Publisher’s Note: Our Best Chance for Reform?

The faltering state of U.S. healthcare is sure to remain a very hot topic throughout the race for the White House. All of the major candidates agree that something must be done.

Consequently, if any reform is on the horizon, the period just after next year’s election is the best time for it.

But before any of us pops the cork on a bottle of celebratory champagne, I’d like to share with you an anecdote that the mayor of a medium-sized Florida city regularly shares with his audiences:

In the span of a month or so, he attended the openings of a new library and a dog park. Only 20 or so people bothered to show up for the library event, while more than 200 turned out for the dog park event.

“Guess what we’ll be building more of in the future, libraries or dog parks?” the mayor asks.

To predict what the next president will do about healthcare, it’s perhaps best to ask what the candidates think the public wants rather than what they think it needs.

Here’s what we’ve heard so far from the would-be presidents.

Sen. Hillary Clinton (D-N.Y) tells anyone who asks that the American healthcare system is broken.

But having gotten slapped in the face when she tried to revolutionize healthcare as first lady 14 years ago, Clinton makes clear that she won’t be leading the march for reform.

“I’ve tangled with this issue before - and I’ve got the scars to show for it,” she told an audience at George Washington University in May. “The key is to develop the political will to make it happen.”

Translation: I’d rather be president than push unsuccessfully for healthcare reform.

After eight years of George W. Bush - who has suffered a series of failures on big domestic issues such as immigration, Social Security, healthcare, and tax reform - it’s a sure bet that our next president will choose the path of incremental change and bipartisanship.

Clinton isn’t the only candidate who is tentative about healthcare.

Republicans Rudy Giuliani and Sen. John McCain (Ariz.) say it’s time to “do something” about healthcare. But they recognize that forcing Americans to trade in their employer-provided insurance, and its succulent tax deduction, will take a lot of persuasion. Not something to do in the heat of a campaign.

Mitt Romney is pushing a plan similar to the one he passed when he was the governor of Massachusetts. But like his fellow Republicans, he is vague on some details.

Among the other Democrats, Sen. Barack Obama (Ill.) says healthcare can be made more affordable if the government encourages the creation of private markets, while guaranteeing healthcare coverage for everyone except those between the ages of 26 and 62. Details to follow Inauguration Day.

John Edwards, the one-time trial lawyer, U.S. Senator, 2004 Vice Presidential candidate, and poverty think-tanker, stands out from the crowd on this issue, having made public a very specific plan. He would enact a universal health plan funded by large tax increases.

Look, I don’t know how to fix healthcare, either. But I do know Clinton has one thing right: Changing healthcare in America would be a big deal. And nothing that big will become law without support from many different groups, or at least a promise from those groups not to oppose what is proposed.

Among those groups will be physicians. What’s likely to be asked of you? Any healthcare plan will almost certainly include a continued push by the federal government for physicians to deploy EMRs and other technology in hopes of reducing errors, streamlining payments to physicians, and cutting unnecessary processing costs.

And what will you ask in return?

For starters, how about a fully funded, permanent physician payment plan? Some federal protections against medical malpractice?

What else? Please share your ideas with me. We’ll publish them throughout the primary season. After all, we’ve got to let the candidates know what you need and want.

Ken Karpay is the publisher of Physicians Practice. He can be reached at kkarpay@physicianspractice.com.

This article originally appeared in the October 2007 issue of Physicians Practice.