Health Care Stuff
or: why I like Obama's health plan more then Clinton's. In medicine, it is my moral obligation to advocate for patients in the larger arena - it's part of my code as a doctor, and as a person. Health care reform is perhaps the biggest area I could try and tackle, but why not? It's important.
And this is really one of the things my vote comes down to. Single-issue voting, I know, but the more time I spend with patients (on top of the Holly and Kaylene stuff), the more this is a central issue in my life. I like other things about Obama and Clinton, but this.... this is a big deal.
So, I looked at both websites, and read, carefully, through both outlines plans.
General impressions: Obama gives more examples, and has a more specific list of emphases. He also offers examples of what he's done in the past that follow his philosophy (Clinton does not, oddly, even though I know how hard she's worked on these issues). I realize that specifics are dangerous in that they may not be implementable. However, they are substantive (arguing against the "fluff" criticism he's been getting), and they tell my what matters to him.
More specifics:
Both of them offer tax credits for families who can't afford the new insurance. Obama talks about actual subsidies for such families. There are tax loopholes that people would fall through so that they wouldn't gain enough from a tax credit to purchase insurance, and a direct subsidy would work better in those cases. Clinton's plan discusses making sure that health insurance premiums only cost a certain percentage of a family's budget, but that seems like a dangerous game to me. Looking at net income and subsidizing accordingly will still have some people falling through the cracks, but setting percentages will disenfranchise far more people who simply do not fit the model (and would necessitate some sort of exemptions office, which will be overrun.... looking at the current SSI-Disability process now for exemptions, etc, this does not sound enticing).
Obama specifically mentions covering all children (with the option to cover them until age 25). This may seem redundant if you're going to cover everyone, but the focus on this makes me feel secure about his commitment to making sure families have the coverage they need.
Expanding Medicaid and SCHIP - this is critical. Both candidates are talking about adding an insurance system on top of the already existing motifs. Medicaid and SCHIP are good programs, with unfortunate loopholes that many people fall through. Expanding eligibility will utilize the existing programs better as the new plans are getting underway. Both candidates talk about insurance and pharmacological reform, which is good, as no Medicaid changes can happen without a serious overhaul of our relationship to "BigPharma." Clinton talks about fixing holes in both programs, which is commendable, but I prefer the idea of utilizing something existing that's good to it's full extent rather than just patching it and adding something on to it.
Three really big things for me: Obama's emphasis on managing chronic illnesses better (prevention and care), Obama's insistence on hospital transparency in terms of outcomes and other markers (hospital-acquired infections, etc), and the creation of a National Health Insurance Exchange to monitor the existing and continuing private plans to keep their coverage in accord with the national plan.
I'm a huge proponent of hospital transparency. Recently, Medicare has stopped reimbursing hospitals for events they deem to be caused by hospital negligence (infections, etc). Hospitals have to eat those costs. Great incentive, but not open enough to guarantee that safety protocols are being followed. Transparency works - looking at both the trackable data for Wisconsin medical systems and BIDMC in Boston. It gives the employees incentive to maintain safety (because it's real feedback rather than general statements and occasional studies), and it gives the public some way of not just choosing their health care, but preparing themselves for likely outcomes (or unlikely ones).
And I'm in general favor of watchdog groups, whether it's something along the lines of the GAO (which I suspect a new Exchange would be), or concerned citizens groups (though they often have misinformation and go way too far).
Other key things that Obama mentions and Clinton does not:
Improving mental health care. Remember what happened when Reagan emptied the institutions? Ever been to Athens, Ohio? yeah......
Increasing research funding. There are definitely some well-funded diseases out there, but there's a lot of research, in fact most research, that has felt a serious crunch in the last 8 years. Clinton also talks about improving
Lead poisoning in kids - if you're not from an urban area, or haven't read the studies, you probably don't know how big a deal this still is, especially among poor black children. This is a huge problem, still, and one that's remarkably easy to deal with. If we remember to.
I try not to talk politics too much, because I feel it's personal. But this is livejournal, where personal meets the world, right? I can count on one hand the number of my friends who have enough inside knowledge of the health care system to be interested in the differences between the two candidates, and I can't begin to express how critical such differences could be, and how absolutely necessary some sort of reform is. I've heard all the arguments against nationalized health care, and I have a counter-argument for most of them, but that's not why I'm posting this, so we can hash that out some other time.
But yeah, a little analysis from my corner.
Addendum: It has come to my attention that Hillary did, indeed, mention such things as improved research funding and mental health care in her recent speech in Madison, and perhaps elsewhere. I applaud that move. I wish she'd put such things on her website instead of the rather vague policy points that are currently there. I don't think I would've changed my mind, but it would have given me a more fair basis for making a decision.
Last, but not least, I'd also like to state for the record that I do not think either plan is the ideal. Both are band-aids for a current gap in health coverage, not an overall solution. However, either plan is a great leap forward relative to our current state, and the subsequent leaps will be smaller. I will endeavor to keep you more in the know as to the ongoing discussion in the future.
