In the candidates’ own words …

While there is nothing wrong with the links I posted earlier, this is the Bush/Kerry comparison I wanted all along.

A poster at last week’s Medical Group Management Association annual conference compared the healthcare proposals of both presidential candidates, based on answers each campaign provided to a series of questions. With permission of and credit to the MGMA, specifically Rob Tennant, Dave Gans and Liz Johnson, the full text appears below.

I know it’s unrealistic to say these really are the “own words” of Bush or Kerry, but these at least have their approval. No additional spin has been applied.

Let the debating begin.

2004 Presidential Candidate Questionnaire

The MGMA Government Affairs Committee developed and submitted the following questions affecting medical group practices to the presidential campaigns.

Q: Every year it costs physician practices more to care for patients, but Medicare’s reimbursement formula keeps lowering physician rates. If you are elected, how will your administration change the way Medicare updates physician reimbursements to ensure they keep pace with the rapidly rising costs of caring for patients?

PRESIDENT BUSH: The Medicare bill I signed into law has helped reform the physician and hospital payment system. The law increases Medicare funding for doctors, hospitals, and other health care providers, especially in rural areas, where reimbursement levels are far below what is paid in other regions of the country. Last year, I signed into law two pieces of legislation that averted what would otherwise have been three consecutive across-the-board reductions in Medicare payments to physicians, and instead increased Medicare reimbursement. Clearly, the statutory formula used to compute Medicare payments to doctors must be reviewed to assure that beneficiary access to physician care is preserved.

SENATOR KERRY: While I believe that controlling the soaring cost of health care is essential, I agree that arbitrary cutbacks to physicians is not the answer. The underlying problem for physicians is that the sustainable growth rate (SGR) method used to establish Medicare’s payment rates for physicians’ services is fundamentally flawed. This methodology ties physician payments to the GDP, which bears no relationship to patients’ health care needs or physicians practice costs. Left untouched, it would have already resulted in dramatic decreases in physician reimbursement rates under Medicare. Despite policymakers’ actions to prevent such reductions in 2004-2005, the SGR method will again be used to establish payment rates in 2006, resulting in even more dramatic reductions in the physician fee schedule for 2006-2012.

Most physician offices are small businesses that cannot absorb big payment reductions such as that experienced by physicians in 2002. That’s why I voted for relief and as president, I will work to revise Medicare’s reimbursement formula.

Q: In order to address the medical liability crisis confronting medical practices, do you support a federal limit on non-economic damages? If not, what federal reforms do you propose to relieve the exorbitant insurance premiums that are forcing some physicians to relocate or stop performing certain procedures?

PRESIDENT BUSH: Our Nation’s litigation system is broken, and trial lawyers are clogging the courts with frivolous, time-consuming lawsuits, driving up the cost of doing business, costing doctors and nurses their jobs, and preventing patients from making decisions regarding their care. We need to reform the legal system to ensure that it is fair and just, that every person has his or her day in court, and that baseless litigation no longer hinders our economy’s growth.

Medical liability reform is needed to control the cost of medicine and ensure that patient care is the central concern in all medical decisions. Right now, qualified medical professionals are being forced to raise costs, practice defensive medicine, and even close their practices altogether. This hinders their ability to provide affordable, quality care to patients. I have proposed a reform plan that will reduce the number of frivolous lawsuits, lower health care costs for businesses and employees, and help maintain strong doctor-patient relationships. My proposal would ensure that injured persons are fully compensated for their economic losses, while reasonably limiting non-economic damages to $250,000. It would also reserve punitive damages for cases in which they are justified, ensure that old cases cannot be brought years after an event, and provide that defendants should pay judgments in proportion to their fault.

SENATOR KERRY: I have great concern for the rise in medical malpractice insurance premiums across the country. I will promote efforts to reduce unnecessary lawsuits by requiring that a qualified specialist certifies a medical malpractice case’s merit before it is allowed to move forward. I will also work with states to ensure the availability of non-binding mediation in all malpractice claims before cases proceed to trial. Under my proposal, lawyers who file frivolous cases would face tough, mandatory sanctions, including a “three strikes and you’re out” provision that forbids lawyers who file three frivolous cases from bringing another suit for the next 10 years. I also oppose punitive damages — unless intentional misconduct, gross negligence, or reckless indifference to life can be established. I will also hard work to eliminate the special privileges that allow insurance companies to fix prices and collude in ways that increase medical malpractice premiums.

Q: Health information technology promises to greatly reduce expenses and streamline the collection and clinical utilization of information while ensuring patient confidentiality. With this technology in place, medical group practices could provide better quality patient care while lowering overall healthcare costs. How would your administration ensure that medical groups have timely and cost-effective access to this vital technology?

PRESIDENT BUSH: I believe health information technology will improve patient care, save lives, and save money. At the same time, security and privacy of electronic medical records will be more secure and private than paper-based records. Health information technology also offers much greater access to and control of health records by consumers themselves.

Expanding the use of health information technologies will enhance the delivery of care in our health care system. I have set a goal that within 10 years most Americans will be able to access their health records electronically. I have doubled the funding for grants that support Health IT, and created the new Office of the National Coordinator for Health Information Technology to help facilitate the move to electronic medical records. My Administration continues to work with the private sector to develop the technical standards that will make it possible for different health care providers to share and store personal medical records across health care settings and across the country. And my Administration is looking at ways to leverage our role as a payer to incentivize health professionals to adopt these technologies.

