What does the Election of Barack Obama Really Mean for Health Care

We have chosen Barack Obama as our next President! This means that his proposal for how to reform health care will certainly set the tone for our discussion about how to improve quality, cut rising costs and extend medical coverage to about 45 million additional Americans.

Since any proposal must be submited to Congress, it is reasonable to assume that elements of Obama's proposal may well be modified, but at the core of his proposal are principles that would change health care delivery and coverage in the U.S.

The cornerstones of Obama's plan are:

• Expand Medicaid eligibility to include greater numbers of the uninsured
• Mandate coverage for children
• Create a national exchange where uninsured folks can purchase a public or private policy;
  
• Provide subsidies to lower-income individuals and small businesses to help defray the cost of purchasing insurance; and,
• Tax medium and large-size employers that decline to provide their employees with health insurance.

Of crucial importance in all of this is the need for us to remember that quality of care, and value for the money we spend, must be improved dramatically for any plan to be truly successful. Obama has chosen great advisers who understand this, but there is great danger that economic concerns could drive attention into only cost cutting steps, without insuring that we adequately pay for improved access and provision of primary care services. We could do the most to improve access and quality, while simultaneously lowering costs, by supporting legislation requiring all plans to provide payment for the personal medical home. Simply expanding programs like Medicaid, without this type of reform, will fail, since they do not pay primary care physician adequately for providing the care!

We have discussed the specific benfits of the personal medical home previously, and it is important to remember in a time of scarce resources, that by supporting the provision of primary care first, we are supporting the only thing that has ever been shown to be associated with both improved quality and decreased cost of medical care! Although well intentioned, throwing more money at our current health care mess will be bound to dissapoint us, by making more people eligable for the dysfunctional, and unorganized type of care that is currently bankrupting us.

Is there a Health Plan proposal that stands out in the Presidential Race? I think so!

On October 23, 2007 , Democratic Presidential Candidate Sen. Joseph R. Biden Jr. of Delaware unveiled a health care plan that would provide health insurance for all children, provide more coverage options for adults, and focus on disease prevention and modernizing the nation's health care system.

Biden's plan would permit uninsured Americans to buy into an insurance program similar to the one that provides health care benefits to federal employees and members of Congress. People would pay on a sliding scale based on income. Biden's proposal would continue the Medicare program, and inaddition, allow people between the ages of 55 and 64 to buy into the Medicare program, with the federal government providing a subsidy to low-income individuals.

The State Children's Health Insurance Program (SCHIP) would be expanded to children in families with incomes of 300 percent of the federal poverty level or below. This equates to $61,950 for a family of four, and coverage to children in the family would be extended to at least age 21. Biden's plan also would have the federal government "reinsure" 75 percent of the cost of catastrophic health costs for cases exceeding $50,000 per individual, in order to help keep the cost of the commercial plans low.

Senator Biden has said that if he is elected, he would convene a meeting, within the first 90 days of his administration, with all players involved in health care, in hopes of making coverage both universal and affordable. "Getting this done will require the kind of experience and leadership that comes from years of success corralling bipartisan support for numerous issues," he said. "I have that experience and it will prove invaluable when I am president."

Here are some other important elements of Biden's plan:

• Eliminate co-payments for physicals, vaccinations, vision and hearing screenings, and preventative dental checkups for children of all income levels.
• Prohibit employers and insurers from collecting or using genetic discrimination when making decisions about hiring or providing health care coverage, including the cost of a policy.
• Invest at least $1 billion yearly to help hospitals, physicians, and other health care providers move to electronic health records systems.
• Add 100,000 new nurses to the workforce in the next five years and establish scholarship and loan repayment programs to encourage people to join the public health workforce.

After reviewing all of the plan proposals from the Democratic and Republican candidates for president that have so far been released, this plan seems like the best to me! It combines the strengths of our private insurance system with intelligent government subsidy for those who need it. It also encourages access to needed types of primary care in order to improve quality and decrease cost. It addresses a growing problem of older adults not yet able to join Medicare, ensures treatment for children, and covers the large group of younger adults who are ignored by most other proposals. Most importantly, this plan avoids the "false choice" between pouring more money into our dysfunctional current system, or going to a government take over of health care. It is an intelligent middle way, that includes important reforms along with intelligent funding.

One of my adult daughters has given money to the Biden campaign based on her support of this proposal, and I hope this plan receives a great deal of attention and debate!

Click here to read more from the Biden Campaign