Last night, I attended my university’s Election Forum, a health policy discussion with Thomas Barker from the Romney presidential campaign, and Vivek Murthy from the Obama campaign (slightly more information about event and the speakers is here, sorry for the facebook link). You can see the live-tweeting of the event here, but I thought I’d try to use this mostly defunct blog to organize a few takeaways:
1. Republicans are much more in favor of payment reform than I thought. With all the rhetoric flying about repealing PPACA, I just assumed that the payment and practice reform provisions were on the chopping block as well. Not so, apparently: Mr. Barker had very positive things to say about patient-centered medical homes, ACOs, and capitated reimbursement.
2. Romney’s been pushing “repeal and replace the ACA” pretty heavily. While he could likely repeal/block large portions of it, it is highly unlikely that he’d have a cooperative Congress with which to implement his own reforms. Mr. Barker slammed Obama a bit for ramming through PPACA “in a very partisan fashion,” though I’m not sure it would be possible any other way. Perhaps a more bipartisan law, with Romney/Ryan’s premium-supported Medicare, and also all the popular parts of PPACA like the pre-existing conditions requirement (which Romney aims to keep!), would make it through the process, and would be stronger for the compromises. But I’m A) not that optimistic and B) think that such a thing would be pretty devastating for those who qualify for insurance subsidies and the Medicaid expansion (read: the poor).
3. For Republicans, fixing Medicare insolvency is the top priority (I didn’t catch an equally clear “top priority” from Dr. Murthy). According to Mr. Barker, this needs to happen by switching Medicare from a “defined benefits” entitlement to a “defined contribution” model (a decent, and really long, outline of that argument by a Romney health care advisor is here). Those terms, and that whole question, will require an entire post (or series) of their own.
4. Surprise! There’s disagreement about Medicare Advantage! Mr. Barker characterized it as “the future of Medicare,” while Dr. Murthy was less sanguine about its purported benefits. My memory of his actual words is foggy now, but a common Democrat position seems to be that Medicare Advantage costs the government (CMS) more than “regular” Medicare, without delivering more benefits. This is something I need to look into, clearly. (Care to educate me in the comments?)
5. Tort reform didn’t seem to be very high on either agenda. Not surprisingly, either: it’s not actually as large a driver of health care costs as people tend to think, and cost seems to be the major driver in health reform recently. But it’s still a very important issue, and it would be nice to see more coherent ideas articulated by both parties.
6. Confusion about graduate medical education (GME), the insufficiency of which is a large contributor to the physician shortage, especially in primary care. Mr. Barker’s take: repealing PPACA will restore the cuts Obama’s making to CMS (the infamous $700 billion), which includes funding for GME. Dr. Murthy’s answer was less clear-cut to me: it seems that the Prevention Fund allocates money to primary care GME, but this money is in danger if we go over the fiscal cliff. GME funding reform has been needed for ages, and it’s disappointing to see it getting largely overlooked in the health policy conversation.
7. Overall, the discussion was very amicable, and a good reminder that both Republican and Democrat health policymakers have the same “Triple Aim” in mind, namely: “improve the health of the population; enhance the patient experience of care (including quality, access, and reliability); and reduce, or at least control, the per capita cost of care.” While the effects of PPACA on Medicare and the federal budget make Republicans very critical of any comparisons to Massachusetts health reform, there is a large amount of overlap between the parties on this issue.
8. However, the very significant differences between Republican and Democrat approaches to health care also became clear several times during the event (no surprise here). Broadly, the most controversial part of health care reform seems to the parts of PPACA that seek to implement universal insurance coverage. According to Mr. Barker, adding a huge new entitlement without paying for it is a great threat to the solvency of Medicare/Medicaid (and, by extension, the federal government itself). However, that new entitlement, the expanded insurance coverage of low-income citizens (through the Medicaid expansion and subsidies available for use in the insurance exchanges), is an indispensable component of health care reform for Democrats, and for anyone who considers equitable access to health care a fundamental aspect of social justice (like me). On this issue, I doubt there will ever be bipartisan agreement.
9. It will be very interesting to see what happens in this election. No matter who is elected, major changes are coming our way.
Thanks for reading! This is something of an inaugural health policy post for this blog, so I could really use some feedback/correction if I’m misrepresenting any issues or positions here.