Next year, a new president will take the White House and likely will be the one to lead the United States toward much-needed healthcare reform. What does the near future hold? What should hospitalists know about each candidate’s healthcare policies and proposals? Here, a hospitalist and a government advocate for hospitalists each weigh in.

Are the Times a-Changin’?

Laura Allendorf, SHM’s senior adviser for advocacy and government affairs, keeps a close eye on healthcare legislation, values, and trends in Washington, D.C. She predicts that regardless of which candidate takes office in 2009, change is coming fast.

“Healthcare will definitely be a top priority for the new administration … regardless of who wins the White House,” she says. “There’s been an unprecedented level of discussion already. Congressional committees have already held hearings to prepare for changes next year. They’re laying the groundwork now.”

However, not everyone agrees that we’ll see healthcare reform so soon: Bradley Flansbaum, DO, MPH, chief of hospitalist section at Lenox Hill Hospital in New York City, believes other major issues, such as the slow economy and the war in Iraq, may take precedence.

There’s been an unprecedented level of discussion [on healthcare reform] already. Congressional committees have already held hearings to prepare for changes next year

—Laura Allendorf, SHM senior adviser for advocacy and government affairs

“There are a lot of things on the agenda in Congress right now,” he points out. “I’m not sure how fast [healthcare reform] will really happen.” He says regardless of which man (Barack Obama or John McCain) wins, “he will have two or three top priorities as soon as he takes office—if healthcare reform is one of those priorities, some changes will happen.”

However, the business of Washington still can get in the way of a new administration. Dr. Flansbaum points to a House bill (HR 6331) that requests a delay in implementation of the Medicare competitive bidding program for durable medical equipment. “Lobbyists have sway over what legislators do in Washington, D.C.,” he notes. “Just because Obama or McCain come into office doesn’t mean those lobbyists will go away.”

Despite the forces against change, each candidate is touting major changes to healthcare access.

Do Your Research

For the latest relevant details about the candidates’ positions on healthcare, along with a discussion forum and links to other resources, visit SHM’s new “Election 2008: Race to the White House” Web site.

“We wanted a place where [hospitalists] could quickly access information on the candidates’ positions on healthcare issues,” Allendorf says. “As the candidates expand on their policies or engage in debates where healthcare is discussed, we’ll update the content. We want to keep it timely.”

Follow the link on the home page at www.hospitalmedicine.org.—JJ

McCain and Tax Credits

Republican candidate McCain has released a healthcare plan based on instituting a federal tax credit to be used by individuals to purchase their own health insurance—regardless of whether they are covered (or can be covered) through an employer or through the non-group market.

His plan would replace a tax break for those who receive health insurance from their employers with a refundable tax credit of as much as $2,500 per individual and $5,000 per family, to be used for buying private coverage of their choice.

McCain’s plan proposes compensating physicians and hospitals based on performance, including tying Medicaid and Medicare reimbursements to results. His plan also includes ideas for containing healthcare spending by better treating chronic diseases, such as diabetes and heart disease.

“I believe that the best way to help small businesses and employers afford health care is not to increase government control of health care but to bring the rising cost of care under control and give people the option of having personal, portable health insurance,” McCain has said. He added that his proposal would allow individuals to retain their health insurance “even when they move or change jobs.”

Policy Points

Medicare Urged to Innovate Payments

At the Senate Finance Committee’s Health Care Summit on June 16, Karen Davis, president of the Commonwealth Fund, mentioned hospitalists while testifying that Medicare can be a leading force for change in healthcare quality. “… both Medicare and private insurers could move much more quickly to offer new methods of payment for patient-centered medical homes, physician group practices, hospital systems that employ hospitalist physicians, and integrated delivery systems that are willing to be accountable for the total care of patients and willing and able to assume financial risk for a broader continuum of care over time,” she told the committee.

Premier Project Pays Out

The Centers for Medicare and Medicaid Services (CMS) announced it is awarding $7 million to 112 top-performing hospitals in the third year of its pay-for-performance project with Premier Inc., a nationwide alliance of not-for-profit hospitals. The project, initially scheduled for October 2003 through June 2007 and then extended through 2009, has 250 Premier hospitals reporting on 34 quality measures. CMS has found that current results show substantial and continual improvement among all 250 participating hospitals in 36 states.

Pay-for-EHR Demo

The Department of Health and Human Services (HSS) has named 12 locations that will participate in a five-year Medicare demonstration project that offers incentive payments to providers who use qualified electronic health records. The participants are Alabama; Delaware; Georgia; Jacksonville, Fla.; Louisiana; Madison, Wis.; Maine; Maryland/Washington, D.C.; Oklahoma; Pittsburgh; South Dakota; and Virginia.—JJ

Obama’s Funding Plan

Meanwhile, Democratic candidate Obama approaches the issue with a different solution. He proposes universal coverage through the following:

The proposal would mandate all children have healthcare coverage, and would expand eligibility for Medicaid and SCHIP (State Children’s Health Insurance Program);

A new public insurance program that would bridge the gap of the uninsured, covering Americans who don’t quality for Medicaid or SCHIP and have no access to coverage through their employer. The coverage would be similar to that offered to members of Congress; and

A National Health Insurance Exchange to aid individuals and businesses that want to purchase private health insurance directly. Obama’s plan would require all employers to contribute toward health coverage for their employees or toward the cost of the public plan—all, that is, except small businesses who meet certain exemptions.

Congress Is the Decider

“McCain’s plan is, far and away, the more daring, and will present a greater shock to the system,” Dr. Flansbaum maintains. “It would probably lead to gridlock in Congress, because it would need bipartisan agreement to pass and I don’t think the Democrats would agree to it.” If, on the other hand, Obama wins the election, he would almost certainly have a sympathetic Democratic Congress to work with. “He’d have a greater chance of leading change along his lines,” predicts Dr. Flansbaum. “In this case, we might see a Massachusetts-esque plan.”

In either case, the candidate’s proposal may not become reality. “Folks have to remember, it’s Congress that has to come up with the plan” for reform, Allendorf cautions.

A strong president may carry some weight in this regard. “Like all presidents able to effect change, once [the 2009 electee] has the bully pulpit and can sway opinion, Congress should fall into line,” says Dr. Flansbaum. “There will be pressure to change things.”

That change, whatever shape it takes, is almost certain to include some belt-tightening for hospitals, he says. “You have to look at the facts: One-third of healthcare dollars are spent in hospitals … and the numbers given for waste in care in the system are upwards of 30%. You have to assume that hospitals are the logical place to cut.” Regardless of the election outcome, he cautions: “Hospitals will probably have to make painful cuts and changes. It’s going to happen at some point, though I’m not sure that Congress has the political will to push through any changes soon.”

Luckily, hospitalists are accustomed to continuous change and shifting policies, roles, and responsibilities. Their skills at adapting to changing conditions should serve them well in the post-election months. TH

Jane Jerrard is a medical writer based in Chicago.

Presidential Opportunity