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How the Election Could Impact Physicians

Elyas Bakhtiari, for HealthLeaders Media, October 9, 2008

The question, however, is timing. Insurance coverage can be expanded relatively quickly, but it will take years to train enough primary care doctors. Will the current work force be able to handle the higher patient demand in the meantime? Will costs continue to skyrocket? A recent analysis in Health Affairs criticizes the Obama plan for failing to address the economic incentives that drive healthcare spending.

Senator McCain's plan
The McCain plan is in many ways more unique and a bigger change than Obama's. It seeks to shift health insurance purchasing from the employer to the individual by offering individuals a $2,500 tax credit ($5,000 for families) to purchase private health insurance. It will also adjust regulations to allow people to shop for insurance across state lines.

How it might help physicians: McCain wants to "unleash the market and promote competition in the healthcare system," Oberlander says. Physician groups that have made strides toward transparency and catering to healthcare consumerism will continue to do well.

McCain's plan could also expand coverage by making private insurance more accessible, although that has been highly debated.

How it might hurt: One source of that debate was the same issue of Health Affairs that critiqued Obama's plan. McCain may offset his tax cuts by eliminating "the current tax exclusion of employer payments for health coverage," which the authors argue could push individuals away from employer-based insurance and expand, rather than decrease, the number of uninsured within five years.

The bigger question that has yet to be answered is how McCain's promise to allow insurance shopping across state lines would affect physician-payer relationships, as well as the overall system.

"Of course it's OK to go across state lines because in Arizona they may offer a better plan that suits you best than it does here in Tennessee," McCain said during Tuesday's debate.

But how will that affect the physician group in Tennessee whose patient population relies on one or more of the major payers in the state? Will physicians now have to negotiate contracts across state lines with dozens of companies all across the country? Will insurers adjust reimbursement rates to reflect variable costs in different locations? Will disputes and regulations be handled by the physician's state, the insurer's state, or the federal government?

"I would project that the number of doctors taking Tylenol would increase because the administrative headaches have to go up," says Oberlander. "There's already the madness of dealing with the insurers in your own state. Now you're going to take on other states' madness?"

The bottom line
Each of the plans raises questions, and neither completely addresses problems of coverage and costs, both of which are crucial elements to healthcare reform.

But from what I can gather, physicians tend to agree with the Senator from Illinois. A group called Doctors for Obama claims it is the largest number of physicians to ever endorse a candidate for political office, and as of this writing 7,369 doctors and medical students have signed their letter supporting Obama's plan.

But that's all the information I have—political pollsters unfortunately don't single out physicians. What do you think? Do you support one plan over the other, or do you think both are flawed? send me an email with your thoughts.


Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
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