Organizing for America | Unite for Change: OBAMA RESPONDS TO AMERICAN ACADEMY OF FAMILY PHYSICIANS

OBAMA RESPONDS TO AMERICAN ACADEMY OF FAMILY PHYSICIANS

By Doc from Orlando, FL - Jul 15th, 2008 at 4:17 pm EDT

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Seniors/MedicareHow would you help doctors who can no longer afford to take new Medicare patients because of Medicare’s declining and unpredictable rate of payment?

Medicare’s reimbursement for doctors is based on a formula that is antiquated, ineffective and overdue for major revision. Any serious proposal to reform this nation’s health care system must prioritize fair and reasonable payment to doctor to ensure access to high quality care for seniors.

How do you propose to correct the physician Medicare payment rate
formula?

Although I acknowledge that corrective changes to the physician Medicare payment rate formula are needed, I believe that a new formula must be developed carefully and collaboratively with physician professional societies. As such, my plan does not include a detailed proposal for a permanent “SGR fix”.

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Health Care ReformDo you support a patient-centered medical home? (In this new model, the traditional doctor’s office is transformed into the central point for Americans to organize and coordinate their health care, based on their needs and priorities.)

Yes, I support the concept of a patient-centered medical home, and as part of my health care plan, I will help providers establish them. Rates of chronic diseases have skyrocketed in the last 2 decades; over 133 million Americans have at least one chronic disease. With proper care, the onset and progression of these diseases can be contained for many years. In addition to the needless suffering and early death they cause, these chronic conditions cost a staggering $1.7 trillion yearly. More than half of Americans with serious chronic conditions have 3 or more different physicians, leading to duplicate testing, conflicting treatment advice and prescription drugs that are contraindicated.

As president, I will encourage and provide appropriate payment for providers who implement the medical home model, including physician-directed, interdisciplinary teams, disease management and care coordination programs, quality assurance mechanisms, and health IT systems which collectively will help to improve care for those with chronic conditions.

Can you describe your plan for health care reform?

I believe that every American has the right to affordable, comprehensive and portable health coverage. My plan will guarantee coverage for every American through partnerships among employers, private health plans, the federal government, and the states. My plan both builds on and improves our current insurance system, which most Americans continue to rely upon, and leaves Medicare intact for older and disabled Americans. Under my plan, Americans will be able to maintain their current coverage if they choose to, and will see the quality of their health care improve and their costs go down. My plan also addresses the large gaps in coverage that leave 47 million Americans uninsured.

Specifically, my plan will: (1) establish a new public insurance program, available to Americans who neither qualify for Medicaid or SCHIP nor have access to insurance through their employers, as well as to small businesses that want to offer insurance to their employees; (2) create a National Health Insurance Exchange to help Americans and businesses that want to purchase private health insurance directly; (3) require all employers to contribute towards health coverage for their employees or towards the cost of the public plan; (4) mandate that all children have health care coverage; (5) expand eligibility for the Medicaid and SCHIP programs; and (6) allow flexibility for state health reform plans. By mandating coverage for children, making health insurance affordable and
enrollment easy, my health care plan will cover every American.

How does your health care proposal pay for coordination of health care (e.g., email, consultation with other physicians, patient registries, non face-to-face visits)?

Under my plan, the medical system as a whole will save money; we will realize tremendous savings within the health care system from improving efficiency and quality and reducing wasted expenditures system-wide. Specifically, these saving will result from investments in health information technology, improvements in prevention and management of chronic conditions, increased insurance industry competition and reduced industry overhead, the provision of federal reinsurance for catastrophic coverage, and reduced spending on uncompensated care.

While the medical system as a whole will save money, respected economists’ estimate that my health plan will cost between $50 billion and $65 billion per year when fully phased in. The additional Federal costs of the subsidies would be paid for by allowing the Bush tax cuts to expire for people making more than $250,000 per year, as they are scheduled to do.

Does your health care plan provide for basic primary care and preventive medicine?

Too many Americans go without high-value preventive services, such as cancer screening and immunizations; less than 4 cents of every health care dollar is spent on prevention and public health. I support increased investment in prevention. My health care plan will include coverage of all essential medical services, including preventive, maternity and mental health care. It will require that plans that participate in my new public plan, Medicare or the Federal Employee Health Benefits Program (FEHBP) cover proven disease management programs as well. My plan will expand worksite interventions, work with schools to create more healthful environments for children, increase funding to ensure a strong workforce, expand access to clinical and community-based preventive services, and support state and local government efforts to promote prevention.

Why do you think health care costs are rising so quickly? What specific measures do you propose to curb this trend?

Health insurance premiums have risen 4 times faster than wages in the past 6 years, and increasing co-pays and deductibles threaten access to care. Many insurance plans cover only a limited number of doctors’ visits or hospital days, exposing families to unlimited financial liability. Nearly 11 million insured spent more than a quarter of their salary on health care last year. And over half of all personal bankruptcies today are caused by medical bills.

Health care spending is expected to double within the next decade. Though Americans spend almost twice as much per person as citizens of other industrialized countries, their health status is no better and by many measures actually worse.

I believe we must dramatically redesign our health system to reduce inefficiency and waste and improve health care quality, which will drive down costs for families and individuals. The health care plan I propose will improve efficiency and lower costs in the health care system by: (1) offering federal reinsurance to employers to help ensure that unexpected or catastrophic illnesses do not make health insurance unaffordable or out of reach for businesses and their employees (2) ensuring that patients receive and doctors deliver the best possible care; (3) adopting state-of-the-art health information technology systems; and (4) reforming our market structure to increase competition in the insurance and drug markets.

