LOPEZ: Has it affected the doctor-patient relationship?
MOFFIT: The president has repeatedly said that you can keep your doctor. The problem is that your doctor may no longer be able to keep you. The new law will add new layers of bureaucracy on top of the existing regime of red tape and paperwork. Increasingly demoralized doctors will be subject to new rules and reporting requirements, and, with the massive Medicaid expansion, more of their practices will be subject to government payment rules and reductions. The time, energy, and effort to comply with bureaucracy steals doctors’ time and focus away from patients as they are forced to make sure they are following Washington’s rules. Most doctors are hostile to the law, many will leave practice earlier than they had originally planned, and this will exacerbate the doctor shortage.
LOPEZ: What is wrong with health care in America?
MOFFIT: There’s a lot wrong. The federal tax treatment of private health insurance is inefficient and unfair. The tax law undermines portability of coverage, fuels higher costs, discriminates against those who do not or cannot get health insurance at their place of work, and this directly contributes to uninsurance. State health-insurance markets are not competitive, and the giant public programs, Medicare and Medicaid, are outdated and plagued with fraud and waste and threaten to drown current and future taxpayers in red ink. Meanwhile, millions of Americans are uninsured, millions suffer from gaps in coverage, and the quality of care is uneven.
LOPEZ: What is right?
MOFFIT: There’s also a lot right. America is the home of the post–World War II pharmaceutical revolution, a fountain of exciting biomedical research, and the premier training ground for dedicated doctors and medical professionals. For patients, especially those with good private coverage, the best feature of American health care is the rapid response in treating and curing serious disease, particularly cancer. Our challenge is to expand access to coverage but to do it in a way that rewards quality and innovation.
LOPEZ: How big a role will Obamacare play in the presidential race?
MILLER: It will be one of the top issues. The American public does not appreciate incumbents who essentially tell them they are going to get what’s “good for them,” whether they like it or not, particularly when the early results are so poor and the future looks more dismal. Of course, the overall economy still trumps everything else as the biggest issue. A slow-growth scenario in 2012 would magnify the unpopularity of Obamacare and tie it further to broader economic malpractice. A “dead cat” bounce upward for several quarters early next year — for whatever short-term reasons — could push voters toward more support of the president. We simply don’t know yet whether a Republican nominee (finally) will have something interesting, serious, and inspiring to say about health policy next year.
LOPEZ: Do you find Mitt Romney plausible on this issue? Does he deserve some credit for taking reform on at the state level?
TURNER: Former governor Romney talks a great deal about the damage that Obamacare will do to our health sector and economy and says he is committed to repealing the law. He gets credit for understanding the importance of health reform and the need for states to get involved in solutions. But he went way too far to the left in compromising with the Democrats in the Bay State, and the architecture of Romneycare is indeed very similar to the federal law. His claims that the law he helped write in Massachusetts is different from Obamacare are not going to withstand the withering debate of a presidential primary. He has to give a speech devoted to health care that explains what he hoped to do in Massachusetts and that repudiates his support for what the legislature ultimately passed.