Health care reform is gaining momentum among American public in election year

Senator McCain seeks tort reform. Senator Obama calls for universal health care coverage for children.

DENVER — The state of U. S. health care remains a growing concern among Americans and both presidential candidates have proposed health care reform as part of their platform.

“In 2008, there is an increased confluence of opinion that U.S. health care is in need of somewhat of a reform, and public opinion in this regard is gaining momentum,” Michael B. Wood, MD, said during his presentation at the American Orthopaedic Foot and Ankle Society 24th Annual Summer Meeting.

“There is agreement by both Democrats and Republicans that quality needs improvement, and that patients need objective data so that they can make informed market oriented decisions about their care,” he said. “Both candidates feel a program needs to be put in place to make health care more affordable and provide a more robust safety net for those who cannot afford health insurance, at least for a basic benefits package.”

Public concern

In a recent Gallup Poll, health care ranked third among the highest domestic concerns for voters. A survey of 2,000 physicians also showed that 59% supported legislation for a national health insurance program.

“The bottom line is there appears to be enough angst among the American electorate and enough angst among those intimately involved in the health care profession that there is little doubt that U.S. health care, as it concerns costs, quality and access, is a major political issue,” Wood said.

Health care reform is an important political issue due to the rising cost of care, the perception of decreased quality in care, and the growing aging and medically uninsured populations, he said.

Health care spending totaled 16% of the country’s gross domestic product (GDP) in 2006 and is projected to be 20% of the GDP by 2016. He also noted that more employees and beneficiaries are carrying the cost of care. In addition, recent reports regarding the number of preventable hospital deaths and errors have contributed to the perception that Americans are paying more for less-effective care.

People older than 65 years represent 13% of the population and are projected to make up 20% of the nation by 2030. The elderly also have the greatest need for health care services, Wood said.

“[There] is a large a growing segment of our population of medically uninsured or underinsured, and this has a broad impact on the entire health care system,” he said. There are 47 million uninsured citizens, which comprise 16% of the population. Wood noted that some of this group can afford insurance but choose not to, but the majority of the uninsured are in low-income families. Those without health insurance generally wait to receive medical care until they have a serious illness at which time the costs of health care are much greater.

The candidates’ goals

Both Senators John S. McCain and Barack Obama seek to provide health care coverage to more citizens, decrease health care costs, improve quality, highlight the need for chronic disease management and promote preventative health care, Wood said.

McCain seeks to broaden coverage by giving incentives for purchasing health care insurance, and hopes to make insurance more affordable.

“His approach, at least at this time, is probably closest to the status quo as far as physicians are concerned,” Wood said. “McCain proposes eliminating favorable tax treatment for employer provided health insurance and replacing it with a fixed tax credit for individuals and families. This will likely prove to be very controversial and contentious.” He also advocates for tort reform, drug reimportation and increased provider competition by broadening the role of non physician providers, Wood noted.

Obama’s cost-cutting and quality-improvement proposals are similar to those of McCain, and he seeks to finance his plan by repealing President George W. Bush’s tax cuts, according to Wood.

“Obama’s main goal is also universal coverage,” he said. “At least at the outset, he does not mandate this for all citizens. His mandate would be only that all children have coverage.”

Obama would also likely increase requirements on private insurers and advocate drug reimportation, Wood said.

“My personal guess is that as the new president and Congress take office in 2009, the preoccupation will be with restoring growth and stability to the U.S. economy and executing an end to the Iraq war, along with continuing homeland security efforts,” he said. “If all that happens without other major cataclysmic events, over the next few years I think we can expect health care to be at the top of the list with [other] domestic issues in 2012.”

For more information:
Michael B. Wood, MD, can be reached at the Mayo Clinic College of Medicine, 4500 San Pablo Road, Jacksonville, FL 32224; 904-953-0853; e-mail: michael.wood@mayo.edu. He has no direct financial interest in any products or companies mentioned in this article.

Reference:
Wood MB. Kenneth A. Johnson, MD, Memorial Lecture: Politics and the future of U.S. health care. Presented at the American Orthopaedic Foot and Ankle Society 24th Annual Summer Meeting. June 26-28, 2008. Denver.