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How the Election Could Impact Physicians

Elyas Bakhtiari, for HealthLeaders Media, October 9, 2008

When John McCain and Barack Obama talk about their respective plans for healthcare reform, they understandably focus almost exclusively on how patients will be affected. But what about physicians and other providers within the healthcare system?

Now that healthcare is becoming a more prominent issue in the presidential campaign, that's a question that needs to be answered.

The Senators' approaches are steered in part by their respective philosophies—at Tuesday night's presidential debate, Obama said healthcare "should be a right for every American," whereas McCain said it was a responsibility, but stopped short of calling it a right.

You can get into the nitty-gritty details of their proposals about issues like tort reform and EMR adoption on the Obama and McCain Web sites. But for now, let's consider how their two overarching approaches might impact how physicians practice.

Senator Obama's plan
In short, Obama wants to expand coverage through a combination of public and private options, including a new National Health Insurance Exchange that will offer insurance modeled on the Federal Employees Health Benefits Program. Although the plan is not universal, he would mandate coverage for children up to age 25.

How it might help physicians: Obama's approach could alleviate some of the burdens associated with uncompensated care by covering up to three-quarters of the current uninsured population, says Jonathan Oberlander, PhD, associate professor of health policy and politics at the University of North Carolina at Chapel Hill.

Uninsured patients who currently rely on the ED as their primary source of care would have better access to the preventive and primary care services that come with full health insurance. That could also boost practice bottom lines. Doctors who provide a lot of uncompensated care may start seeing revenue come in from patients who couldn't pay before, Oberlander says.

How it might hurt: We already have a pseudo-bellwether in Massachusetts. Although Obama's proposal doesn't mandate coverage for everyone, as the Massachusetts model does, the challenges may be similar.

The problem is a lack of resources to meet an increase in demand. Twelve of 18 specialties in Massachusetts are experiencing shortages, according to a work force study released this week by the Massachusetts Medical Society. Although there are a lot of factors involved—many of which are being seen across the country—the influx of insured patients has strained the understaffed healthcare system. Safety-net hospitals are struggling, and the average wait to see an internist is 50 days.

Obama offered "loan repayment, adequate reimbursement, grants for training curricula, and infrastructure support to improve working conditions" as strategies to boost the number of primary care physicians in a response to a questionnaire from the American Academy of Family Physicians.

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