What Election 2008 means for you

What Election 2008 means for you
What Election 2008 means for you
With health-care reform occupying a top spot on the political agenda, primary-care clinicians have a lot invested in this year's Presidential election.

Whether it's Senator Barack Obama (D-Ill.)  or Senator John McCain (R-Ariz.)  who triumphs at the polls next month, primary-care clinicians should brace themselves for a larger pool of potential patients and an increase in the delivery of prevention and wellness services. Despite the many political differences between the Democrats and the Republicans, the 2008 platforms of the two parties reflect similar intentions to greatly expand health-care coverage and have people make greater use of clinical programs that will help them maintain their health.

Aiming for more coverage

Both parties emphasize the importance of affordable health insurance. Case in point: “If one thing came through in the platform hearings, it was that Democrats are united around a commitment that every American man, woman, and child be guaranteed affordable, comprehensive health care,” states the report of the Democratic platform committee.

Yet the avenues the party would take in pursuit of this goal are admittedly unclear. “While there are different approaches within the Democratic party about how best to achieve the commitment of covering every American, with everyone in and no one left out, we stand united to achieve this fundamental objective through the legislative process.”

A mandate for universal health-insurance coverage for anyone other than kids can probably be ruled out right off the bat. In their platform report, the Democrats say they will ensure that every child has health insurance. “We reject those who have steadfastly opposed insurance coverage expansion for millions of our nation's children while they have protected overpayment to insurers and allowed underpayments to our nation's doctors.”

Adults, too, could acquire or improve health-insurance coverage but not through a legislative guarantee. Instead they would purchase new or better policies made more affordable by various proposed measures. Tax credits and “other means” would help subsidize these costs, say the Democrats.

The Democrats do believe that individuals and families should be able to keep their current coverage or choose from “a wide array” of other plans, both private and public. In fact, in its platform report, the party makes clear its opposition to “those who advocate policies that would thrust millions of Americans out of their current private employer-based coverage without providing them access to an affordable, comprehensive alternative….”

This is no doubt a reaction to the Republican agenda, which operates from the angle of empowering individuals to take charge of their own health care and keep larger entities out of it. As noted in the Republican platform report, “Republicans believe the key to real reform is to give control of the health-care system to patients and their health-care providers, not bureaucrats in government or business.”

Republicans support the private practice of medicine and “oppose socialized medicine in the form of a government-run universal health-care system.” Democrats, in contrast, promote a message of shared responsibility: They call for a joint effort by employers, employees, insurers, providers, and government to achieve affordable, high-quality health care for all. For example, Senator Obama's party wants all employers to offer health insurance to all employees. Senator McCain's party agrees that all employees (as well as all other individuals) should be able to obtain an affordable health-care plan—but not necessarily from an employer.

The Republicans charge that the current system puts a heavier tax burden on people who do not receive health-care benefits from their employers, gives more generous health tax benefits to upper-income employees, and fails to provide every American with the ability to purchase an affordable health plan. To correct these disparities, the Republicans would give everyone the same tax benefit, through a tax credit or some other means, as those who are insured through work. This would enable people to unchain themselves from employer-sponsored plans and seek other options that may better suit them if they so desire.

Clearly, the need to offer affordable health insurance can place a heavy burden on entrepreneurial companies. Not wanting to discourage the formation or continued operation of these job-generating entities, the Democratic party would give all start-up companies a tax credit for health insurance. In addition, small businesses would get a new tax credit if they offer “quality” health insurance to their employees. The definition of the term quality might be found in the “Meaningful Benefits” section of the Democrats' platform report.  According to that section,  families should have health insurance coverage “similar to what Members of Congress enjoy.” Furthermore, families should not have to deal with “skyrocketing premiums, unaffordable deductibles or benefit limits that leave them at financial risk when they become sick.” (The report notes that medical bills are responsible for half of all personal bankruptcies in this country.)

The Republicans are also well-attuned to the needs of small business, “proudly call[ing] ourselves the party of small business because small businesses are where national prosperity begins.” Their platform assures voters that the plan to return control of health care to patients and providers will benefit small-business employers and employees alike. 

Support for portable health insurance transcends party lines, with both campaigns getting behind the idea that people shouldn't have to lose or change their coverage when they lose or change their job. Each group believes portable coverage would give people more job mobility, greater financial independence, and a better sense of security. Rather than people worrying about losing their health insurance, “insurance companies should have to worry about losing the patients' business,” say the Republicans.

Both parties would seek to end health-insurance discrimination: “Health-insurance plans should accept all applicants and be prohibited from charging different prices based on pre-existing conditions,” notes the Democratic platform report; the Republican version concurs that people with pre-existing conditions need to be protected.

Primary care takes center stage

The Republicans give special attention to primary care in their platform report, expressing their belief in the importance of primary-care “specialties” and even including notice of their intention to protect “rights of conscience.” This is the party's assertion that no health-care professional should ever be required to perform, provide for, or refer for a health-care service against his or her conscience for any reason. (For some areas that might be affected by this policy, see “Hot-button health issues.”)

