Decision Time

• By David Kopf
• Nov 01, 2008

What will providers ponder when they step into the booth to cast their vote?

By the time you read this column, the presidential election will be just days away. And, if you live in a swing state, I can guarantee that you’ll have been plagued with continual television ads with voiceovers whispering like gossipy neighbors to you about how either candidate is “wrong for America.” I can also guarantee that you’ll be hearing little to nothing about the candidates’ healthcare policies.
Which is a shame, because as members of the HME industry, this is where we want the most detail. Healthcare policies will directly impact the short- and long-term stability of this industry. From a broader perspective, this is where we as Americans want detail, because — as both candidates agree — the American healthcare system needs fixing. With 46 million Americans uninsured and an infant mortality rate that ranks lower than Cuba (we tied with Poland and Slovakia for 29th place, according to the Centers for Disease Control), we clearly could use some leadership when it comes to healthcare.
But whose leadership? It’s tough to say. We all know that politicians promise a lot when they’re running for election, but rarely deliver on those promises. (Remember “No new taxes?”) However, this is one election where the electorate — businesses and consumers alike — really need the candidates to get down to brass tacks. From the industry perspective, we still don’t know where we stand. Is Obama best for HME? Is McCain? I defy anyone to answer that with any measure of certainty.

Keep Your Umbrella Handy
Reading this month’s cover story, “2009 Funding Forecast” (starting on page 52), what we do know is that McCain wants a market-based approach as the fix and Obama wants a more governmental-focal approach. McCain aims to offer tax credits to help individuals and families pay for health insurance, remove tax breaks employers enjoy for providing health insurance, and treat the benefit as a taxable wage. Obama seeks universal health insurance through a federal health system that includes both government and private payor insurance.
In each case, we are talking about massive reform, and the impact of either approach on the HME space is tough to gauge. Judging from our cover story, what we do know is that the industry faces a gloomy funding forecast for the coming year, and it will take some doing to ensure providers can weather that storm, let alone any economic or healthcare storms.

Once Again, ‘It’s the Economy’
In any case, whatever healthcare policy one can glean from the candidates’ websites won’t amount to a hill of beans if our next president is addressing the issues of failing investment banks, crumbling capital markets, and a low- or no-growth economy.
To be certain, the economic crisis has shifted each campaign’s rhetoric, but what about their agendas? We have heard a good deal about McCain’s and Obama’s plans for putting America on the path of economic recovery, but we don’t know how that will impact their healthcare policies.
A question that has been asked throughout all three debates was, “how will the current economic crisis affect what you want to accomplish in office?” It was never answered in any real detail. Maybe that’s because neither candidate wants to admit that he will be able to pull off the kind of reform needed given how deep we already are in the hole.
And that is frustrating, because tabling healthcare to address the economy misses a huge issue: If more people lose their jobs due to the failing economy, how will they get healthcare given the current employer-benefit arrangement? That’s a question that every member of the healthcare industry needs to be thinking about when they cast their vote this month.

This article originally appeared in the November 2008 issue of HME Business.