In particular, I will lower costs and improve the quality of health care by supporting disease management programs, coordinating and integrating care, and requiring full transparency about care quality and costs. Additionally, I will align incentives for care excellence, support comparative effectiveness reviews and research, invest in electronic health information technology systems, and reform medical malpractice while preserving patient rights.

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Health Care CoverageThere are more than 46 million Americans without health insurance today; why has the number of uninsured increased over the past decade?

Skyrocketing health care costs are making it increasingly difficult for employers, particularly small businesses, to provide health insurance to their employees. Nearly 47 million Americans—including 9 million children—lack health insurance. Eighty percent of the uninsured are in working families. Increased medical costs and economic conditions over the past decade have dramatically increased the number of Americans without health insurance, and even those with health coverage are struggling to cope with the increasing unaffordability of medical care.

Have you committed, or will you now commit, to making coverage for all a top priority of your administration if you are elected?

One of the very first commitments I made on my campaign was that, as president, I will sign a universal health care plan into law by the end of my first term in office.

Do you support a major overhaul of the health care system, or do you support incremental steps to widen coverage? Why?

I believe that every American has the right to affordable, comprehensive and portable health coverage. My plan will guarantee coverage for every American through partnerships among employers, private health plans, the federal government, and the states. The plan both builds on and improves our current insurance system, which most Americans continue to rely upon, and leaves Medicare intact for older and disabled Americans. Under my plan, Americans will be able to maintain their current coverage if they choose to, and will see the quality of their health care improve and their costs go down. My plan also addresses the large gaps in coverage that leave 47 million Americans uninsured.

Would you support an approach that provides everyone with full coverage for basic health services and catastrophic care, and allows people to obtain additional benefits through private insurance?

The new public plan described in my health platform as well as all existing public plans and private plans participating in the National Health Exchange will be required to include coverage of all essential medical services, including preventive, maternity and mental health care, and catastrophic care as well. Americans will be able to choose health plans that offer additional benefits.

Do you think health coverage for all can be achieved without mandating that each individual have insurance? If so, how?

I believe that the primary reason that uninsured Americans do not have insurance is because they cannot afford it, and not because they do not want health insurance. My plan will ensure that every American has access to truly affordable, high-quality health coverage. It does not include individual mandates to purchase insurance, but it does mandate coverage for children.

If we find that after the plan is implemented all Americans are not covered, we will look to see who is not covered and why and take appropriate action to make sure we get to universal coverage. We have the resources set aside in the plan to do whatever turns out to be necessary to cover everyone.

Do you support providing Health Savings Account (HSA) contributions to help people buy private insurance? Do you believe HSAs are an effective way to help cover the uninsured?

Health Savings Accounts may be a helpful way of saving taxpayers money in the current health care environment. But the current health care environment in unsustainable and health savings accounts don’t do nearly enough. In the long run, it’s going to take more than health savings accounts to provide the kind of comprehensive health coverage Americans need and deserve. That’s why I am committing to signing universal health care reform along the lines I have outlined above by the end of my first term.

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Electronic Health RecordsDo you support the development of grants and loan programs for small and medium sized practices to acquire an electronic health records system that allows physicians and other providers to have instant access to information on treatment options when treating patients?

Yes, it is essential that we modernize our health care system for the 21st century. Most medical records are still stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors. Processing paper claims also costs twice as much as processing electronic claims. I will invest $10 billion per year for five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records. Small providers and those serving rural and underserved populations will be prioritized for financial support.

How would your administration balance patient privacy concerns with the need for an electronic health records system?

The primary issue concerning health data collection and sharing will be ensuring patient control and confidentiality. The exact way this will happen will depend on the type of information systems that are adopted for various purposes. Regardless, part of the standard setting process, I will work with the private sector to ensure that electronic records are available when needed, but also confidential and under patient control.

Do you have an electronic personal health record? Why or why not?

[No response provided.]

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Workforce DevelopmentWhat is your plan to increase the number of medical students who choose family medicine and primary care?

Primary care providers and family medicine practitioners have and will continue to lead efforts to protect and promote the nation’s health. Yet, the numbers of both are dwindling, and the existing workforce is further challenged by inadequate training about new health threats such as bioterrorism and avian flu, antiquated funding and reimbursement mechanisms, and limited access to real-time information and technical support. To increase the number of medical students who choose family medicine and primary care, I will expand funding—including loan repayment, adequate reimbursement, grants for training curricula, and infrastructure support to improve working conditions—to ensure a strong workforce that will champion prevention and public health activities.

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Medical LiabilityDo you support a cap on non-economic damages in medical liability lawsuits as a way to help doctors afford to practice in our state?

Since my days as an Illinois state senator, I have been opposed to caps on jury awards for medical malpractice.

At what level? //Or// Why not?

I don’t support such caps because they do not reduce insurance rates and limit the rights of patients.

If you do not support a cap on lawsuits, what is your specific proposal to keep liability insurance affordable?

I recognize that increasing medical malpractice insurance rates are making it harder for doctors to practice medicine and raising the costs of health care for everyone. I will strengthen antitrust laws to prevent insurers from overcharging physicians for their malpractice insurance. I will also promote new models for addressing physician errors that improve patient safety, strengthen the doctor-patient relationship, and reduce the need for malpractice suits.

My administration will also ensure that insurance and drug companies are not abusing their monopoly power through unjustified price increases – whether on premiums for the insured or on malpractice insurance rates for physicians. I have introduced legislation in the Senate that would repeal the longstanding antitrust exemption for medical malpractice insurance.

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