Vol. 77 November 1, 2012 Obamacare and Romneycare: Are They Different? Do You Care?

The New England Journal of Medicine invited President Obama and Governor Romney to submit statements of their health care platforms for publication. They were published in the October 11 issue. Below I have extracted only the concrete action elements in each statement. I have omitted tedious repetition “of the problems we face” since we are all familiar with those. I have made no attempt to discern or define any “code words”.  Both statements do not include all of their plan’s elements since these statements are specifically directed at physicians. I hope to have highlighted only what each candidate will try to do when they are President“ in their own words”.

President Obama
“Securing the Future of
Health Care”
Governor Romney
“Replacing Obamacare with
Health Care Reform”
-restore health care as a basic pillar of middle-class security -Repeal Obamacare
-maintain employment-based health insurance -keep employer-sponsored coverage
-small business able to pool together for leverage on private insurance rates -facilitate purchasing pools and open up an interstate market
-tax credits to small business to provide worker coverage -empower people to buy their own insurance plans
-tax credits for middle class families who don’t get coverage at work -insurers will compete for the business of these price-sensitive, quality conscious consumers
-establish strong consumer protections as they purchase insurance
-revise Medicare flaws that threaten physician reimbursement -genuine entitlement reform but no change to Medicare for those who are now over 55 yo
-form Accountable Care Organizations and initiate bundled payments to providers -develop a set of Medicare insurance plans to choose from with premiums set by competitive bidding. Will always include a fee-for-service plan.
-reduce health-care associated infections and preventable admissions -FDA committed to a practical and predictable approval process
– have 30 million currently uninsured begin to purchase affordable coverage in 2014 -government will provide premium support for poor and sick
-medical malpractice reform but no arbitrary caps on awards -medical malpractice reform (with federal caps for awards)
-interoperability of information technology
-convert Medicaid to a block grant program to allow flexibility for the states
-children up to 26 yo covered under parent’s plan (2010) -already accepted by insurance companies due to market forces
-no exclusion for pre-existing conditions in children -prevent insurers from excluding people with pre-existing conditions who maintain continuous coverage
-already accepted by insurance companies due to market forces
-”BOTTOM LINE” in President Obama’s words:
-everybody should have the basic security of health care
-we will work together to implement and improve this plan
-we will be better off 5, 10, and 20 years from now if we do this
-”BOTTOM LINE” in Governor Romney’s words:
-markets over regulation
-doctors and patients over bureaucrats
-tailored state programs over a Washington solution
-reformed insurance markets with fair competition
-real entitlement reform

What each says about the other’s plan

President Obama says that Romney  will Governor Romney says that Obama will
-cause excessive copays of preventive care -cause $1 trillion in increased taxes
-eliminate 1600 NIH grants -not reduce Medicare costs by $470 billion
-convert Medicare to a voucher program and cut funding by 1/3 – expand coverage by using the broken Medicaid system for 1/3 of the newly covered
-make millions for insurance companies and hurt seniors and the disabled with a voucher program -provide no long-term solution to entitlement crisis
– undo progress made toward a more coordinated delivery system -create an unelected board of 15 bureaucrats to cut costs without congressional approval

What others say:

On Romney – “When Mitt Romney campaigned in 2002 to become governor of Massachusetts, he offered no hint that he would lead the enactment of the most consequential state health care reform law in U.S. history…His [current] Medicare and Medicaid proposals would irrevocably transform these programs. His budget and tax proposals would threaten the country’s basic health infrastructure as few in living memory have done. One can only hope that if elected President, Romney would surprise the United States as he did Massachusetts.”   NEJM 367 Oct. 18.2012, Eli Adashi, MD et al.

On Obama – Not heavy enough on penalties for non-compliance with the individual mandate, not far enough on the reorganization and reimbursement of care, not far enough on reforming of physician reimbursement “which is the most dysfunctional part of Medicare”, “too modest  bonuses” for improving quality, not far enough on alternative physician reimbursement to encourage multi-specialty group practices, BUT too far on ACO’s which should be just a pilot program since their outcomes are not proven. It is not “market-friendly”. “If market-friendly Medicare reform is your aim, a good place to look is the plan proposed by vice-president candidate Paul Ryan.”  NEJM 367 Oct.18.2012, Gail Wilensky, Ph.D.

My 2 cents worth: President Obama says “this election offers a fundamental choice between two very different visions for the future of the country.” In terms of health care reform, I am not too sure of that. I remember the expanded coverage and cost “containment” (better called “cost shifting” in both plans) elements in the Romneycare of Massachusetts. At this point the election looks like a toss-up. Clearly it is difficult to understand Obama’s complicated plan and all its unintended consequences and real costs, but it is impossible to even guess about Romney’s unrevealed ones.

We shall begin to see after January when the Supreme Court Chief Justice says  “Will the real President of the United States please stand up.”

One Response to Vol. 77 November 1, 2012 Obamacare and Romneycare: Are They Different? Do You Care?

  1. Thanks for writing a good summary. The ACO plan is really different from what Romney proposed–it seems to align incentives correctly for all parties. Now that Obama has won the contest hopefully we will see some details. There are pilot projects underway.

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