Obama vs. McCain: Readers Weigh In

Elyas Bakhtiari, for HealthLeaders Media, October 30, 2008

I received more e-mail from readers about my recent column covering the Obama and McCain healthcare reform plans than anything else I've written this year.

With less than a week until the election, I'd like to share some of that feedback so you have a fuller picture going into the voting booth (some of the e-mails have been edited for length):

  • A physician writes: "Do either of them have physician advisors? I am curious as to how they can revamp the system without input from physicians—primary care, surgeons, and specialists. They want us to give care but are not seeking our input.

    We are adversely affected also by the poor economy because we cannot get loans and our patients are increasingly unable to pay us, and of course our reimbursements continue to plummet. Is either candidate going to do something about plummeting reimbursements? If not, the physician shortage will get worse. Are they even aware of the impending physician shortage? There should be arrangements made for all physician specialties, not just primary care."

  • A cardiovascular business consultant writes: "The one factor that everyone keeps silent on is the funding of Obama's plan. You may have greater access for all citizens up to 25 years of age like you mentioned, and the physicians will be paid for their services, but your take-home pay as a physician will be stagnant at current levels or may actually decrease through all the taxes required to fund such a program as well as his other initiatives.

    As with the financial crisis—the money has to come from somewhere. Physicians are interested in the bottom line, not just that they will get reimbursed—and you failed to mention at what level the reimbursement will be for the services provided. Reimbursement doesn't directly translate into higher take-home pay."

  • Betty Via, who has worked in healthcare since 1983, writes: "After trying to become acquainted with both the Obama and McCain proposals, I know they both have challenges. As of this writing I tend to believe that Obama's plan is better for numerous reasons.

    Providers have difficulty now when a patient has an out-of-state plan because the local carriers can't answer questions and because the computer systems don't integrate and read each other. Imagine not being able to get benefit and claims information routinely. The McCain plan has not been thought out. The Obama plan may need some work and definition, but I believe that it will be easier for providers and also the patients.

    Health insurance may not be a right, and it absolutely should not be a privilege, but it should be a "shared' responsibility. By that I mean individuals and government alike should share in creating plans that insure people at reasonable rates and "pre-existing" and people termed "uninsurable"(survivors of a terrible illness) should be language that disappears from the American vocabulary.

  • Ronald T. Libby, professor of political science at the University of North Florida writes: "The larger issue has to do with the out-of-control costs of healthcare in the country. We cannot afford what is currently mandated for Medicare and Medicaid let alone future expansion of these programs.

    Inevitably, there are only two solutions. One is to ration healthcare, which is what the Canadian and European social democracies do, or we must transfer some of the costs onto patients. We simply cannot provide unlimited, free healthcare to everyone without destroying what is widely acknowledged as the best healthcare system in the world."

  • An anonymous reader writes: "Neither candidate has a clue how to fix healthcare. It is too big a problem to fit in a sound bite. The country cannot afford to simply insure everyone without a dramatic change in how healthcare dollars are spent. Not every headache needs a CT scan, not every backache needs an MRI. Evidence-based medicine would lower costs quickly.

    Doctors should be incentivized to do procedures in their office rather than the hospital or surgery center. There are also many examples of routine testing which I will bet are not cost effective. Teaching kids how and what to eat would help a lot. Stressing normal weight with healthy eating would lower blood pressure and cholesterol, decrease back problems, enhance self esteem, decrease sleep apnea, and decrease heart disease, cancer, and other illnesses. Kids don't even take Phys Ed anymore. Anyway, it's a large, complex problem. The politicians do not want Americans to think they cannot have it all when it comes to healthcare, but that is the truth."

One final note: I came across a study a while back suggesting physicians have lower voter turnout rates than the general public. That, to me, is mind-boggling considering physicians' livelihoods are so heavily influenced by state and federal government decisions. Even if you don't agree with either presidential candidate, there are a lot of down-ticket positions and ballot issues being decided next week as well.

So vote.

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