Medical News: Campaign '08

Campaign '08: Presidential Frontrunners Play it Close to the Vest on Healthcare

excerpts:

"Still, the lack of information about how the plans will directly affect physicians is frustrating. Repeated requests to the campaigns are rebuffed, for example, on details about how they might reform the Medicare pay formula, where physicians face annual cuts and Congress rides to the rescue to restore them at the last minute. So far, no campaign has responded with any specifics.

Neither have they gotten specific about how they would try to fulfill promises of improved efficiency and reduction of fraud and waste in the healthcare system.

One Clinton healthcare adviser is Jonathan Gruber, Ph.D., a professor of economics at the Massachusetts Institute of Technology. A member of the Institute of Medicine and former Deputy Assistant Secretary for Economic Policy at the Treasury Department, he's written extensively about healthcare policy.

Austan Goolsbee, Ph.D., a professor of economics at the University of Chicago Graduate School of Business, has been a top economics adviser to Obama since he ran for the Senate. A member of the Panel of Economic Advisers to the Congressional Budget Office, he helped formulate Obama's healthcare plan.

For McCain, his top domestic adviser is Dan Crippen, Ph.D., who headed the Congressional Budget Office for four years, retiring in 2003. Dr. Crippen was a domestic policy adviser to Ronald Reagan."

"Clinton and Obama each would create public plans that would compete with private ones. They'd expand government programs such as Medicaid and the State Children's Health Program. Tax credits or subsidies would be provided to those who can't afford insurance. Both candidates describe health plans and pharmaceutical companies as the "powerful special interests" they'll battle to achieve reform.

They'd insist that Medicare negotiate directly with pharmaceutical companies for lower prices. Both say they'd pay for their plans by rolling back President Bush's tax cuts on the wealthy and through greater efficiency by promoting prevention, electronic health records, and other reforms. Neither favors caps on malpractice awards for pain and suffering promoted by the American Medical Association."

"Clinton wants all individuals to be required to purchase health insurance with tax subsidies for those who can't afford it. She attacks Obama's plan, which mandates coverage only for children, for leaving 15 million Americans without coverage and questions his dedication to the cause of universal coverage, calling it a core Democratic value.

Obama argues that forcing people to buy insurance before it's affordable is unrealistic. He wants to lower health costs first and would consider an individual mandate only if necessary. He's challenged her to say how she would penalize those who didn't buy coverage."

"Healthcare hasn't been nearly as contentious an issue on the Republican side, where the focus is more on controlling costs than achieving universal coverage.

John McCain is adamantly opposed to individual or employer mandates. "We [Republicans] do not believe in coercion and the use of state power to mandate care, coverage, or costs," he said.

McCain favors changing the tax code to enable people to buy insurance on the individual market. He'd provide all Americans with a refundable tax credit, $2,500 per individual, $5,000 per family. The credit would apply whether they received insurance through employment or bought it on their own. That proposal is similar to those of other Republican candidates and President Bush's proposal to expand tax deductions for health insurance.

The Arizona senator would allow insurance to be sold across state lines. He'd allow small businesses and the self-employed to purchase insurance through any organization or association. Such entities, often known as association health plans, would have to meet rigorous standards and certification. Coverage would be portable and would bridge the time between retirement and Medicare eligibility.

McCain believes the liability climate and defensive medicine lead to increased costs. He'd limit frivolous lawsuits and excessive damages and provide safe harbors for practice within clinical guidelines and safety protocols.

McCain would control costs by having the government demand and pay for quality outcomes rather than volume of services or medical mistakes. He'd promote the use of alternative providers such as nurse practitioners and treatment settings such as walk-in clinics in retail outlets. He'd expand current pay-for-performance programs. Consumers must be provided with more information on treatment options and he'd require "provider transparency" regarding medical outcomes.

The health industry would have to meet national standards to measure treatments and outcomes. For example, rather than paying a physician for each medical service performed, the doctor might be paid for a month or a year's services, with a variety of treatments bundled together. Then the doctor would be judged on performance in treating the disease, such as type 2 diabetes.

Medicare should increase payments for better coordination of care, and cut reimbursement for unnecessary hospitalizations and preventable errors.

"The first principle of real reform is that Americans should pay only for quality,'' McCain said. He'd establish a database to show which doctors or programs are more successful."

Full Article