Obama's man on campus talks healthcare

Short White Coat is a blog written by second-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

David Cutler, Harvard healthcare economist and senior health policy advisor to Barack Obama, provided some fodder for thought as we head to the polling booths on Super Duper Tuesday.

He began with the broad strokes: Democrats pretty much agree on healthcare and tend to shoot themselves over minor differences, he told a packed audience of medical school students, faculty, and affiliates on Thursday. Republicans pay less attention to healthcare as a campaign issue.

And then the arguments for his candidate: The two greatest barriers to healthcare are affordability and accessibility. The vast majority of Americans would have health insurance if they knew where to find it and could put up the cash, he argued, so plans that mandate insurance coverage miss the point. (Believing it's the only way to achieve universal coverage, Hillary Clinton would require people to get insurance; Obama wouldn't. Both their plans, however, include subsidies to make coverage more affordable.)

Cutler said both plans have the ingredients to improve healthcare quality and cut costs -- including electronic record systems and rewarding doctors based on how well they perform. The problem in healthcare is not that we don't have ideas, it's that we haven't been able to implement them, Cutler paraphrased from Obama’s words. (Cutler worked on the Clinton health plan in the '90s, so he's no stranger to political stagnation.)

He argued that Obama would be able to reach across the aisle to get things done. It’s a campaign promise we’ve heard many times, but in the context of healthcare reform -- a notoriously difficult political beast -- it’s certainly tempting to believe it.

Cutler opened with a joke about a healthcare reformer going to heaven and asking God if the U.S. would ever achieve universal health coverage. Not in my lifetime, God replies. Whoever takes the Democratic nomination, and the national vote in November, I'm hoping we'll achieve it in mine.