羅姆尼的醫療政策對美國醫生有什麽好處

Introduction

Mitt Romney's healthcare approach would be better for America's physicians because it would unleash free-market forces to let doctors deliver quality healthcare, give consumers more private insurance choices, and drive down costs in both private and public insurance programs, say many conservative physicians.

Some physicians who favor Romney say that he will bring positive changes for physicians and the practice of medicine:

• Many physicians backing Romney ardently support his call for repealing President Obama's Affordable Care Act (ACA), which they see as destructive to US healthcare.

• Doctors like Romney's proposal to encourage individual ownership of health insurance by giving people an income tax deduction for premium payments.

• They favor his ideas for deregulating insurance by letting out-of-state insurers sell policies nationally without having to meet state benefits, and boosting high-deductible health plans by letting people pay premiums out of their tax-free health savings accounts.

• And they love that Romney wants to curb medical malpractice lawsuits and reduce defensive medicine by capping noneconomic damages.

These conservative doctors may represent the majority view of physicians. A randomized national survey of 3660 doctors in September 2012, conducted by healthcare staffing firm Jackson & Coker, headquartered in Alpharetta, Georgia, found that 55% of physicians said that they would vote for Romney while 36% would vote for Obama.^[1] Male doctors, who comprised 72% of respondents, were far more likely to support Romney, while female doctors, who comprised 28%, were evenly split between the 2 candidates. The percentage who said that the ACA should be repealed and replaced was 55%, with 40% saying that it should be implemented and improved.

Romney supporters admit to some reservations because as Governor of Massachusetts, Romney passed a state healthcare reform law that served as the model for the federal law. Still, supporters say that, on balance, he would be far better than Obama for doctors.

Indeed, some conservatives admit that their presidential vote on November 6 will be as much anti-Obama as pro-Romney. "We have to repeal that monstrous law [the ACA]," says Robert Sewell, MD, a solo practice surgeon in Southlake, Texas, who represents the American Society of General Surgeons in the American Medical Association (AMA) House of Delegates. "I have to take Gov. Romney at his word that, if elected, he would do that. In that case I'm a supporter of his."

Physicians Who Are Staunch Romney Supporters

Others are more ardent in their support for Romney. "Romney wants to restore the doctor-patient relationship and have healthcare decisions made by patients in conjunction with their doctor, not by a panel of government-appointed bureaucrats," says Scott Atlas, MD, a Stanford University neuroradiologist and Hoover Institution senior health policy fellow who is advising the Romney campaign.

"He focuses on improving private insurance options rather than shifting millions of people into government insurance. That's good, because doctors in general don't want to practice in an environment where their hands are tied in how to diagnose and treat patients," says Dr. Atlas.

They also much prefer Romney's positions on taxes, deregulation, and the economy. While Obama proposes to end the Bush tax cuts on family incomes over $250,000 and says that wealthier Americans should pay more, Romney proposes to keep the Bush tax cut for higher incomes, maintain the lower capital gains rate, reduce income tax rates by 20% across the board, and eliminate the estate tax.

"Rich people are already paying the vast majority of taxes," Dr. Sewell says. "Romney believes that the solution is to increase the number of people with jobs paying taxes. It should be a disgrace that 47% of people don't pay federal income taxes."

No Benefit From Redistributing Wealth

That's echoed by Jane Orient, MD, a Tucson general internist and executive director of the Association of American Physicians and Surgeons, which promotes the private practice of medicine. "Romney believes in free enterprise and he doesn't believe we can solve problems by redistributing wealth, which is what Obamacare is about. Obama believes we can make people better by taking from people who are successful. That's totally destructive to the economy."

Conservative physicians express confidence that Romney's approach would give doctors greater freedom to practice medicine in the way they think is best for patients. They believe Obama's healthcare law puts too much emphasis on trying to keep people healthy through preventive care at the expense of providing high-tech tests and treatments for sick people. They think that it favors primary care physicians over specialists. And they believe that it creates mechanisms that would tell doctors how to practice and limits access to state-of-the-art services.

