Securing the Future of American Health Care (original) (raw)

The Presidential candidates' health care reform platforms: Different principles but few details

Clinical Therapeutics, 2008

In this upcoming election with its stark ideological contrasts, the candidates' health care platforms may be among the clearest choices facing voters on November 4th. Nearly 1 in 4 Americans have difficulty affording health care and health insurance, 1 so it is not surprising that health care reform spotlights the differences between platforms. At the time they were formulated, the proposals of Senators John McCain and Barack Obama were based on then-current assumptions about the public's existing and expected economic circumstances. Recent economic events are bound to challenge these assumptions, given that most people's economic capacity will be reduced for the foreseeable future, perhaps substantially so. Senators Obama and McCain express similar concerns and goals with respect to health care reform, but they take fundamentally different approaches. 2,3 Emphasizing personal responsibility and reliance on the private market, Senator McCain would replace the current tax-exempt status of employer-provided health insurance with tax credits to individuals, who would then purchase their own insurance. Anticipating the barrier to private-market insurance for those with preexisting conditions, Senator McCain asserts that he would "work with states to create guaranteed-access plans…with reasonable premium limits." 4 Senator Obama, relying on a blend of public and private health insurance plans, would require that all children have coverage and that employers (excluding small ones) either offer health insurance of a certain standard or pay into a health insurance fund. 5 This fund would support a National Health Insurance Exchange that would provide small groups and uninsured persons with guaranteed access to new public plans or approved private plans. These are high-level policy principles and, as such, contain few details about implementation or acknowledgment of the need for legislative inputs or constraints. Senator Obama's plan rests on 3 tenets: access to medical care; development of a coordinated state and local public health system; and elimination of waste-specifically "layers of bureaucracy that serve no purpose, duplicative tests and procedures…and doctors providing unnecessary care for fear of being sued." 5 While the Senator notes various problems with the current system and preferred features of their resolution, his plan's most specific commitment is to support health information technology with 10billionperyearfor5years.SenatorMcCain′splaninvolves4centralideas:affordability;accessandchoice;portabilityandsecurity;andquality.4Eachplanwouldhavesubstantialbutdifferentdistributionalimpactsonhealthinsurance,theaffordabilityofpharmaceuticals,thenumberoftheuninsured,andthecoverageofuninsuredchildren.AsofOctober8,2008,theLewinGroupestimatedthe10−yearnetcostoftheObamaandMcCainproposalsat10 billion per year for 5 years. Senator McCain's plan involves 4 central ideas: affordability; access and choice; portability and security; and quality. 4 Each plan would have substantial but different distributional impacts on health insurance, the affordability of pharmaceuticals, the number of the uninsured, and the coverage of uninsured children. As of October 8, 2008, the Lewin Group estimated the 10-year net cost of the Obama and McCain proposals at 10billionperyearfor5years.SenatorMcCain′splaninvolves4centralideas:affordability;accessandchoice;portabilityandsecurity;andquality.4Eachplanwouldhavesubstantialbutdifferentdistributionalimpactsonhealthinsurance,theaffordabilityofpharmaceuticals,thenumberoftheuninsured,andthecoverageofuninsuredchildren.AsofOctober8,2008,theLewinGroupestimatedthe10−yearnetcostoftheObamaandMcCainproposalsat1.17 and $2.05 trillion, respectively, assuming full implementation of each plan as described. 6 The uninsured (and, by extension, those who are underinsured with respect to medications) currently pay higher prices for retail pharmaceuticals than do those with insurance. 7 Both candidates directly address the rapidly increasing cost to individuals of prescription drugs, and, if the relevant features of their proposals were enacted, both would likely improve the retail price paid by consumers. Senator McCain's approach would "bring greater competition to our drug markets through safe re-importation of drugs and faster introduction of generic drugs." 8 His proposal emphasizes transparency of price, cost, and measures of quality, as well as publication of drug prices. 9 Senator Obama's proposal focuses on allowing Medicare to negotiate directly with pharmaceutical companies for better prices on drugs covered under Medicare Part D, lowering drug costs "by allowing the importation of safe medicines from other developed countries, increasing the use of generic drugs in public programs," and encouraging faster introduction of generic drugs to the US market. 10 Implementing regulations to accomplish the salient aspects of either plan would require confronting and overcoming sizeable barriers. For example, the potential for a drug's manufacturer or the manufacturer's Volume 30 Number 10 Clinical Therapeutics Each candidate must expand on the details of his health care reform proposal so that on November 4th, voters can make an informed choice based on the changed economic landscape. Otherwise, opting for the health care reform proposal of one candidate or the other will mean voting for an ideological approach rather than an actual plan.

Emerging health care reform issues in the US presidential debate

Health Economics, Policy and Law, 2008

The 2008 presidential election in the United States has again elevated the issue of health care reform to center stage. Reform proposals are proliferating in the states as well as nationally. Virtually all candidates-both Republican and Democratic-running for President have outlined their plans for reforming health care. The renewed interest in health care reform reflects the fact that several key measures of the performance of the US health care system continue to deteriorate. Since 2000, the (nominal) cost of private health insurance has doubled. 1 Over the same period, the number of Americans without health insurance has increased from 38.7 million to 47 million in 2006. 2 Objective measures of the quality of health care provided to chronically ill patients are also of concern; such patients only receive approximately 56% of the clinically recommended preventive health care (McGlynn et al., 2003). Of course, these problems plaguing the American health care system are not new. However, what is new is the flurry of activity at the state level. Absent federal leadership of the issue over the past seven years, two states-Vermont and Massachusetts-have recently passed comprehensive health care reform plans. Massachusetts passed an individual mandate that requires all residents of the state to have health insurance. Health plans offered through the state's insurance ''connector'' offer comprehensive benefits. Individuals can purchase a low cost sharing or a higher cost sharing version of these plans (premiums differ by about $35 per month for the two plans). 3 Certain exceptions to the law were made for individuals and families earning more than three times the US poverty level. These individuals may apply for a waiver from the requirement and remain

Health Is on the Ballot in the Presidential Election

JAMA health forum, 2024

The 2024 presidential election will have major implications for health policy, 1 with the 2 major party candidates having markedly different records and divergent campaign messages. 2 We examine the health policy choices at the heart of the 2024 election.

The Politics of Health Care Reforms in U.S. Presidential Elections

International Journal of Health Services, 2008

This article analyzes why people in the United States have major problems in accessing medical care that are due to financial constraints. The author suggests that the cause of these problems is the way in which medical care and elections are funded in the United States, with private sources being the largest component in the funding of both activities. The article includes a comparison of funding of the electoral process in the United States with similar electoral processes in the countries of the European Union, and postulates that privatization of the funding of U.S. elections (primary and general) is responsible for privatization of the funding of medical care—the root of people's problem in paying for their medical care. Privatization of election funding gives undue power to the economic, financial, and professional groups that dominate medicine in the United States.

Health reform and the obama administration: reflections in mid-2010

Healthcare policy = Politiques de santé, 2010

The reforms that finally emerged from the Obama administration's initiative were the result of a year of nasty, demagogic and misleading claims in the US public forum, coupled with the complexities of crafting legislation that stood a chance of passing both the House of Representatives and the Senate. The resulting "hybrid" approach to healthcare reform produced a conservative strategy that ignores the experience of other wealthy democracies. More significantly, its long period of implementation, given a possible change of administration in 2012, increases uncertainty regarding whether and how reforms will be rolled out by 2014 and after.