Modernizing Health Care with IT

rninformatics, DNP, RN · Oct 10, 2008

Modernizing Health Care With President Obama or President McCain

by David Merritt for iHealthbeat

With just a few weeks left until the presidential election, Americans have an important decision to make regarding the future of health care. With the perpetual problems of rising costs, poor quality and the uninsured, Americans must decide which candidate is better suited to help build a 21st century intelligent health system that saves lives and money for all Americans.

A critical part of any solution will be the rapid deployment of health IT. Both Sens. Barack Obama (D-Ill.) and John McCain (R-Ariz.) know the importance of modernizing our system through IT, and while some may condemn one or the other as someone who "doesn't get it," one point needs to be clarified: health IT is not a bipartisan issue -- it is a nonpartisan issue. Everyone agrees on its necessity. Everyone agrees on the goals we should work toward.

Where many advocates and policymakers disagree is how best to accomplish these shared objectives.

I believe that a President Obama or a President McCain will make health reform, and thus health IT, a top priority. It is just too important an issue to ignore.

So what would each man do to advance health IT specifically? Yes, we can look at their promises from the stump and read their health care plans for a general sense of how each man would advance health IT, but the reality is that campaign politics do not allow for intricate or exhaustive policy proposals, nor should the campaign trail be the place for this kind of policy development.

To get a better idea of what each would do to advance health IT, the best crystal ball, which is still murky at best, is to examine their general governing philosophies, particularly as they relate to health care, and combine this with what each has advocated in the past.

Under President Obama

It is fair to say that Obama is a firm believer in the power of government. From trade to taxes to education to climate change, the heart of nearly every policy proposal rests with government to affect change. His ideas in health care are no different. His health reform plan:

Mandates insurance coverage for children;

Requires employers to "pay or play";

Federally reinsures catastrophic health costs for businesses;

Taxes the profits of health insurers;

Introduces a new nationalized health insurance product into the private market; and

Creates a National Health Insurance Exchange.

The list of government-driven solutions is long, and the price tag is huge. A recent study funded by the McCain campaign put the cost of Obama's health reform plan at more than $450 billion annually.

What about health IT specifically? When Obama announced his health care plan in May 2007, health IT was one of his key priorities. He has a lengthy paragraph in his health care plan devoted to it, which hits the major points: interoperability, privacy and provider adoption. He pledges to invest $50 billion over five years to advance these priorities. This is a substantial investment -- far greater than any lawmaker has proposed to date -- and Obama should be commended for it.

Given Obama's general approach to governing, one can assume that government activism would be a central part of his health IT agenda. He said he would "phase in requirements for full implementation of health IT," which likely means that providers must use an electronic health record or other technologies if they want to treat Medicare patients or do business with the federal government.

Obama also said that he "will ensure that these systems are developed in coordination with providers and frontline workers." One can infer that this "coordination" will be done with government.

Furthermore, how does he propose to spend the $50 billion? Would he systematically change payment models to encourage providers to invest in health IT? Or would he simply extend grants to providers to purchase a system? This is the approach he's used for his Making Work Pay "tax cuts," where instead of fundamentally changing the tax code, he would send a one-time check of up to $500 per person, or $1,000 per working family.

Obama covers the waterfront in his health reform plan, from comparative effectiveness to transparency to prevention and wellness. The driving force behind most, if not all, of his proposals is the federal government. One can expect to see this in practice when addressing health IT.

Under President McCain

Obama famously attacked McCain because McCain allegedly doesn't use a computer. Former President Bill Clinton doesn't either, but does that mean they do not understand the power of technology?

For seven years, McCain was the chair of the Senate Commerce committee, which has jurisdiction over telecommunications, the Internet, interstate commerce, technology, manufacturing and other critical aspects of our economy. The technological boom our economy has seen over the past 15 years passed through Senator McCain's committee, so he knows the issue of technology well, why it's important, and how government can best facilitate its advancement.

Generally speaking, McCain favors private-sector solutions over government intervention. His health reform plan certainly reflects this approach. The heart of his plan would give all Americans a tax credit of $2,500 ($5,000 for families) for the purchase of health insurance, be it through an employer or in the individual market. He would also break down regulatory barriers that restrict consumers' choice to only those insurance policies licensed in their state. This would create a competitive, nationwide marketplace for insurance.

This belief in market-based, private-sector solutions is not to say that McCain is averse to using the power of government when he feels it is right. His leadership on the issues of campaign finance reform, climate change, a patient's bill of rights and tobacco regulation are proof of that.

What does all this say about how McCain would advance health IT? He, too, referred to the importance of health IT when he rolled out his health care plan earlier this year, and he, too, has a passage in his plan acknowledging its necessity.

McCain specifically mentions the issue of increasing the use of technology for physicians to deliver care across state lines. Telemedicine has been used for many years, and those who practice it or seek to expand its use run head-on into licensing issues in every state.

Inland Northwest Health Services, a member of the Center for Health Transformation, has an impressive array of telehealth tools that leverage technology to expand access to care to rural or underserved areas. Many know the success of Visicu, an innovative company that uses telemedicine and remote patient monitoring to deliver 24/7 care to patients in intensive care units. Ask them if the framework for state licensure could be improved to expand telemedicine.

I suspect McCain would reach out to state governments to seek agreement on how best to reform state laws that limit telemedicine. This is what he has said he would do to expand coverage through his proposed Guarantee Access Program, a state-federal partnership for high-risk patients.

McCain's health reform plan relies on government when necessary and the private sector whenever possible.

More Questions Than Answers, As It Should Be

What would a President Obama or a President McCain do about interoperability? How would they change or build upon the work of HHS Secretary Mike Leavitt? What would each do to solve the privacy debate once and for all? Do they favor using incentives or penalties to drive change?

These questions and many more await the man elected on Nov. 4. Based on political philosophies and policy proposals, a President Obama is likely to favor a more government-centered approach, while a President McCain is likely to favor private-sector leadership.

With the right blend of these approaches, we will make great strides in modernizing health care. I am confident that whoever assumes office next January will agree.