By Reed Cooley

A panel of economists agreed Tuesday that while the presidential candidates’ health care overhaul proposals have the potential to address some issues, the large-scale effects that each plan will have on cost remain unclear.

“Most us would favor [some of the stipulations of the presidential health care proposals], but if you give us a truth serum, most of us would say that whether it saves dollars per year is not so clear,” Uwe Reinhardt, an economics professor at Princeton University, said at a briefing hosted by the Alliance for Health Reform.

According to Reinhardt, the nation’s high health care costs are more deeply entrenched in U.S. economic policy than the proposals recognize. “U.S. policy is consciously geared to keeping the demand side splintered and weakened,” he said, and this will not be changed “by tinkering at the margins with pay-for-performance.”

Reinhardt cited huge discrepancies in what someone might pay for a given procedure in different regions of the country. He cited anecdotal evidence of the total cost of all services involved in an appendectomy ranging from $800 to $13,000. He said the discrepancy lay not in the cost of the individual services involved in a given procedure but in the quantity of the services such as the number X-rays, doctors’ visits and the like.

We ask for evidence-based medicine all the time, he said, but “has anyone ever asked for evidence-based administration?”

Mark B. McClellan of the Brookings Institution agreed. “Regional variation isn’t based on prices; it’s based on quantity,” he said.

McClellan — who served as administrator for Centers for Medicare and Medicaid Services from 2004 to 2006 and as Food and Drug Administration commissioner from 2002 to 2004 — encouraged reporters to persist with questioning candidates how they propose to pay for their plans. He pointed out that rolling back the Bush tax cuts (PL 107-16, PL 108-27), which have been a linchpin of the plan offered by Sen. Hillary Rodham Clinton , D-N.Y., would not be a significant help as most of the tax cuts are scheduled to expire shortly after the arrival of the new administration.

McClellan added that the proposal of Sen. John McCain , R-Ariz., has been most realistic with regard to what a health care overhaul will cost the government and how to offset that cost. “This is the first time I can remember a Republican candidate not proposing anything new as far as subsidies,” he said.

McClellan and Reinhardt also agreed that McCain’s plan stood out from those of Clinton and Sen. Barack Obama , D-Ill., in its efforts to change the current system.

Reinhardt called McCain “the true radical in this among these three,” referring to the McCain’s proposal to abolish a “sacred” tax exemption on employer-based health insurance packages, replacing it with a tax credit for all Americans covered by private or employer-based insurance. The proposal is designed to encourage consumers to choose less expensive coverage plans.

Reinhardt called for more changes of this scope, citing the “unwritten law that the U.S. government cannot raise more than 18 percent of GDP [gross domestic product] on taxes” and that if the government raised taxes to 23 percent of GDP, many of the country’s health care problems would end.

“You can’t look at God and say ‘God, we can’t afford it.’ He’ll just laugh at you,” Reinhardt said. “What you’re really saying is we don’t want to afford it.”