"Obama's plan shifts spending priorities from specialty care to generalist care, and that's rolling back the clock to the 1950s and dumbing down healthcare," Dr. Atlas contends. "All doctors know that the key to healthcare improvement has been more and more specialist care and more access to technology and innovative drugs."

Dr. Orient says, "The Romney plan boils down to giving people more freedom and doing away with impediments put in place by intellectuals who think they know everything, and that if the federal government sets the rules then everything will be fine."

She believes that Romney's approach is better than Obama's from an overall clinical perspective. "If you put all of the resources into checking blood pressure and free contraceptives and telling patients not to smoke, it takes resources away from taking care of people who are old and sick."

More Freedom to Negotiate Fees

Conservative doctors believe that Romney also would give doctors greater freedom to negotiate fees with insurers and patients and get out from under government-set prices, along the lines of Medicare private contracting legislation introduced by Republican lawmakers. That's because Romney says that he would encourage the growth of health insurance plans that put more financial responsibility on consumers, including high-deductible health savings account (HSA) plans.

"Romney's general attitude is that he's a free-market businessman and that if you bring free-market principles back to medicine, it will be good for everyone, including doctors and patients," Dr. Sewell says.

Dr. Orient argues that Romney's proposals would create a virtuous cycle that would help physicians in smaller practices remain independent. Giving consumers a tax deduction for buying individually owned insurance, allowing out-of-state sales of health insurance policies without state-mandated benefits, and encouraging high-deductible policies all would boost smaller insurers. In turn, independent doctors would have greater negotiating power with those insurers than with larger insurers. In contrast, she says, under Obamacare, independent doctors are "targeted for extinction."

Dr. Atlas argues that the greater competition between insurers will lower premiums and lead to more Americans having insurance -- even without the ACA's refundable tax credits to help people afford coverage, which he calls a "fantasy handout." Romney's plan "reduces prices; more people will have insurance, and that's good for doctors," he says.

Hopefully an Improvement in the Malpractice Madness

Even physicians leaning toward Obama say that Romney's approach toward medical liability is better for doctors. Romney has proposed a federal cap on noneconomic damages in malpractice lawsuits -- a change long sought by organized medicine -- along with alternative dispute resolution of malpractice cases.

"The Affordable Care Act falls way short of what's needed on medical liability. It just kicks the can down the road, and the problem needs to be fixed," says Mario Motta, MD, a Salem, Massachusetts, cardiologist and member of the AMA House of Delegates who generally supports Obama's healthcare policies.

Dr. Robert Sewell strongly favors Romney's damage cap proposal, which his state, Texas, passed in 2003. He says that the Texas cap has resulted in fewer "frivolous" lawsuits, a sharp decline in liability premiums, and an influx of doctors into the state -- though he acknowledges that it still hasn't reduced defensive medicine or overall healthcare costs. "What's driving up the cost of care is defensive medicine, but [the impact of the cap] hasn't filtered into the real world yet," he says.

Doctors who back Romney also say that their candidate's Medicare and Medicaid proposals would help doctors and patients by preserving the fiscal solvency of those programs. Romney wants to turn Medicare into a defined-contribution program in which seniors receive a fixed amount and pick either a private health plan or traditional Medicare. On Medicaid, he would give states a capped block grant and let them run the program with greater flexibility. Dr. Atlas believes that moving more Medicare patients into private health plans would boost payments to doctors and give patients better access to care. "Romney's plan would save Medicare and Medicaid," he says.

A Better Philosophical Fit

Overall, conservative physicians simply find Mitt Romney's philosophical approach a better fit with their own personal and professional worldview. They see themselves as independent physicians and entrepreneurs, and they prefer Romney's vision of expanding free-market medicine over President Obama's model of competition within a more regulated framework.

"I think Romney's platform is right: It's short and it's nonintrusive," Dr. Sewell says. In contrast, he believes that Obama's approach will "make us into employees of the government. I didn't go to medical school, do a surgical residency, and spend 30 years in practice to become a government employee. I'll retire before I allow that to happen."