American College of Physicians: Internal Medicine — Doctors for Adults ®


ACP members champion their presidential candidates

From the October ACP Observer, copyright 2004 by the American College of Physicians.

Bush: a strong record on tort reform

By Ned Snyder, FACP

I believe that as president of the United States and as governor of Texas, George W. Bush has a more compelling record than his opponent on key issues for internists.

Like ACP, for instance, President Bush fully supports comprehensive tort reform, including caps on noneconomic damages. The malpractice environment in many states has increased our overhead costs and caused an access crisis in many specialties. It has also changed our practice culture to one of defensive medicine—a major obstacle to our goal of providing cost-effective, quality care.

I believe the best solution is a federal one. President Bush has supported tort reform legislation that would limit noneconomic damages and discourage frivolous lawsuits. While the House of Representatives has passed tort reform, the Senate has defeated tort reform bills on two separate occasions. Both Sen. John Kerry (D-Mass.), the Democratic presidential candidate, and his running mate, Sen. John Edwards (D-N.C.), were vocal opponents.

I look forward to seeing more tort reform legislation introduced in upcoming Congressional sessions, and I believe our best hope for getting that legislation passed is to continue to have strong pro-reform leadership.

Boosting physician pay

Many internal medicine practices are now filled with older patients, while general internists face tough economic times because of dwindling reimbursements. Once again, President Bush has been on our side.

The Bush administration has successfully backed two bills that have averted cuts in Medicare fees for physicians. Sen. Kerry, on the other hand, was one of 29 senators in January 2003 who voted against an omnibus spending bill that halted a 4.4% decrease in physician fees in 2003.

And late last year, Sen. Kerry did not support the Medicare Modernization Act of 2003 that turned a scheduled 4.5% physician pay cut for 2004 into a 1.5% increase—and assures a 1.5% increase for 2005. President Bush worked hard to get that bill passed, one that will also give needed drug benefits to seniors beginning in 2006.

As governor of Texas, President Bush worked with physicians on several practice-related issues. During his tenure, for instance, the Texas legislature passed a prompt pay bill as well as one of the nation's first patients' bill of rights.

And as president, Mr. Bush has focused national attention and resources on the need for interoperable information technology. The administration strongly supports a bold health information technology initiative endorsed by ACP and headed up by one of our own, internist David J. Brailer, MD. The initiative is designed to create a national information technology network that will allow us to improve health care quality and reduce medical costs.

And President Bush has been a friend of medical research. During his administration, funding for the National Institutes of Health (NIH) has doubled, with $28.6 billion requested for the NIH this year.

Moreover, the administration is funding embryonic stem cell research. In fiscal 2003, $25 million in NIH funds were allotted to embryonic stem cell research, while an additional $496 million will be spent on other forms of stem cell research.

Helping the uninsured

The number of Americans without health insurance has grown steadily under both Presidents Clinton and Bush. Neither president, I believe, is responsible for that troubling trend. Instead, the ranks of uninsured Americans have swelled because health care coverage has simply become too expensive for many individuals, families and small businesses.

Neither of this year's presidential candidates advocates for nationalized health care. And realistically, given budget deficits and the cost of the war on terror, it is difficult to imagine the federal government being able to commit major funds to expand coverage in the short term.

But both candidates have proposed plans. I believe Sen. Kerry's proposals rely too heavily on a large expansion of Medicaid while they reintroduce the concept of "managed competition." In Sen. Kerry's plan, all of the dollars flow to the government, insurance companies and employers.

I don't think we'll ever arrest health care costs unless we put the patient back into the equation. The Bush administration's plan stresses individual health savings accounts (HSAs). The plan would give individuals in small businesses—which employ half of all uninsured Americans—incentives to create HSAs. The plan would also subsidize low- and moderate-income Americans to help them purchase health insurance.

The Bush plan for expanded care also stresses developing community health care centers to provide care for low-income patients. And it encourages civic and religious groups, as well as small businesses, to ban together to buy group health insurance.

Because of the policies he's pushed for in his first term and the plans he's laid out for his second, I believe President Bush deserves our vote.

Ned Snyder, FACP, is a gastroenterologist and professor of medicine at the University of Texas Medical Branch in Galveston, Texas. Having served as president of the Texas Academy of Internal Medicine (ACP's Texas chapter) from 2002-2003, Dr. Snyder continues as an Academy board member.

