Sunday, February 3, 2008

Super Tuesday: Who to choose for Health Care Change?

In general, my blog is geared toward patients and consumers of health care with a focus on how to interpret the latest health care "hot topic" proclaimed by the media. However, given that Super Tuesday will likely play a major role in determining each party's nominee for President, who in turn will or will not be able to make substantive changes in our failing health care system, I take a rare political diversion by announcing my Super Tuesday picks for actual health care change.
There are obviously many issues to vote on (the war, the economy), but as a health care provider, I am most interested in health care.

A few disclosures:
1. I am a Democrat and will likely support the Democratic nominee for President.
2. I feel that in order for real change, we need some type of mixed public private insurance that would allow for a single payor system to cover most needs for all.
3. I don't believe that any of the current candidates has an actual solution for true health care reform (though some are closer than others). Both of the major candidates on each side essentially keep private, for-profit health insurance intact, which I feel is a big part of the problem. Additionally, none of the candidates are truly addressing critically important issues. Many pay lip service to primary care, but no candidate discusses how many primary care physicians are leaving practice will few new physicians to fill their shoes. Some discuss the benefit of Electronic Medical Records, but no one has a plan to pay for the huge upfront costs.

That said, it's essentially down to Romney and McCain on the Republican side and Obama and Clinton for the Democrats. The Kaiser family foundation does a nice job on their web site to allow you to compare all of the candidates plans.

The Republicans
In general, the Republicans want to keep the private, for-profit insurance companies in tact, and allow tax credits to be used for purchasing health care. Personally, I think this is a mistake. Though competition may drive health care costs down, Americans don't always put their health first. If my neighbor chooses not to purchase home or fire insurance and his house burns down, it's his loss not mine. However, if someone chooses not to get a mammogram, and cancer is caught at a later stage that is more expensive to treat, this adds cost to the whole system. A recent study in the New England Journal showed that for patients in managed medicare plans, higher co-pays were associated with fewer covered patients getting mammograms.

In comparing McCain's and Romney's plan side by side, there are not substantial differences, but McCain seems to have more concrete ideas. Though both support malpractice reform, McCain mentions re-importation of prescription drugs and providing national (not state) insurance, as well as mentioning "invest in prevention and care of chronic illnesses."
Thus, if you are Republican and hope for some change in health care, I would recommend voting for McCain.

The Democrats
Deciding between Clinton and Obama on health care is a little trickier, since, as Obama pointed out in the last debate, that both health plans are “95%" similar, offering goverent sponsored insurance to all, but leaving private insurance in tact. Practicing in D.C. with many federal employees in my practice, I can tell you that government sponsored insurance would be great to have. Patients tend to have more services covered, and I have fewer hassles with prior authorizations.
The major difference between the two candidates is requiring that insurance be covered. Obama insists that if the cost for health care is low enough, people will sign up. Clinton states that there are many Americans currently who could afford insurance, but don't have it. She's right!

The best example is the State Children's Health Insurance Program (SCHIP) which both candidates are in favor of expanding. People might not know that there are many people who qualify for SCHIP (free health care) that simply don't get it. There are a variety of reasons for this, but the point is that even if you offered free health care for anyone making less then the median income of the country, there would still be some individuals that would remain uninsured. As above, using the home and fire insurance example; when people who choose not to have health insurance end up costing the system, it becomes my problem.
Since the only real difference is mandates for health care coverage, if you are a Democrat, I would recommend voting for Clinton.

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