has some downside.

If candidates talk about a “British solution” or a “Canadian solution,” or the “free market solution,” and cannot specifically delineate the downsides to those solutions, you may buy the land they want to sell you but don’t buy their plan to solve our health care problems.

6. Can the candidate actually answer difficult and complex questions about the plan with difficult and complex answers? If the answers sound like simplistic sound bites designed for the media and mass consumption, that’s what they are. Any candidate who has really thought about health systems issues should sound a bit like a health care policy geek when they answer questions about their plan.

Candidates for big offices often have consultants feeding them health care proposals made for the mass market of voter consumption, and many candidates have not thought about health care policy past the media sound-bite answers to questions about their plans. If a candidate appears to have a stroke when asked what we should do about the “doughnut hole” in Medicare Part D, or “pay for performance,” he or she probably does not know health care policy issues from a bagel recipe.

On the flip side, if their answer to every question sounds smoother than honey, you are being fed a sugar pill of a plan from someone trying to play at being thoughtful about health care issues. Gag the pill back up.

There they are; six easy steps on how to biopsy the health plans of political candidates over the next six weeks. If you don’t use this just send me $20 so I will feel better that health care is not the only reason people vote.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.