As if healthcare spending weren't already a train wreck in the making, it's projected to nearly double by 2017, the Centers for Medicare and Medicaid Services announced today. That means it'll reach a whopping $4.3 trillion and account for 19.5 percent of our gross domestic product, up from 16.3 percent now.
Meanwhile, in a parallel universe called Campaign Land, the candidates for president propose expanding coverage to some or all of the 47 million who are uninsured. Democrats Hillary Clinton and Barack Obama in particular are talking up huge new programs that they claim would accomplish the laudable goal of making healthcare coverage universal. John McCain's plan is less far reaching, but he, too, proposes improving access to affordable healthcare.
I know that candidates don't like to get bogged down in specifics while they're weaving their spells, but this particular voter is finding it hard to give in to their enchantments while there's this distracting little voice inside saying, "Show me the money."
It's not that the candidates haven't discussed costs. They have. Using the handy side-by-side comparison tool at the Kaiser Family Foundation's election website, I can easily see that Clinton estimates her program will cost $110 billion annually once it's fully phased in, while Obama says his will cost $50 to $65 billion. McCain hasn't yet spelled out what his plan would cost, so it's harder to hold his feet to the fire, at least for now.
The Clinton and Obama campaigns maintain that they've figured out how to pay for their proposals without worsening the deficit. The problem is that given the difficulties we already face—that $4.3 trillion—their mechanisms to finance these programs just aren't very convincing. In addition to discontinuing tax cuts for wealthy Americans and reducing our presence in Iraq, they rely extensively on savings from quality and efficiency improvements within the healthcare system itself. That's like saying you're going to pay for a weight-loss program with the money you'll save on groceries once you're slim. Beefing up prevention and adopting electronic health records do indeed hold out great promise for long-term healthcare savings. But how are we going to pay for them in the here and now?