Election campaigns typically feature pontificating politicians flashing silver bullets to slay painlessly the nation's problems.

Just move some money from here to there, cut some government waste no one apparently ever noticed, and then fund an unattainable promise with an outlandish price tag.

Barack Obama's health care reforms fit this model nicely. He bundles three evergreen feel-good concepts — electronic medical records (EMR), disease prevention and chronic-disease management — and totes up dubious savings to fund his ultimate goal of making health insurance affordable to everyone.

Obama has pledged to lower health care costs to save the typical family $2,500 annually in insurance premiums by the end of his first term.

This is an unbelievably tall order — and an increasingly elusive target. Ironically, Obama's own Web site points out that health insurance premiums have risen six times faster than wages in the last four years. And a survey of insurers indicates that health care costs will go up 10 percent in 2009.

Obama and his health advisers believe that investing in EMR would save $77 billion a year, citing a RAND Corp. study. They say that improved disease prevention and chronic-disease management would save $81 billion, and that repeal of the Bush tax cuts will save the day. The financial blueprint is virtually the same as Hillary Clinton's.

Obama's timeline is four years. Unfortunately, changes in health economics and epidemiology have their own timetables, and they inevitably span several presidential administrations.

The causal pathway — improved care to disease reduction to cost savings — is uncertain, circuitous and resistant to steering by outside forces.

The RAND study did say EMR would save $77 billion — by 2019, when an estimated 90 percent of hospitals and physician's offices would be equipped. The Congressional Budget Office issued a report in May questioning RAND's methodology and calling it "an inappropriate guide" for costs savings.

The House Small Business Committee got an earful this month from physicians who said implementing EMR in their offices cost up to $44,000, plus ongoing maintenance fees — putting them out of reach for most solo practitioners. Witnesses complained of inter-office system incompatibility and inferior product quality.

Widespread prevention programs are great for a population's health, but they cost more than they save. A highly optimistic report issued in July by the Trust for America's Health asserted that an investment of $10 per person annually in community-based programs aimed at at-risk populations to increase physical activity, improve nutrition and prevent tobacco use could save $16 billion annually in five years.

The report assumes that these programs could surgically target at-risk population segments, require no medical care and that people would use newly built sidewalks and parks. And the programs would not begin to pay back until the third year, the report said.

Chronic-disease management would seem to be the most promising area of all for expense management. Treatment of chronic illness suffered by about 133 million Americans accounts for 75 percent of the $2 trillion spent on health care every year. Chronic illness, which causes about 70 percent of U.S. deaths, includes arthritis, asthma, cancer, heart disease, depression and diabetes.

It makes less sense to treat chronic illness in the office of a primary-care physician who is trained to treat many patients with a variety of illnesses in quick succession.

A chronic-disease patient requires a more detailed case-management approach than a family physician can provide, focusing on prevention of exacerbation of the condition, consistent monitoring and accountability for following guidelines.

The Permanent Medical Group in Northern California did just that for six years. The results: substantial quality-of-care improvement — and no cost savings.

Two other factors conspire against chronic-disease management savings.

A study just published in the Annals on Internal Medicine points out that an estimated 1 in 3 working-age adults without insurance has a chronic condition for which they are inadequately treated. If access to health care is broadened in the next administration, count on the chronic-illness bill to grow substantially.

The proportion of overweight and obese Americans is expected to rise from about two-thirds of Americans to about 75 percent in 2015 — one year before the conclusion of a second Obama term. That is a leading contributor to chronic disease.

To be sure, there are many laudable goals in Obama's plan. He wants universal coverage for all children, which is an efficient investment of healthcare dollars. He believes that he can make a significant dent in the 47 million uninsured by expanding Medicaid and the State Children's Health Insurance Program. He also has a federal health plan similar to one offered to federal government employees to enhance affordability.

Investing in EMR, prevention and chronic-disease management will improve the nation's health and may moderate — if not lower — long-term health care costs.

However, the near-term price tag is clearly being underestimated to make the medicine go down a little easier.

Steve Jacob is publisher of the Star-Telegram of Arlington (Texas) and is a master's degree student in health policy and management at the University of North Texas Health Science Center in Fort Worth.