The New England Journal of Medicine lent its pages to both President Obama and Governor Romney to present their health care visions for America. Unsurprisingly, the president promises to move energetically forward implementing Obamacare. From, “Securing the Future of American Health Care:”
If I am elected for a second term, I will follow through on all the work we have started together to implement the Affordable Care Act. I have also been clear that additional steps are needed. We need a permanent fix to Medicare’s flawed payment formula that threatens physicians’ reimbursement, rather than the temporary measures that Congress continues to send to my desk. I support medical malpractice reform to prevent needless lawsuits without placing arbitrary caps that do nothing to lower the cost of care. I also know we must continue to support life-sciences research and ensure that our regulatory system helps bring new treatments and tools to pharmacies, doctors’ offices, and hospitals across the country. I will keep Medicare and Medicaid strong, working to make the programs more efficient without undermining the fundamental guarantees.
Pretty vapid. Medical malpractice reform? That’s primarily a state issue no matter what federal candidates for office tell us. Moreover, Medicare cost containment will be made undemocratically by the appointed czars of the Independent Payment Advisory Board, which by the way, will not be subject to judicial review. Yikes!
Let’s see if Romney does better. From, “Replacing Obamacare With Real Health Care Reform:”
In the health care system that I envision, costs will be brought under control not because a board of bureaucrats decrees it but because everyone — providers, insurers, and patients — has incentives to do it. Families will have the option of keeping their employer-sponsored coverage, but they will also be empowered to enjoy the greater choice, portability, and security of purchasing their own insurance plans. As a result, they will be price-sensitive, quality-conscious, and able to seek out the features they want. Insurers will have to compete for their business. And providers will find themselves operating in a context where cost and price finally matter. Competition among providers and choice among consumers has always been the formula for better quality at lower cost, and it can succeed in health care as well.
To achieve this aim, we must end tax discrimination against persons purchasing insurance, we must strengthen and expand health savings accounts, and we must establish strong consumer protections. The result will be patients who can confidently choose the coverage that is right for them, who know and care what health care costs, and who reward providers that deliver effectively. For this choice to be meaningful, insurance market reforms must promote competition by eliminating onerous mandates, facilitating purchasing pools, and opening up an interstate market.
That is a far more efficacious prescription. Why isn’t Romney making a bigger point of this in his campaign?
As I wrote here, Obamacare is the cornerstone for the construction of an EU-style democratically unaccountable bureaucratic state. Obama wants to accelerate the transfer of power to the Feds. Romney wants to decentralize. That is a distinction with a meaningful difference determining the future of American federalism.