Health Care: You Bet Your Life

In offering solutions for medical insurance, politicians of all stripes keep reassuring voters about their right to be treated by "the doctor of your choice" rather than some faceless bureaucrat in a white coat under socialized medicine.

There are problems with this argument. Most Americans are now covered by HMOs, which present them with lists of "in-network" physicians either on their payroll or who have agreed to pre-set fees and, in many cases, face pressure to make life-and-death decisions on what's best for the insurers' bottom line.

In California, this divided loyalty recently came into focus with Blue Cross' attempt to enlist doctors in reporting patients who fail to disclose previously existing conditions.

"We're outraged, "the President of the California Medical Association responded, "that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality."

The Blue Cross backed off, but the sanctity of the doctor-patient relationship is definitely showing symptoms of stress. New York Attorney General Andrew Cuomo is suing UnitedHealth for operating "a defective and manipulated database that most major health insurance companies rely upon to set reimbursement rates for out-of-network medical expenses.”

Translation: If you see "the doctor of your choice," your insurer will stiff you on how much of his or her bill they will pay.

That aside, there is the question of how Americans pick their physicians when they can. From all evidence, most do so more casually and with less information than they gather before buying a car or trying a new restaurant.

There is no Zagat guide to medical services, and consulting the "best doctors" lists of regional magazines only leads to the discovery that most are not taking new patients. Too often, the decision is based on the casual advice of a friend or neighbor.

The US Department of Health & Human Services has a few rudimentary suggestions for getting information, but for the most part, finding the right doctor is no more fact-based than finding the right mate. You have to trust your instincts and hope for the best. No politician can help with that.

The Economy, Stupid--Again

With the imminent passage and signing of the stimulus bill, both parties have signed on to acknowledging that the economy is the major issue of the Presidential campaign. How will the candidates adjust?

Hillary Clinton has the 1992 "It's the economy, stupid" playbook in place as well as a new, improved Bill Clinton to stump on the good times of his tenure without creating new animosity and resentment.

Barack Obama will be hard-pressed to translate his idealism into leadership on the issue without looking too dreamy on the one hand or too scary with any practical solutions he proposes. FDR would be the most likely template--"nothing to fear but fear itself" with the argument that government can be the solution, not the problem.

John McCain will likely try to overcome his admitted deficiencies as Economist-in-Chief by shielding himself with a panel of Free Enterprise gurus while he hammers away at Republican verities about the wisdom of the marketplace.

Meanwhile, voters will be worrying about whether the downturn is going to be long, as Paul Krugman suggests today, or with rebate money in their pockets lighten up enough to believe that the economy will soon turn around, as it always does.

Shoved into the background will be ugly fact that Iraq continues to consume not only American lives but enormous amounts of money that could be invested in our infrastructure and put people to work.

But as McCain goes about proclaiming "victory" with "honor," making that case may turn out to be a hard sell.