With so much of the early coverage of campaign health plans focusing on coverage, we listened eagerly at today's AARP Solutions Forum to advisers from the Obama and McCain campaigns discuss "What Should the Next US President Do About Health Care Costs?"

Harvard professor David Cutler represented the Obama camp, and AEI's Tom Miller took on the McCain placard. NPR's Julie Rovner served as moderator, and AARP's Director of Policy and Strategy, John Rother, presented the voice of Everyman (you know, the one who doesn't understand the jargon but can't figure out why his medicine costs so much). The result: a 90-minute discussion on health care economics that was even more substantive than the forum's buffet (chicken, beef AND salmon!!). Here's the main meat of the discussion:

• Drivers of Cost: Both sides agreed that medical technology, third party insurance, and poor management of chronic disease contributed significantly to cost growth in health care (although they didn't list them in the same order). Cutler emphasized that, based on the literature, close to one-third, to a half of health care spending produced little benefit to the patient, both in terms of services patients don't really need and administrative waste. Miller argued our system pays for volume not value and stressed the need to also look upstream at population health—things like education and obesity—whose effects on costs may not been seen until decades later.
• Payment Reform: As Cutler said, we need to know more so we can pay smarter. He argued that health IT was a crucial tool for that transformation. Miller presented a similar front, stressing the need to incentivize more integrated care (which he said wouldn't happen overnight) and made the case for Medicare to be the driver of that change.
• How do you finance it? Although the two camps had some of the same agenda items, the fine print of health reform proved to be a fertile ground for debate. Cutler argued Obama's plan would use money from expiring to tax cuts to make significant investments upfront in areas like IT that would lead real savings in the foreseeable future. Miller argued that if the problem is high costs, spending more money isn't the solution.

It was actually a pretty lively discussion, and although we strongly support coverage expansion, we know that confronting the costs is also essential. These kind of discussions are the amuse bouche de health reform, and much like the buffet, we're always ready to come back for seconds.