Published “online first” today in the New England Journal of Medicine are two articles, authored by the Democratic and Republican presidential nominees, President Barack Obama and former Massachusetts Governor Mitt Romney, describing their health care platforms and their visions for the future of American health care. The editors of NEJM had asked the nominees for these statements which are brief and concise, summing up the two positions in less than 1,300 words each.
President Obama’s statement, titled “Securing the Future of American Health Care,” recaps the highlights of the Affordable Care Act, passed in his first term, and lays out plans for future improvements. For example, he writes:
“We need a permanent fix to Medicare’s flawed payment formula that threatens physicians’ reimbursement, rather than the temporary measures that Congress continues to send to my desk. I support medical malpractice reform to prevent needless lawsuits without placing arbitrary caps that do nothing to lower the cost of care. I also know we must continue to support life-sciences research and ensure that our regulatory system helps bring new treatments and tools to pharmacies, doctors’ offices, and hospitals across the country.”
He continues to warn that his opponent will repeal “Obamacare” (yes, he accepts and even embraces that moniker) on Day One and undo all the progress that has been made, that Medicare will be turned into “a voucher program, with insurance companies set to make millions while seniors and people with disabilities are forced to pay thousands more every year.”
Obama also writes that his opponents have “proposed a budget that could force drastic cuts to investment in medical research, eliminating 1600 National Institutes of Health grants and slowing our progress on scientific and medical breakthroughs.”
Romney’s piece, titled “Replacing Obamacare with Real Health Care Reform,” warns that “the current path is unsustainable — that for all its frustrations, the system is becoming more expensive and will eventually bankrupt our government,” leaving millions without health coverage of any kind. His solution differs significantly from Obama’s; he will:
“…repeal Obamacare and replace it — not with another massive federal bill that purports to solve all our problems from Washington, but with common-sense, patient-centered reforms suited to the challenges we face. In the health care system that I envision, costs will be brought under control not because a board of bureaucrats decrees it but because everyone — providers, insurers, and patients — has incentives to do it. Families will have the option of keeping their employer-sponsored coverage, but they will also be empowered to enjoy the greater choice, portability, and security of purchasing their own insurance plans. As a result, they will be price-sensitive, quality-conscious, and able to seek out the features they want. Insurers will have to compete for their business. And providers will find themselves operating in a context where cost and price finally matter. Competition among providers and choice among consumers has always been the formula for better quality at lower cost, and it can succeed in health care as well.”
Precisely how this will be accomplished obviously cannot be detailed in a short declaration, but the plan basically turns health care into a marketplace of purchasing pools that will be regulated in certain aspects. For example, Romney states, “Regulation must prevent insurers from discriminating against people with preexisting conditions who maintain continuous coverage,” a comment that has been criticized previously because it is unclear how it will apply to those who currently have no insurance at all. Romney also writes that Medicaid be turned into block grants, to be administered by the states, as they see fit, in order to tailor that aid for their specific populations.
The NEJM has opened comments on these articles — or you can comment below. I’d be interested in hearing specifically how readers think these opposing plans might impact the treatment of heart disease and interventional cardiology.
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