For more information on President Bush's health care platform, go online.

Kerry: ambitious access proposals

By N. Thomas Connally, FACP

One of the biggest challenges facing our country and profession is the growing number of uninsured patients. Under the current administration, that figure jumped in 2003 to a record 45 million people nationwide—an increase of 1.4 million over the previous year.

Sen. John Kerry (D-Mass.), the Democratic presidential candidate, wants to end that coverage crisis and make quality insurance affordable for all, including low-wage earners and those who work in small businesses.

Under his proposed plan, the federal government would pay 75% of claims that exceed $50,000—coverage that would reduce the cost of individual and family benefits by up to $1,000 per year. That coverage would also ensure that small business owners are not unduly burdened if one employee becomes severely ill.

To help make coverage more affordable, Sen. Kerry also proposes to offer tax credits to low-income workers, those between jobs, and those between the ages of 55 and 65, a difficult age group to insure. ACP has enthusiastically backed a similar set of coverage proposals in its seven-year plan to expand health care coverage by the end of this decade.

Sen. Kerry would pay for these proposals by rolling back the Bush administration's tax cuts that benefit only the wealthiest Americans. The senator would use that same tactic to pay down the federal deficit, which now stands at a record $422 billion and threatens to cripple the integrity of other vital federal programs.

Under Sen. Kerry's proposals, more than 27 million Americans who now lack health care benefits would be covered. By contrast, coverage proposals put forward by the Bush administration would cover only 2 million to 6 million Americans.

Patients' rights

Sen. Kerry would also continue his vigorous support for real patients' bill of rights legislation to allow patients to fight HMO decisions and protect "whistleblowers" who report health care quality problems.

Federal legislative protection is even more necessary now that a recent Supreme Court decision effectively made it impossible for patients in states with bill of rights laws to hold health plans accountable for their coverage decisions. Both physician and consumer groups have been lobbying for this bipartisan legislation for years, but the Bush administration and the insurance industry continue to oppose it.

Because Sen. Kerry wants all Americans to have access to affordable health care, he opposed the Medicare Modernization Act of 2003. While the law, on its surface, purported to give drug benefits to seniors, Sen. Kerry believes it effectively subsidized health plans and drug companies at seniors' expense.

Because some Congressional leaders and the Bush administration pushed for that flawed bill, the federal government is now prohibited from negotiating with pharmaceutical companies to get lower drug prices for Medicare patients. By the time the drug benefit kicks in in 2006, if drug prices continue to rise between 12% and 15% a year, many of the benefits seniors were supposed to receive under the new law may be negated.

Sen. Kerry believes that is unacceptable. As president, he would want the Centers for Medicare and Medicaid Services to negotiate reasonable drug discounts with pharmaceutical companies, and he would institute other measures to ensure that Americans have access to affordable prescription drugs.

Sen. Kerry also has a plan that will help curb rising Medicare administrative costs and work to eliminate waste by modernizing our health care system. He is calling for secure, private medical records for all patients by 2008, and he wants to give physicians financial incentives to adopt information technology.

Liability reform and research

Over the past several months, I've spoken with Sen. Kerry three times. In two of those conversations, he has raised with me his concerns about medical liability insurance problems.

As senator and now as a presidential candidate, Sen. Kerry supports a state system of mandatory arbitration before medical liability cases go to trial. He wants to make sure that no case is filed without a certified expert witness testifying that the case has merit.

He also supports suspending lawyers who file three frivolous suits, and he opposes punitive damages unless there is intentional misconduct, gross negligence or reckless indifference to life.

And finally, Sen. Kerry understands the importance of basing clinical guidelines, health care policy and coverage decisions on science, not ideology.

He knows that unfettered scientific research will lead to medical advances and a stronger, more competitive economic future for all Americans. He will not let politics or the narrow views of a small group of supporters hinder research that could one day save lives.

Our profession needs a president who understands the full range of complicated issues we tackle every day. As individuals—and as a medical community—I believe we should choose Sen. Kerry to be that leader.

N. Thomas Connally, FACP, practiced general internal medicine in Washington for 30 years before retiring four years ago. A former professor of internal medicine at Georgetown Medical School, Dr. Connally remains active in ACP, serving on several boards and committees.

For more information on Sen. Kerry's health care platform, go online.


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