The confetti and streamers have long been swept from the floors of the Democratic and Republican national conventions. The way I see it, there’s a candidate for everyone, from the angsty youth (Obama) to patriotic veterans (McCain), from the foreign-policy guys (Biden) to the independent hockey moms (Palin). All are very intriguing, but before you pull that lever or punch your chad, ask yourself this question: How will each candidate impact emergency medicine?
While you could hinge your vote on any number of specific issues, there are two that will ultimately have the biggest effect on your life: health care and the economy. According to a study published in August by The Commonwealth Fund, 41% of working-age Americans are now struggling to pay medical bills and have accumulated personal debt solely due to medical care. According to statistics published by the National Coalition on Health Care, in 2007, health care spending in the United States reached $2.3 trillion, and was projected to reach $3 trillion in 2011. Health care spending is projected to reach $4.2 trillion by 2016 when it will account for 20% of the GDP up from 16% in 2005 as the population grows and ages. Forget the societal implications of universal and better health care, from an economic perspective alone, health care is big business and will continue to be so for a long time.
Today, both Obama and McCain are claiming to be the candidate for “change,” which is the standard political battle cry when the voters are unhappy with the status quo. Put simplistically, McCain promises smaller government and more personal choices while Obama promises bigger government and more federal programs. McCain promises to work in a bipartisan fashion, something he has taken heat from Republicans for over the years (McCain has historically voted with the Republican leadership only 83% of the time). Obama promises similar bipartisan dealings, but he has yet to do so on a major legislative issue. Obama has rarely broken ranks during his three years, voting with the party leadership 97% of the time.
As with every candidate for political office, both men promise more than they can realistically deliver. Let’s face it, that’s how you get elected…convince enough people that you will deliver on “their” issue. So what have McCain and Obama promised to deliver on health care?
Thumbs Up: More than any other specialty, emergency medicine could stand to benefit from a more “universal” plan. Shouldn’t we get paid for taking care of everyone on a 24/7/365 basis? Imagine a day when the concept of a “Self Pay” patient doesn’t exist.
Provide affordable and high-quality universal coverage (including mandated coverage for children) through a mix of private and expanded public insurance.
The Basics: Sen. McCain has campaigned on a platform of reforming the health care system by restoring control of health care decisions to patients and ensuring they have more choices. McCain believes in providing patients more opportunities to purchase health care insurance. If families are not covered by employer-based health care insurance or if they opt out of that system, they would be provided with a $5,000 tax credit ($2500 for individuals) which could be used to directly pay a private insurer for health care insurance. McCain also promotes making health care insurance portable and increasing the use of Health Savings Accounts (HSAs). McCain states that he will work with state governors to develop a Guaranteed Access Plan (GAP) to develop a best practice model for providing insurance to those who have traditionally been uninsurable, those individuals without prior group coverage or with pre-existing medical conditions. McCain promises to pay for expansion of coverage through a series of cost saving measures including lowering drug prices through safe re-importation, chronic disease management, improved IT coordination, tort reform, and Medicaid and Medicare reform.
Thumbs Down: I’m not sure how the insurance tax credit math works since most family health care insurance policies are running about $14,000 per year. And while all the mechanisms to raise funds sound good, there’s a whole lot of detail that we’re not seeing, like how long it will take to really see any financial benefit from any of those items and how do we pay for them now. Interestingly for emergency medicine, McCain also promotes increased access and convenience of care, and specifically touts that “government should promote greater access through walk-in clinics in retail outlets.” Not exactly a “warm fuzzy” for those of saving lives in the ED on a 24/7 basis.
Provide access to affordable health care for all by paying only for quality health care, having insurance choices that are diverse and responsive to individual needs, and encouraging personal responsibility
In the booth
Okay, now you have the inside scoop on the candidates. You can choose bigger government that covers everyone, but which will come out of your pocket, or you can vote for smaller government, every man for himself, and lower taxes. OK, so that’s an uber-simplification, but you get the idea. Take a close look at the candidates for yourself. Listen to the debates and see what they are saying about where they will take health care. Your livelihood could be in the balance.