This, you know: The roots of President Obama’s contentious Affordable Care Act share a little more soil with former Governor Romney’s reforms in Massachusetts than either candidate would like to dig into anytime between now and election day. Hence the collectively unflattering moniker Obamaneycare.
What’s more, as a pair of companion pieces in the esteemed New England Journal of Medicine demonstrates both men have similar visions – and not merely histories – for next-generation healthcare in America.
Parsing both candidates’ redundant rhetoric in the NEJM shows some of the healthcare intentions that each laid out – just not necessarily in any great detail.
In his article, President Obama recounted his administration’s accomplishments thus far achieved under the ACA, reiterated his appreciation of how the previously-derogatory term Obamacare actually shows that he cares and, as did Romney, took aim at the opposition.
Then, toward the end, the President paused just long enough to essentially state that if re-elected, he would continue apace with the ACA, making any necessary changes.
Here it is, then, excerpted from the article titled Securing the Future of American Health Care:
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. 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.
Dedicating a more sizable chunk of his article to the future, Romney began by acknowledging the importance of healthcare to American citizens, mounting an attack on Obama’s ACA and then, continuing his “repeal and replace” mantra, launching into his intents.
From the article Replacing Obamacare with Real Health Care Reform:
If elected President, I 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.
To achieve 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 reward providers that deliver effectively. For this choice to be meaningful, insurance market reforms must promote competition by eliminating onerous mandates, facilitating purchasing pools, and opening up an interstate market. Regulation must prevent insurers from discriminating against people with preexisting conditions who maintain continuous coverage.
A 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. Innovators should increase their investments in new cures, and those cures should reach the market faster. Achieving 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.
Finally, 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.
I will 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. The 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.
Nor can 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. I will 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 [percent] of our residents insured without raising taxes.
Everyone can agree on the goal of health care reform: ensuring affordable access to high-quality care for all Americans.
Romney’s last line in the excerpt, echoing the very name of Obama’s Patient Protection and Affordable Care Act, essentially comprises two parts of the triple-aim, that being improved patient-centered care, at a lower cost, to the betterment of population health.
[Related: Political strategists on how Obama, Romney should handle healthcare in the election.]
Other commonalities? Both candidates are in favor of reforming Medicare and Medicaid payments, giving the practice of care a patient-centered bent, controlling costs, extending coverage to more low income and otherwise uninsured citizens, investing in innovation, revamping medical malpractice, and preserving the entitlement safety nets for future generations.
Perhaps the biggest distinction is that President Obama wants to trudge forward on a bill that is inarguably unwieldy while former Governor Romney would kill the ACA to plant a new seed that reforms the healthcare system with strikingly similar end-goals.
Indeed, it’s the matter of “how” that divides them. But the questions: Would it be better for the next president, be that Obama or Romney, to bring about reform by building on the ACA, as Obama suggests, or is Romney correct in maintaing that the ACA must be scrapped? Is either plan actually better than the other and, if so, why? Comment below.