The Republican party also encourages primary-care clinicians to practice in rural and underserved areas of the country. The Democrats want to implement programs that diversify the health-care workforce to help ensure culturally effective care and end health-care disparities among minority and  low-income groups.

Prevention and wellness are featured players in the health-care reform plans of both parties. The two platforms promote the importance of healthy lifestyles, disease prevention, and disease management. Opportunities for nurse practitioners and physician assistants could well get a boost from such initiatives: Democrats are especially interested in implementing health-promotion programs in workplaces and in schools.  In his own health-care proposal issued this past spring, Senator McCain lauded retail clinics (often run by NPs and PAs) as an innovative delivery route for health-care services.

The platform reports remind voters that chronic diseases soak up 70% of overall health-care spending in the United States, or about three of every four health-care dollars. Both parties want all Americans to have access to preventive services that will stave off diabetes, hypertension, heart disease, and other costly chronic ailments. Special mentions are also given to tobacco- and substance-abuse prevention, mental health and substance use disorders, and the fight against obesity, especially in children. In fact, speakers from The Obesity Society appeared at both the Democratic and Republican national conventions this past summer to advocate better, more focused training for practitioners in dealing with obesity.

Neither party has a quibble with increasing access to quality and affordable long-term care services for seniors and people with disabilities, even those who don't qualify for Medicaid or Medicare. Not surprisingly, combat veteran McCain is keeping veterans in mind (many of whom require long-term care): He and his party want former military personnel to be able to use their VA benefits at non-VA providers who can offer them convenient, timely, and high-quality care. (This means that primary-care clinicians could be seeing more of the traditional VA patients.) The Republican platform also calls for beefing up VA medical services at VA facilities, for female as well as male veterans.

Medicare payment changes

Upon debuting his own health-care plan last spring, Senator McCain asserted that Medicare should not pay for preventable medical errors or mismanagement. The Republican platform backs him up with a plan to “revive” Medicare by rewarding quality care—not to mention promoting competition; rooting out waste, fraud, and abuse; and allowing patients and providers to control treatment options. The Republicans propose compensating practitioners who coordinate care, particularly for patients with multiple chronic conditions. Patients, for their part, should have more choice regarding their doctors and should be free to add their own funds to government benefits if they so choose.

The Democrats' plans for the Medicare program include:

• Repealing the ban on negotiating prescription-drug prices
• Prohibiting drug companies from paying generic producers to refrain from entering drug markets
• Ending special preferences for insurance companies and private plans, such as Medicare Advantage, forcing them to compete on a level playing field.

Health care for seniors would receive an additional boost from the Democrats, who want to improve the availability and quality of long-term care by paying caregivers a fair wage, training more nurses and health-care workers in that field, and reforming the financing of long-term care to ease the burden on these patients and their families.

The Democrats and Republicans both pledge to build on existing successful state models of care in enacting nationwide health-care reform. “We envision a new Medicaid partnership with the states, improving public health through flexibility and innovation,” note the Republicans. For example, they like the idea that several states have allowed patients to use their Medicaid dollars to buy regular health insurance.

The Republicans support a state-regulated national market for health insurance, believing it would heighten competition and increase choices for consumers while wringing out excess costs and overhead. They also “strongly urge” managed-care organizations to base decisions about coverage on the practice patterns and medical treatment guidelines in the state in which the patient lives.

In addition, the Republicans believe families, small employers, churches, community groups, and fraternal societies should be able to purchase policies across state lines.

Reducing malpractice headaches

The Republicans pledge to pass tort reform that would help eliminate frivolous medical lawsuits responsible for driving up insurance rates for practitioners and, ultimately, the cost of health care for everybody.

Malpractice issues were not covered in the Democratic platform report. However, in the health-care proposal Senator Obama issued himself last spring, he addressed the topic by noting his intention to strengthen antitrust laws to prevent insurers from overcharging physicians for their malpractice insurance. In addition, he stated that he would promote new models for addressing errors that would improve patient safety, strengthen the doctor-patient relationship, and reduce the need for malpractice suits.

Technology is a “virtual” given

Both parties agree on the use of health information technology (HIT) to improve health care and lower costs.

“The simple step of modernizing record keeping will mean faster, more accurate treatment, fewer medical errors, and lower costs,” point out the Republicans. The Democrats see it the same way: They anticipate a $2,500 annual savings for the typical family—plus a reduction in the number of lawsuits spawned by medical errors—with the implementation of state-of-the-art HIT systems, privacy-protected electronic medical records, and reimbursement incentives, as well as the establishment of an independent organization that reviews drugs, devices, and procedures “to ensure that people get the right care at the right time.”

The Democratic party is serious enough about the greater use of technology that it is pledging to appoint a national Chief Technology Officer. The Republicans would reform and make permanent the Research and Development Tax Credit to encourage greater collaboration between technology and small business. n

Ms.Yard is a senior editor for The Clinical Advisor.

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