Obama and McCain’s health plans

Health Affairs critiques both Obama's and McCain's health plans, and proposes a compromise plan.

As I wrote in my open letter to the candidates last week, I don't think either plan will work unless they adequately address the primary care shortage.

Dear Senators McCain and Obama: I am a Nashua, New Hampshire primary care physician and as an independent, swing voter, will be important to your Presidential fortunes in this battleground state. As a primary care doctor, it comes as no surprise that I have focused on your proposals to reform our healthcare system. I applaud both of your efforts, and they could not be more different. The election will ...

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Costs, not the uninsured

Robert Samuelson gets it brilliantly right in this Newsweek piece:

The trouble with casting medical-care as a "right" is that this ignores how open-ended the "right" should be and how fulfilling it might compromise other "rights" and needs. What makes people healthy or unhealthy are personal habits, good or bad (diet, exercise, alcohol and drug use); genetic makeup, lucky or unlucky, and age. Health care, no matter how lavishly ...

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The candidates on tort reform

The whole issue of tort reform is pretty much DOA now. If it couldn't be done in the past 8 years, it's certainly not going to happen with the next administration. That being said, here's are McCain and Obama's take on the issue.

Rather than caps, physicians should be pushing for more expedient compensation to injured patients. No-fault malpractice would be an ideal solution, providing quicker ...

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Obama invokes single-payer

And touches off a firestorm of debate on the WSJ Health Blog.

If there was a single thing he could do to lose my vote, endorsing single-payer would be it.

A bleak primary care future

Matthew Holt opines that the primary care crisis will hasten the outsourcing of medical care:

In fact, the result of the primary care crisis may not be inspired reform. it may instead just end up causing globalization and technology outsourcing to come into physicians' lives. Just like it has to auto workers, steel workers and call center clerks.
That is no doubt a possibility. However, the choice will be ...

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The following is a reader take by Malinda Markowitz.

If you wonder why Republican campaign strategists are worried about their party's vulnerability on health care, consider the story of Leslie Elder of West Palm Beach, Fl..

"We had major medical health insurance, and than I was diagnosed with breast cancer in 1987. After a radical mastectomy, I was again diagnosed with breast cancer and another radical ...

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Physicians for a National Health Plan (PNHP) is a group of radical left-leaning doctors in favor of single-payer health care. As progressive blogger Ezra Klein writes, they are opposed to any measure that isn't single-payer:

Their take on Obama's health plan is that it's not single payer, so they don't support it. And their take on Health Care for America Now coalition is that it's not pushing single payer, so ...

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The assertion that electronic records will save money is largely a myth. Obama and the other Democrats should know better.

There are two ways to adopt universal electronic records.

Implement VistA free of charge to every physician office in the country. If the politicians are so confident that electronic records will save money, this is a no-brainer.

Or, mandate physicians to implement VistA ...

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"Whup them"

Obama is going to take a stick to those who oppose his health reform plan.

More importantly, I would like to hear some language on how he's going to address the primary care shortage. His plan of reducing the uninsured assumes that there are enough primary care physicians available to treat them.

As Massachusetts is finding out, that's simply not the case.

The following is a reader take by S. Robert Snodgrass.

I want a better American healthcare system. I scan blogs for plans and wisdom, but I mostly find slogans. Paul Krugman's columns, the Archimedes Movement and current proposals to repair the healthcare system frustrate me. They have different political philosophies, but each considers healthcare in isolation and repeats the same stale incantations.

Our ...

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1) Every few weeks or so, there is an "ED overcrowding story" detailing the crisis and its associated horrors.

My take: The story never seems to change, and always seems worse than the last one.

This is indeed a serious problem. Overcrowding leads to rushed treatment and missed diagnoses, not to mention that care in the emergency venue is often the most expensive.

The obvious ...

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Winter break



I'll be away until the end of the week. In the meantime, here are some things to keep you occupied.

Read other blogs on the Feeds page.

Check out the latest MedBlog Power 8.

Catch up on recurring discussions: primary care, defensive medicine, malpractice, and single-payer.

Say "health care is not a right" and see what happens.

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I'd love to hear their answers to these questions.

1) NEJM: "Sweeping statements about the cost-saving potential of prevention, however, are overreaching. Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs."

My take: A must-read for Hillary and Obama every politician, who pin their cost-cutting hopes on preventive medicine. It isn't going to work. Cost cutting means keeping people out of the ...

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Talking about access is easy. Cost control is not, hence the lack of attention paid to it during this election cycle.

1) There is a perception that the salaries of American physicians are too high, making them a frequent target to cut.

My take: When expressed in GDP per capita, American physicians are indeed compensated at a higher rate compared to other countries. However, context is needed. New American physicians graduate with a mortgage-sized $150,000 debt. In Canada and Europe, medical education is heavily subsidized. Furthermore, ...

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1) Heath Ledger died as the result of acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam, and doxylamine.

My take: Two narcotics, three benzodiazepines, and one sedating antihistamine. If a single physician was responsible for these prescriptions, that's a serious error in judgment. It is more likely that Mr. Ledger received multiple prescriptions from different physicians around the world, perhaps not knowing the ...

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1) My take on the individual mandate wars between Hillary and Obama: it's comical. The level of nuance they are arguing about may satisfy the wonks, but it's over the head of the average voter. In any case, Hillary's arguments for mandates is leaving her open to attack. Obama's Harry and Louise ads and Hillary's "garnishing wages" comment will resonate more with the voters than the importance ...

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Obama goes Harry and Louise

I'm telling ya, the more Ezra and Krugman gang up on Obama, the more appealing he is to me.

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