Medscape Medical News by Robert Lowes and Emily Lea Berry –
October 2, 2012: The first presidential debate of 2012 between Republican challenger Mitt Romney and President Barack Obama, scheduled for tomorrow night, allots a mere 15 minutes to the subject of healthcare.
Physicians and other healthcare professionals, more than anything, want the candidates to use that precious time to talk about the Affordable Care Act (ACA) and healthcare reform in general, according a new Medscape survey.
Readers were asked what they would like to ask both the presidential and vice presidential candidates during the upcoming debates. They did not mince any words.
“Is it better to have a flawed law on the books but actually have reform, or tear the whole thing up and start over?” said a Navy physician, who wanted an answer from both Romney and Obama.
A number of Medscape readers asked Romney what he would substitute for the ACA if he became president and delivered on his promise to repeal the law. “Be specific!!!!!!” one physician demanded. Other readers wanted him to explain why he opposed the ACA even though it was modeled after the healthcare reform he enacted in Massachusetts when he was governor. “How does the law Gov. Romney signed in Massachusetts differ from the one President Obama signed?” a psychiatrist inquired.
President Obama came in for some grilling, too. A pharmaceutical sales representative noted how the ACA saves roughly $700 billion over 10 years by slowing the growth of Medicare spending. The law does that in part by reducing payments to hospitals and other providers.
“Many docs do not take new Medicare patients now because of underpayment,” the sales rep said. “How does reducing their reimbursement increase access or quality of care like you claim?”
Other readers used the survey simply as an opportunity to vent political steam. “Why don’t you simply go away quietly?” a radiologist asked Obama.
PBS Newscaster Jim Lehrer Referees First Debate
Medscape conducted the survey in collaboration with the Commission on Presidential Debates, which is sponsoring 3 face-offs between Romney and Obama this month, as well as a single event pitting GOP vice presidential nominee Rep. Paul Ryan (R-WI) against Vice President Joe Biden. The commission will submit the questions from Medscape readers to debate moderators for their consideration.
The first presidential debate, to be moderated by PBS newscaster Jim Lehrer, takes place at 9 p.m. EST on October 3 at the University of Denver in Colorado. The 90-minute affair, all about domestic policy, is divided into six 15-minute segments. Three segments are dedicated to the economy, the number-one issue in the race, according to polls. The role of government gets another 15 minutes, as does governing itself. The remaining 15 minutes belong to healthcare. However, this broad topic could surface during the other segments, especially the one regarding the role of government, because critics of the ACA such as Romney call it a government takeover of one sixth of the economy.
In their second debate, scheduled for October 16 at Hofstra University in Hempstead, New York, the candidates will field questions on both domestic and foreign policy in a town-hall format with questions from the audience. Obama and Romney will concentrate solely on foreign policy in their last debate on October 22 at Lynn University in Boca Raton, Florida. Its format will be the same as the first.
The vice presidential candidates square off on October 11 at Centre College in Danville, Kentucky.
Readers Want Medicare Reimbursement Addressed
Medscape surveyed readers for 5 days in September on what they wanted to ask the candidates during the debates. Readers were instructed to pigeonhole their questions in 1 of 8 categories. Of the 137 questions received, 49.1% came from physicians, 12.1% from nurses, and 32.4% from other healthcare professionals.
The category attracting the most queries (28.5%) was the ACA and healthcare reform, with Medicare and its sustainable growth rate (SGR) formula (16.8%) and access to care (12.4%) rounding out the top 3.
The general public, in contrast, puts Medicare ahead of the ACA in its election-year thinking, according to a poll conducted in September by the Kaiser Family Foundation (KFF). Medicare ranked as the third most “extremely important” issue in the presidential race behind the economy and the federal budget deficit. The ACA tied for fourth place with Medicaid and defense spending.
The ACA continues to split public opinion roughly down the middle, with supporters outnumbering opponents 45% to 40%, according to the September poll. However, a Kaiser Family Foundation survey in July showed that a majority of Americans want opponents to stop trying to block the law and instead focus on other national problems.
Medicare has succeeded the ACA as the hottest hot-button issue in healthcare largely because of Romney’s and Obama’s starkly different prescriptions for the federal program. Romney and running-mate Paul Ryan propose converting Medicare to a premium-support program in which beneficiaries receive a fixed amount of money — known as a defined contribution — to purchase coverage from a private insurer or traditional Medicare. Obama by and large wants to preserve the status quo, with Medicare benefits guaranteed for all seniors.
Healthcare professionals responding to the Medscape survey were concerned about the fate of Medicare and its beneficiaries, but their questions on this subject also reflected anxiety about reimbursement. After all, the SGR formula calls for a 27% Medicare pay cut for physicians in January unless Congress acts to avert it.
“Sixty percent of physicians in our area do not accept Medicare,” said an obstetrician-gynecologist, addressing Obama. “Reimbursement decreases suggested for the future will cause more physicians to deny Medicare. What (will) you do?”
Both Medicare and the ACA prompted questions about access to care in the Medscape survey. One physician put the matter succinctly.
“Gentlemen,” he asked Romney and Ryan, “why isn’t healthcare a right?”
Stay tuned this October to see whether any answers from the Democratic and Republican rivals are forthcoming.