The Plank

Mccain: U.s. Health Care Is Just Dandy

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John McCain's new health care advertisements states--not once but twice--that the problem with American health care isn't the quality. The problem, he says, its its high cost--and how that high cost frequently makes it inaccessible. You can see the ad here, via Marc Ambinder.

He'll get no argument from me on the second part: Cost and access are indeed huge problems. If only he dealt with them adequately! (For more on this, see Ezra.)

But quality is a huge problem, too. In fact, the problems of cost and quality are closely related.

I could explain why, but I thought TNR readers might benefit from hearing from a real expert on this. So I asked Shannon Brownlee, author of superb book Overtreated, what she thinks of the ad. Her response:

John McCain telling the American people that there isn’t a problem with the quality of our health care has got to be causing at least a little cognitive dissonance right now. Anybody who has spent any time in the hospital as a patient or as the family member of a patient knows better. Our “high-quality” system kills between 40,000 and 90,000 people through avoidable medical error, and harms another 400,000 with side effects from drugs. Then there’s the little problem of unneeded care, which consumes 30 percent of our health care dollars and puts patients at unnecessary risk. What McCain should have said is health care is a leading cause of death in this country, and we need to improve the quality as well as make it more affordable and available.

The really weird part here is that, as I wrote a while ago, the most redeeming part of McCain's health care plan were his promises to tinker with Medicare payment formulas so that they provided incentives for higher quality care--an idea that Shannon, among others, has advocated in the past. But I guess the McCain policy shop, such that it is, doesn't have much pull with the communications department.

--Jonathan Cohn

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