Care Reform and the Presidential Candidates
30, 2012 - The September 26 issue of New England Journal of Medicine contains
these statements by President Obama and Governor Romney on their positions and
visions of health reform. The
statements are directed to physicians,
59% of whom are pessimistic about
the future of the health system and 92%
of whom are unsure about the future or where they will fit in over the next
five years according the Physicians Foundation national survey of 630,000 physicians,which was released on September 24.
of American Health Care
moment I took office, the central challenge we have confronted as a nation has
been to recover and rebuild from the worst economic crisis since the Great Depression.
We’ve taken extraordinary steps to repair the immediate damage and lay the
foundation for an economy built to last. And a critical first step on this
journey has been taking action to restore health care as a basic pillar of
you, America is blessed with the world’s most talented health care
professionals, who do a heroic job serving and saving our citizens. But for
years you have faced a health care system that was increasingly fractured.
Insurance companies had unchecked power to dictate care and cap and cancel your
patients’ in-surance. Tens of millions of Americans were left uninsured and
underinsured. Health carecosts were growing at an unsustainable rate, and our
delivery system rewarded quantity of care over quality of care. You were
spending more of your time on insurance forms and appeal letters — and less
time doing what you trained to do: care for patients. But after a century of
trying, a broad coalition of doctors, nurses, hospitals, businesses, AARP, and
patients helped me sign into law the Affordable Care Act.
and detractors alike refer to the law as Obamacare. I don’t mind, because I do
care. And because of Obamacare we’re moving forward toward a health care system
that broadly provides health security.
majority of Americans who get health insurance through their employer, the law
won’t change that, but it will make their coverage more secure and affordable.
Today, 105 million people have seen a lifetime cap on their coverage lifted, so
your patients no longer face the tragedy of approaching a lifetime limit in the
middle of a round of chemotherapy or an episode in the ICU. Most of your
patients can now get preventive care without paying deductibles and copays,
care that you know saves lives, from early colon- and breast-cancer screenings
to cardiovascular tests and flu shots. Because of new limits on insurance
overhead costs, 13 million Americans got more than $1 billion in rebates — and
by 2019, economists believe, family premiums will be about $2,000 less.
also roots out waste and fraud in Medicare and Medicaid, gets rid of insurance
overpayments, reinvests those savings back into the sys- tem, and adds 8 years
to the solvency of Medicare. Obamacare is closing the Medicare doughnut hole —
saving people an average of $600 last year — and bolstering your efforts to get
your patients to adhere to their medications. More than 3 millionyoung adults
who would otherwise be uninsured have coverage on their parents’ plan until
they are 26 years old, and up to 17 million children with preexisting
conditions are no longer at risk of being denied coverage. Small-business
owners are getting tax credits to provide coverage for their workers and will soon
be able to pool together to leverage better rates, just like big corporations.
surely experience every day, we are also seeing substantial movement in the
emergence of new care models. Everyone understands the limits of our current
system, which rewards increases in the quantity of care, not improvements in
the quality. Still, change has been difficult — and that’s why my
administration has been so encouraged by the response to the reforms in the
health care law. Across the country, provider groups are working with us to
form accountable care organizations, and more and more hospitals are moving
toward bundled payments. We are partnering with hospitals across the country to
prevent health care–associated infections and avoid preventable readmissions
—and meeting our goals together could save $35 billion and 60,000 lives over 3
years. And we are building our health care workforce, recognizing the demands
of an aging population as well as the needs of peo-ple who will become newly
insured. As we move forward, we will remain a partner in working to-gether to
strengthen our system and help you de-liver the best possible care.
there is more to come, since many of the law’s provisions take effect in 2014,
when 30 million currently uninsured people will finally begin to find
affordable coverage. Our insurance market will be strengthened so insurance
compa-nies cannot deny coverage or charge anyone more on the basis of a
preexisting condition, and middle-class families that don’t get insurance at
work can receive tax credits to finally make coverage affordable. As a result,
for the first time in American history, people who lose their jobs, change
jobs, start a business, or retire early will know that they can find insurance
for themselves and their families.
If I am
elected for a second term, I will follow through on all the work we have
started together to implement the Affordable Care Act. I have also been clear
that additional steps are needed. 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. NOT A PRAYER 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. I will keep Medicare and Medicaid strong, working to make the programs
more efficient without undermining the fundamental guarantees.
opponent in this election, Mitt Romney, has a radically different vision for
the future of our health care system — even if it means running from his past
as the architect of health reform in Massachusetts. He would begin by repealing
Obamacare on day 1. Your patients would once again be charged excessive copays
for preventive care, and millions of Americans would be one illness or injury
away from bankruptcy. He would undo the progress we are making toward a more
coordinated delivery system.
his running mate, Congressman Paul Ryan, have proposed a budget that could
force drastic cuts to investment in medi- cal research, eliminating 1600
National Institutes of Health grants and slowing our progress on scien- tific
and medical breakthroughs. They have pledged to turn Medicaid into a block
grant and slash its funding by a third — plunging tens of millions more
Americans into the ranks of the uninsured and leaving our hospitals and health
care providers to grapple with an increasing burden of uncompensated care. And
they are committed to ending Medicare as we know it by turning it 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.
election offers a fundamental choice between those two very different visions
for the future of our country. Although the debate over Obamacare has been
divisive, I signed the legislation not because it was good politics, but
because it was good for the country. It enshrines a core principle that makes
us who we are as Americans: that everybody should have some basic security when
it comes to their health care.
implement the law and work together to improve where we can. But our country
simply can’t afford to refight old political battles, reopen old wounds, and
return to the way things were. We are a nation that does what is hard and what
is necessary and what is right. And we will be better off 5, 10, 20 years from
now because we had the courage and foresight to keep moving forward.