SENATOR KERRY: In the health care system, inefficiency and negligence can lead to serious injury and even death — as well as higher costs. The recent Institute of Medicine study found that between 44,000 and 98,000 people die of medical errors every year. These tragedies are preventable. The vast majorities of injuries are not caused by negligent doctors or hospitals, but because of outmoded practices, habits and systems that fail to adequately protect patients from harmful errors. We must do more to upgrade these systems.

Approximately $350 billion is spent on non-medical costs — principally the costs of the paper work burden, including those costs associated with the preparation, submission, calculation and payment of bills. We will cut administrative costs by ensuring electronic paperless claims. We’ll also encourage greater use of technology to simplify and streamline paperwork so doctors can spend more time with patients and less time filling out forms.

My health care plan offers a “quality bonus” that will enable purchasers and providers to use upfront capital to upgrade quality and reduce errors to improve outcomes. It will also ensure that health care organizations and physicians that invest in advanced information technology are rewarded with financial incentives, including the funds needed to install computerized prescribing systems, which can reduce medication errors by 80 percent or more. Our health care systems are in desperate need of this sort of innovation, and I am committed to making these advances affordable and available to medical group practices.

Q: In addition to hospitals, many medical groups treat large numbers of uninsured patients. How would your administration enable more uninsured patients to be treated and the costs associated with those patients reimbursed?

PRESIDENT BUSH: I am working to make health care more affordable and accessible to all Americans. I want more Americans to have insurance, and all Americans to get the care they need when they need it. I have a comprehensive plan to make health care more affordable and accessible to all. The Medicare bill that I signed into law increases payments to hospitals, especially those in rural areas, by $25 billion over 10 years, and provides an additional $1 billion in Medicare payments to compensate hospitals for emergency care provided to undocumented aliens.

My Administration has made tremendous progress in providing millions of children health coverage for their healthcare needs. The Department of Health and Human Services has helped states to expand coverage through the Medicaid and SCHIP programs, expanding eligibility to 2.6 million people and improving benefits to over 8 million since 2001.

In addition, my health care agenda includes new options to help millions of uninsured Americans obtain coverage. We have enacted Health Savings Accounts that allow Americans to pay for routine medical care and save for future expenses with tax-free savings accounts. To extend the benefits of HSAs to low-income Americans, I have proposed giving families a $1,000 direct contribution to their HSA, along with a $2,000 refundable tax credit to help purchase a policy to cover major medical expenses. I have also proposed tax credits to small businesses that help their employees set up HSAs.

More than half of the uninsured are small businesses, employees, or their families. I have called for Association Health Plans to help small businesses pool together to negotiate for more affordable health coverage for their employees, like large employers and unions currently do. I believe this innovative approach to affordable care should be extended to civic groups and other community organizations as well.

A great deal of uncompensated care is from the uninsured accessing emergency rooms and other providers for routine care. I have opened or expanded more than 600 Community Health Centers to deliver primary and preventive care to 3 million additional low-income and uninsured Americans. This takes a significant burden off of hospitals and medical groups. We are on track to meet my goal to open or expand 1,200 Community Health Center sites to serve 6.1 million new patients by 2006. In my next term, I will work to ensure every poor county in need has a community or rural health center.

SENATOR KERRY: John Edwards and I believe that all American families are entitled to the security and peace of mind that comes from knowing their families have the coverage they need to stay healthy — without breaking the bank. In addition, medical groups must not be stuck with an unfair share of the burden for caring for these individuals, as is too often the case. We are all in this boat together, and we must find a solution quickly.

Over the last three years, the cost of family health insurance has increased by more than $2,600, and the portion paid by families has increased by almost 50 percent. Even today, millions of children lack basic coverage. We have a plan to cut health care costs for families, cut waste from the system, and ensure access to reliable, affordable coverage for 95 percent of Americans, including every American child.

Cut Family Premiums By Up To $1,000: For American Workers. Under our plan, employers will benefit from offering their employees quality care with choices. By helping out with certain high-cost cases, our plan will cut premiums by up to $1,000 per year for America’s families.

Cover All Children And Millions More Adults: By extending state-based programs, we can pick up the full cost of coverage for the more than 20 million children enrolled in Medicaid. In exchange, states would expand coverage for families up to 200 percent of poverty and for childless adults up to 100 percent of poverty. As a result, our plan will extend reliable coverage to:

  • 26.7 million Americans who are currently uninsured
  • 95 percent of all Americans
  • Every child

Help All Americans Buy Into The Same Coverage As Members Of Congress: Our plan will give all Americans access to the same range of affordable plans currently available to members of Congress. This will provide more choices and better, more affordable coverage than is generally available to people without high-quality, employer-sponsored insurance.

Cut Taxes To Make Health Insurance More Affordable: Our plan will provide $177 billion in tax credits to make health care more affordable for people and businesses that buy into the new Congressional Health Plan. These credits include:

  • A 25 percent credit for seniors aged 55 to 64 whose salaries fall below 300 percent of poverty.
  • A 75 percent credit for people between jobs and whose salaries fall below 300 percent of poverty.
  • A tax credit of up to 50 percent for small businesses that cover low-to-moderate income workers.
  • A tax credit for workers not eligible for other provisions of our plan. This credit would limit premiums to less than 6 percent of income for workers below poverty, then phase out to 12 percent of income for workers at 300 percent of poverty.

© 2003 – 2004 Medical Group Management Association. All rights reserved.