And this is really one of the things my vote comes down to. Single-issue voting, I know, but the more time I spend with patients (on top of the Holly and Kaylene stuff), the more this is a central issue in my life. I like other things about Obama and Clinton, but this.... this is a big deal.
So, I looked at both websites, and read, carefully, through both outlines plans.
General impressions: Obama gives more examples, and has a more specific list of emphases. He also offers examples of what he's done in the past that follow his philosophy (Clinton does not, oddly, even though I know how hard she's worked on these issues). I realize that specifics are dangerous in that they may not be implementable. However, they are substantive (arguing against the "fluff" criticism he's been getting), and they tell my what matters to him.
More specifics:
Both of them offer tax credits for families who can't afford the new insurance. Obama talks about actual subsidies for such families. There are tax loopholes that people would fall through so that they wouldn't gain enough from a tax credit to purchase insurance, and a direct subsidy would work better in those cases. Clinton's plan discusses making sure that health insurance premiums only cost a certain percentage of a family's budget, but that seems like a dangerous game to me. Looking at net income and subsidizing accordingly will still have some people falling through the cracks, but setting percentages will disenfranchise far more people who simply do not fit the model (and would necessitate some sort of exemptions office, which will be overrun.... looking at the current SSI-Disability process now for exemptions, etc, this does not sound enticing).
Obama specifically mentions covering all children (with the option to cover them until age 25). This may seem redundant if you're going to cover everyone, but the focus on this makes me feel secure about his commitment to making sure families have the coverage they need.
Expanding Medicaid and SCHIP - this is critical. Both candidates are talking about adding an insurance system on top of the already existing motifs. Medicaid and SCHIP are good programs, with unfortunate loopholes that many people fall through. Expanding eligibility will utilize the existing programs better as the new plans are getting underway. Both candidates talk about insurance and pharmacological reform, which is good, as no Medicaid changes can happen without a serious overhaul of our relationship to "BigPharma." Clinton talks about fixing holes in both programs, which is commendable, but I prefer the idea of utilizing something existing that's good to it's full extent rather than just patching it and adding something on to it.
Three really big things for me: Obama's emphasis on managing chronic illnesses better (prevention and care), Obama's insistence on hospital transparency in terms of outcomes and other markers (hospital-acquired infections, etc), and the creation of a National Health Insurance Exchange to monitor the existing and continuing private plans to keep their coverage in accord with the national plan.
I'm a huge proponent of hospital transparency. Recently, Medicare has stopped reimbursing hospitals for events they deem to be caused by hospital negligence (infections, etc). Hospitals have to eat those costs. Great incentive, but not open enough to guarantee that safety protocols are being followed. Transparency works - looking at both the trackable data for Wisconsin medical systems and BIDMC in Boston. It gives the employees incentive to maintain safety (because it's real feedback rather than general statements and occasional studies), and it gives the public some way of not just choosing their health care, but preparing themselves for likely outcomes (or unlikely ones).
And I'm in general favor of watchdog groups, whether it's something along the lines of the GAO (which I suspect a new Exchange would be), or concerned citizens groups (though they often have misinformation and go way too far).
Other key things that Obama mentions and Clinton does not:
Improving mental health care. Remember what happened when Reagan emptied the institutions? Ever been to Athens, Ohio? yeah......
Increasing research funding. There are definitely some well-funded diseases out there, but there's a lot of research, in fact most research, that has felt a serious crunch in the last 8 years. Clinton also talks about improving
Lead poisoning in kids - if you're not from an urban area, or haven't read the studies, you probably don't know how big a deal this still is, especially among poor black children. This is a huge problem, still, and one that's remarkably easy to deal with. If we remember to.
I try not to talk politics too much, because I feel it's personal. But this is livejournal, where personal meets the world, right? I can count on one hand the number of my friends who have enough inside knowledge of the health care system to be interested in the differences between the two candidates, and I can't begin to express how critical such differences could be, and how absolutely necessary some sort of reform is. I've heard all the arguments against nationalized health care, and I have a counter-argument for most of them, but that's not why I'm posting this, so we can hash that out some other time.
But yeah, a little analysis from my corner.
Addendum: It has come to my attention that Hillary did, indeed, mention such things as improved research funding and mental health care in her recent speech in Madison, and perhaps elsewhere. I applaud that move. I wish she'd put such things on her website instead of the rather vague policy points that are currently there. I don't think I would've changed my mind, but it would have given me a more fair basis for making a decision.
Last, but not least, I'd also like to state for the record that I do not think either plan is the ideal. Both are band-aids for a current gap in health coverage, not an overall solution. However, either plan is a great leap forward relative to our current state, and the subsequent leaps will be smaller. I will endeavor to keep you more in the know as to the ongoing discussion in the future.