Obamacare with Real Health Care Reform
care is at once among our nation’s greatest strengths and most serious
challenges. People come from around the world to receive treatment in America’s
top medical centers, yet too many of our own citizens have difficulty gaining
access to basic services. No issue is of deeper or more personal concern than
guaranteeing the health of our loved ones. No American should ever have to fear
being left uncared for in the middle of the world’s most advanced health care
our challenges grow worse every year. Higher premiums cut sharply into
paychecks that never seem to increase. Losing a job means losing insurance
cover- age at the moment a family can least afford it, and those with
preexisting conditions can be left with nowhere to turn, despite needing the
greatest care. The sheer volume of red tape overwhelms eventhe most savvy
consumers, while taking too much of each doctor’s time and slowing innovation
in life sciences. Through it all, experts continue to warn that the current
path is unsustainable — that for all its frustrations, the system is becoming
more expensive and will eventually bankrupt our government.
Obama’s 2700-page federal takeover does not solve our problems. His $1 trillion
in tax increases hits the middle class hard and drives medical innovation
overseas. His $700 billion in Medicare cuts “will not be viable,” according to
the program’s trustees, jeopardizing access to care for senior citizens and
throwing millions of beneficiaries off the coverage they rely on. Millions of
other Americans who were told they could keep their coverage will lose it, and
more than one third of new coverage will come through the dramatic expansion of
a broken Medicaid system.
this, his plan still fails to control costs (according to Medicare’s chief
actuary) or to provide a long-term solution to the nation’s entitlement crisis
(according to the Treasury Secretary), so he leaves those tasks to a board of
15 unelected bureaucrats empowered to sidestep Congress and impose drastic
President, I will repeal Obamacare and replace it — not with another massive
federal bill that purports to solve all our problems from Wash-ington, but with
common-sense, patient-centered reforms suited to the challenges we face.
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.
this aim, we must end tax discrimination against persons purchasing insurance,
we must strengthen and expand health savings accounts, and we must establish
strong consumer protections. The result will be patients who can confidently
choose the coverage that is right for them, who know and care what health care
costs, and who re- ward providers that deliver effectively. For this choice to
be meaningful, insurance market reforms must promote competition by eliminating
onerous man- dates, facilitating purchasing pools, and opening up an interstate
market. Regulation must prevent insurers from discriminating against people
with preexisting conditions who maintain continuous coverage.
strengthened system must also be one where America continues to lead the world
in innovation and where we continue to attract the best and the brightest, both
from our own towns and from around the world, to the practice of medicine.
Doctors should spend more time treating patients and less time practicing
defensive medicine or processing paperwork.
should increase their investments in new cures, and those cures should reach
the market faster.
these goals requires medical malpractice reform, a streamlined regulatory
framework to support the interoperability of information technology, and strong
Food and Drug Administration leadership committed to a practical and
predictable approval process that appropriately evaluates risk.
for our health care system to work for all Americans, we must have government
programs that effectively serve our senior citizens and people in need without
breaking the bank. In other words, we need genuine entitlement reform.
make no changes to Medicare for those enrolled in the program today or
enrolling during the next 10 years. For younger Americans, I will implement a
system similar to that used by members of
Congress. Future beneficiaries will have a set of Medicare-approved,
guaranteed-coverage plans to choose from, including today’s traditional fee-for-service
option. Plans will participate in a competitive bidding process to establish
the premiums they will charge, as they do in the Medicare prescription drug
plan that has so effectively controlled cost.
government will then provide premium support, set relative to the competitively
bid premiums and made more generous for the poor and the sick than for the
wealthy, which ensures that each beneficiary can afford high-quality coverage.
This approach will guarantee senior citizens the financial support and
high-quality care they deserve while relying on competition and choice — not
bureaucrats — to deliver significant savings.
our society ever turn its back on those who cannot afford the care they need.
We will provide support for low-income Americans and those uninsured persons
whose preexisting conditions push the cost of coverage too high for them to pay
themselves. But my experience as a governor and the lessons from the
President’s attempt at a one-size-fits-all national solution convince me that
it is states — not Washington — that should lead this effort.
convert Medicaid into a block grant that properly aligns each state’s
incentives around using resources efficiently. Each state will have the
flexibility to craft programs that most effectively address its challenges — as
I did in Massachusetts, where we got 98% of our residents insured without
can agree on the goal of health care reform: ensuring affordable access to
high-quality care for all Americans. The question is how. Whenever President
Obama claims that only Obamacare helps those with preexisting conditions, I am
reminded of the woman in Iowa who found affordable coverage in a high-risk pool
despite a preexisting condition.
President’s campaign took credit, but as it turned out, the high-risk pool
created by Obamacare had actually turned her away . . . at which point she
discovered that her state already offered a high-risk pool that met her needs.
Whenever he claims that only Obamacare helps those under the age of 26 stay on
their parents’ insurance, I am reminded that some of our nation’s largest
insurers have already announced they would offerhis option
regardless of what the law requires . . . because they are responding to
consumer demands in the market.
Obama believes the answer lies in a bigger government that decides what care
Americans should receive and how much providers should be paid for it.
plan has already failed to deliver on virtually every promise he made, and its
components are failing as quickly as they go into effect. It must be repealed.
I believe the answer lies with patients and families, with reformed insurance
markets and fair competition, with strong consumer protections and real
tackles our health care challenges without a federal takeover of the entire
system. Instead, it relies on markets over regulations, doctors and patients
over bureaucrats, and tailored state programs over a 2700-page “solution” from
Tweet: President Obama proposes to keep on implementing his health care law as it; Governor Romney would repeal the law and rely on market reform.