Either president will create financial challenges for healthcare industry

Whether you're on board for Obama or marching for McCain, you can expect to see some significant changes to the U.S. healthcare system, regardless of who's elected. While neither is proposing revolutionary changes, both have put forth ideas that could hit healthcare providers in the bankroll.

McCain's plan, for example, would do much to increase the use of high-deductible plans. Putting aside the issue of whether they actually reduce health costs by encouraging smart shopping, it seems likely that they will impose a financial hit on providers. We're already seeing this happen today, as providers struggle to collect on large bills incurred by patients with such plans. Any federal initiative that encourages such plans is likely to make the self-pay collection problem worse.

Obama, on the other hand--who seems to have something Massachusetts-ish in mind--might extend coverage to a larger number of patients, but the coverage they would have is unlikely to be very robust, if the Bay State's experience is any indication. That leaves providers in the position of having to cope on small reimbursements for high volumes of patients, a trick that has already started to wear out on the Medicaid and Medicare populations.

In either case, you can expect to see shortages of key specialists who will take the low-paying state- or consumer-chosen insurance, which increases the costs of finding and keeping the ones you've got.

Meanwhile--and in McCain's plan, if I understand it right--you'll also find lots of people who simply can't qualify for coverage at all, due to pre-existing conditions, leaving providers pretty much where they were before financially.

The bottom line, I guess, is that I'm frustrated by what I've heard from both candidates, as it seems to me that their schemes impose big operational and financial costs without really solving the larger problems. If I were you, I'd brace myself for some new financial headaches, regardless of who you vote for next month. - Anne