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McCain: control costs, ensure access.

For the past several months I have closely followed the health care policies of Sen. John McCain (R-Ariz). I am impressed how the senator places the individual--patient and physician--at the center of this policy. The McCain plan is not simply about insurance or government programs. It is about opening more doors to more Americans when they find themselves in need of health care. Those with insurance, and those without, will see new choices and new options.

The single biggest threat to our health care system is rising costs. Sen. McCain's plan has a set of comprehensive policies that will bring these costs under control and ensure access to affordable care for all Americans. He will accomplish this by promoting research and development of new treatment models, encouraging wellness and prevention initiatives, rewarding quality and coordinated care, investing in technology, and empowering Americans with better information.

Sen. McCain recognizes the discriminatory aspects of our tax code, and proposes changes that level the playing field. Everyone would be treated equally. A refundable tax credit of $5,000 for families and $2,500 for individuals would create more choices, including keeping one's current coverage. Nothing changes as to the tax treatment for the employer. If there was value in providing insurance coverage to employees in the current system, there would be no reason not to continue. On the individual side, the tax break simply moves from being an invisible exclusion to a visible, direct, and portable credit.

So most families with employer-sponsored coverage would see little to no change under the McCain plan. In fact, this generous credit will give additional help to millions of middle-class American families for medical expenses. However, for the first time, those without employer-based coverage, or those with no coverage at all, will have a refundable tax credit to help purchase the insurance coverage of their choice.

Going from a world that discriminates to a world that works is important to Sen. McCain. In addition to retaining the benefit for employer-sponsored insurance, Sen. McCain believes that no American should be denied access to quality and affordable coverage simply because of a preexisting condition like cancer. This is a very important priority in his health care plan. And to make sure people get the high-quality coverage they need, Sen. McCain has proposed a Guaranteed Access Plan that will combine industry, state, and federal resources to help in the purchase of coverage for those hardest to insure, including those with preexisting conditions. There would be limits on premiums, and lower-income Americans would get additional financial assistance.

Cooperation among states in the purchase of insurance would also be a crucial step in ridding the market of both needless and costly regulations, and the dominance in the market of only a few insurance companies. Sen. McCain will break down these barriers to competition, creativity, and excellence with the goal of establishing a national market to make innovative policies and lowest prices available to every person in every state. It makes no sense that an individual in Maryland must pay a higher premium than an individual who lives in the District of Columbia. This type of discriminatory practice must change, and there would be concentrated interest from Sen. McCain to see these changes occur.

If we continue to cling to the ideas of the past, the only opportunity for savings comes in the form of cuts in provider reimbursement. Jonathan Oberlander, Ph.D., writing on the cost of Sen. Barack Obama's national plan, said "its effectiveness in slowing spending would depend on ... the political willingness to restrain provider payments" (N. Engl. J. Med. 2008;359:781-4).

I hear from my physician friends: "I just want to see patients, and yes, I do need to be paid like anyone else operating a small business." Most don't care what the source of payment is, whether it's a government entity, private insurance, or the patients themselves. Doctors operate in a high-stress environment, and as a consequence ask that the "hassle factor" be kept to a minimum. And continued cuts definitely constitute a hassle.

Patients generally want to have care when it's needed, and most are willing to pay for some portion of their care, or some amount each month to have the availability of the service. But what they are disinclined to do is to pay and pay and pay, and then be denied coverage when they need it the most. And they are concerned about continued cuts in reimbursement limiting their access to their doctors.

Frequently I hear policy makers quote doctors in saying "first, do no harm." This is a reasonable philosophy that has carried many of us through our medical careers. But there is another phrase one used by Alpha Omega Alpha, the medical honor society that designates someone as "worthy to serve the suffering." In my opinion, the plan proposed by Sen. McCain provides for both of these lofty ideals.

REP. BURGESS (R-Tex.) is an ob.gyn. and a volunteer adviser to McCain Palin 2008.

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Author:Burgess, Michael C.
Publication:OB GYN News
Date:Oct 1, 2008
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