Surgery News - March 2008 - (Page 8) 8 SURGERY NEWS • M A R C H 2 0 0 8 THE 20/20 Editor’s Note: This article is part of a series of reports on the health care reform proposals of the presidential hopefuls. Previous reports were developed from health policy forums held at the Kaiser Family Foundation in Washington. (See SURGERY NEWS December 2007, p. 6, and February 2008, p. 7.) Sen. Barack Obama did not participate in those forums. This article is a compilation of material from the candidate’s Web site, located at www.barackobama.com/ issues/healthcare. BY DIANE SCHNEIDMAN VISION Evolutionary Changes in Surgical Practice Obama Aims for Guaranteed Access Health Benefits Program (FEHBP), tance of disease management, coordiwould include the following features: nated care, and transparency. ImpleGuaranteed eligibility, prohibiting in- mentation of “medical home–type modsurers from refusing to provide coverage els” would encourage team care as a way to imbased on an individual’s health status. Coverage for “essential” medical ser- prove the coordination vices, including preventive, prenatal, and and integration of care for individuals mental health care. with chronic conditions. Affordable premiums and Hospitals and other health copayments. care providers also would be Subsidies for individuals required to collect and puband families not eligible for licly report health care cost Medicaid or the State Chiland quality data, including dren’s Health Insurance Proinformation about pregram (SCHIP), allowing them ventable errors, nurseto either buy into the new staffing ratios, infection conpublic plan or purchase pritrol, and disparities in care. vate insurance. ‘No one will be Hospitals and insurers would A mandate requiring insurturned away be held accountable for adance companies that particibecause of a dressing any problems that pate in the new public plan to preexisting were identified. report quality and efficiency condition or In addition, the Obama data. illness.’ plan would accelerate efforts Unlike Sen. Hillary ClinSEN. OBAMA to develop and disseminate ton’s (D-N.Y.) health reform proposal (see SURGERY NEWS December best practices and would align payment 2007, p. 6), the Obama plan would not with the provision of high-quality health mandate that all Americans have health care. Surgeons, physicians, and other insurance coverage—only children. He health care providers participating in the would allow young people up to age 25 new public plan, the National Health to continue receiving coverage through Insurance Exchange, Medicare, and FEHBP would be rewarded “for achievtheir parents’ plans. What would Sen. Obama’s plan mean ing performance thresholds on physifor surgeons and other health care cian-validated outcome measures.” Congress would be called upon to providers? It would stress the imporstrengthen antitrust laws to prevent malpractice insurance carriers from overcharging physicians for coverage. In addition, the plan would promote new patient safety–centered models for addressing physician errors. Further, Sen. Obama has indicated that his plan would direct $10 billion per year over the next 5 years toward efforts to broaden adoption of health information technology, including electronic medical records. The creation of a National Health Insurance Exchange would serve as a watchdog for the insurance industry, by setting rules and standards designed to ensure fairness and make coverage more affordable and accessible. Insurers would be required to issue a policy to every applicant and charge reasonable premiums unrelated to an individual’s current medical condition. Plans offered through the exchange would have to be at least as generous as the new public plan and would have to adhere to the same quality and efficiency standards. Employers would be required to offer group plans to workers, subsidize employees’ coverage, or contribute a percentage of the payroll toward the costs of the national plan. Small businesses that meet a revenue threshold would be exempt from these mandates. ■ American College of Surgeons uaranteed access to affordable insurance coverage and effective care are the overarching goals of Sen. Barack Obama’s (D-Ill.) health reform plan. “My plan begins by covering every American,” Sen. Obama said during a stump speech last year in Iowa City. “No one will be turned away because of a preexisting condition or illness.” To achieve this goal, Sen. Obama would allow individuals and families with health insurance coverage to stay with their insurers and would offer a new national health plan to currently uninsured and underinsured Americans. The national plan, which proposes coverage similar to that of the Federal Employees G Comparison of Presidential Candidates’ Health Care Proposals Candidate Sen. Hillary Rodham Clinton (D-N.Y.) How to expand access Individual mandate requiring all Americans to either keep existing coverage, or choose plans similar to FEHBP or Medicare. Cost $110 billion, paid for largely by rolling back Bush tax cuts for annual incomes over $250,000. Effect on insurers Cannot deny coverage to people who have poor health or charge them higher rates. Effect on employers Large employers must either insure employees or contribute to government-run pool. Small businesses receive tax credits. Effect on physicians/ other providers Financial incentives for using team approach and providing coordinated care. “Best Practice Institute” to finance research. Improved use of health information technology (IT). Liability reform. Liability reform. Adoption of electronic recordkeeping. Emphasis on preventive care. Former Arkansas Gov. Mike Huckabee (R) Free market stimulation. Expand health savings accounts to everyone. Provide tax deductions for individuals and families, and tax credits for low-income families. Free market approach. Also expects individuals to take responsibility for preventive care. Expand community health centers. Mandated coverage for children only. Provides subsidies for health care with access to plans similar to FEHBP. Cost estimates unavailable. Portable coverage for individuals who switch employers. Movement away from employerbased benefits. Sen. John McCain (R-Ariz.) Cost estimates unavailable. Interstate markets. Cannot deduct health care costs from taxes. Emphasis on chronic disease management. Increased accountability/transparency for costs. Pay for performance. Single bill for coordinated care. ELSEVIER GLOBAL MEDICAL NEWS Sen. Barack Obama (D-Ill.) $50-$65 billion, paid for largely by rolling back Bush tax cuts for annual incomes over $250,000. Cannot deny coverage for illness or preexisting conditions. Supervision from new National Health Insurance Exchange. Large employers must provide or contribute to cost of health insurance. Expand health IT to improve coordination. Increase importation of prescription drugs and use of generics. Emphasis on prevention. Notes: FEHBP is the Federal Employees Health Benefits Program. SCHIP is the State Children’s Health Insurance Program. Source: American College of Surgeons http://www.nxtbook.com/nxtbooks/elsevier/sn1207/index.php?startid=6 http://www.nxtbook.com/nxtbooks/elsevier/sn0208/index.php?startid=7 http://www.barackobama.com/issues/healthcare http://www.barackobama.com/issues/healthcare http://www.nxtbook.com/nxtbooks/elsevier/sn1207/index.php?startid=6 http://www.nxtbook.com/nxtbooks/elsevier/sn1207/index.php?startid=6
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