America's health care system is unsustainable. It's not one problem, but three combined: high cost, uneven quality and millions uninsured. Major changes will keep coming. Every family will be affected.
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Where they stand:
President Barack Obama's health care law will extend coverage to 30 million uninsured and keep the basic design of Medicare and Medicaid the same. It's not clear how well his approach will control costs for taxpayers, families and businesses. Mitt Romney would repeal Obama's health care overhaul; what parts he'd replace have yet to be spelled out. Romney would revamp Medicare, nudging future retirees toward private insurance plans, and he would turn Medicaid over to the states.
Why it matters:
America has world-class hospitals and doctors, and cutting-edge research labs. But we spend far more than any other advanced country, we're not much healthier, and still leave millions uninsured. In an aging society, we have no reliable system for long-term care. Costs keep growing faster than the economy, unsustainable for federal and state governments, employers of every size, and average folks as well.
The 2012 election offers a choice between two political leaders who'd take the nation on very different paths.
If health care costs are already straining your budget, if you are having problems getting medical attention you need, or if you are concerned that one day you might find yourself in either predicament, choices matter. But whatever your personal health or insurance situation, deeper national debt affects the economy and in some way your own standard of living, or at least that of the next generation. If the government has to spend more on health care, that comes at the expense of more debt, cuts in something else, or higher taxes.
Obama's health care law would grow the government's presence in medical care, but employers and individuals would continue to play a major part. Many uninsured middle-class people will get financial help to buy private insurance in new competitive markets. Low-income people will be covered through expanded Medicaid. Insurance companies won't be able to turn the sick away, and most Americans will be required to have coverage.
The law puts the onus for controlling costs on the hospital industry, the medical profession, drug companies and other service providers. Obama wants to shift Medicare away from paying for sheer numbers of tests and procedures to a system that rewards quality care. He would also keep a strong federal hand in the Medicaid program for low-income and disabled people.
The risk of expanding government-subsidized coverage: Health costs could take off, eating up an ever-increasing share of the economy, and eventually destabilizing the system.
The Republican answer is to favor private insurance over government programs, and cost control through market competition, not price setting by federal officials. They oppose mandates on businesses and individuals. They want to borrow a page from 401(k) pension plans and shift people away from open-ended medical benefits, instead providing a fixed amount for basic health insurance. If you've got a pre-existing medical condition, you could join a high-risk insurance pool. Republicans would also limit medical malpractice awards, which researchers say drive up health care costs, and they would put more restrictions on abortion.
Romney's approach would rein in the growth of federal health care costs, helping to bring down the budget deficit. The risk: more people uninsured, possible erosion of coverage for low-income people, and potential cost shifts.