NEJM Audio Summary - Oct 18, 2012

いつもの大統領選挙以上にNEJMでは選挙に関する記事を取り上げている。というのも、オバマ政権で2010年制定された「患者保護並びに医療費負担適正化法」の行方が今後のアメリカの医療に与える影響が大きいからなのだろう。双方の候補の主張に対する論説が、オーディオ素材込みで掲載されている。

いまさらながらの感もあるが、大統領選挙の全体像に関しては、ConnectUSAのコンテンツが分かりやすい。

Excerpted Script

15:24| "Health Care Policy under President Romney", a perspective article by Eli Adashi, from Brown University, Providence, Rhode Island.
When Mitt Romney campaigned in 2002 to become governor of Massachusetts, he offered no hint that he would lead the enactment of the most consequential state health care reform law in U.S. history. Yet as early as February 2003, Governor Romney began to intimate his intention to engineer the law promising near-universal health insurance coverage that was enacted in 2006. Though plans touted in campaign rhetoric often differ from subsequent policy actions, this gap is especially relevant in considering potential federal health policy under a President Romney. Although Romney has offered many opinions and comments as a presidential candidate, he has not provided any detailed blueprint of his plans for U.S. health system reform, and his proposals provoke questions more than they provide answers. But a review of Romney's campaign website, public addresses, debates, interviews, and other statements reveals some essential elements of his health policy intentions.
Mitt Romney says he'd repeal much of the Affordable Care Act.
His replacement proposals would provide no meaningful security to people who would lose the law's coverage protections. Other policy aims would shift growing Medicare costs to beneficiaries, curtail Medicaid's benefits and shrink its enrollment, and reduce all federal health spending.
17:02| The Shortfalls of “Obamacare”, a perspective article by Gail Wilensky from Project HOPE, Bethesda, Maryland.
U.S. health care suffers from three major problems: millions of people go without insurance, health care costs are rising at unaffordable rates, and the quality of care is not what it should be. The ACA primarily addresses the first — and easiest — of these problems by expanding coverage to a substantial number of the uninsured. Solutions to the other two remain aspirations and promises.
The law's most controversial provision remains the individual mandate, which requires people either to have insurance coverage or to pay a penalty. The penalty for not having insurance is very small, particularly for younger people with modest incomes.  A mandate cannot work without a credible threat that noncompliance will be costly. Moreover, although the ACA expands coverage, it ignores the structural problems in the organization and reimbursement of care.
Most troubling, the ACA contains no reform of the way physicians are paid, which is the most dysfunctional part of the Medicare program.
Finally, as Medicare has since its inception, the ACA focuses all its pressure to reduce spending and improve quality of care on clinicians and institutional providers through regulatory means, rather than trying to harness market forces. (431 words / 191 sec = 135 wpm)