The Affordable Care Act has been the law for 2 years now. Judging from the discussion last night on health care, the analysis of which is found here, the leaders of the two political parties disagree on the impact and the intent of the law. Of course, some of that disagreement is not based on fact:
On how the new law delivers coverage:
Mr. Romney sharply criticized Mr. Obama’s health care law, falsely suggesting that it would allow the federal government to “take over health care.” Mr. Obama noted the similarities between his health care law and the one Mr. Romney signed as governor of Massachusetts, saying: “It wasn’t a government takeover of health care. It was the largest expansion of private insurance.”
On keeping the popular aspects of the new law:
[Mr Romney also] said, “I’m not getting rid of all of health care reform. Of course, there are a number of things that I like in health care reform that I’m going to put in place. One is to make sure that those with pre-existing conditions can get coverage.”
But Mr. Romney’s aides later clarified that he would only explicitly guarantee insurance for people with pre-existing conditions if they have maintained coverage with no significant lapses. That could exclude millions of Americans with conditions like cancer, heart disease and asthma.
Breaks in coverage are common. A recent report by the Commonwealth Fund found that 89 million Americans went without health insurance for at least one month in the period from 2004 to 2007, perhaps because they had lost jobs, been divorced or lost eligibility for a public insurance program.
My question is not how do we teach the intricacies of the new law to politicians (I’m not sure I have the skill set for that) but how to teach the law to medical students. The pipeline from a pre-med student contemplating admission into medical school to entering into practice is roughly 10 years. When I entered my premed program in 1978, for example, Medicare for end stage renal disease was just 6 years old and policy makers were just beginning to realize how expensive an open invitation to use dialysis might become. I, as an 18 year old, was clueless.
There is a study published last month in the Archives of Internal Medicine (found here) that illustrates just how little attention medical students pay to things such as this. In this study. Minnesota medical students were asked questions regarding their knowledge of the new law and their assessment of the impact it might have on their practice. I will acknowledge that Minnesota medical students (55% liberal with more than half anticipated a primary care specialty) are a little different than the ones I teach. That being said, less than half felt they understood a law that would rearrange their professional life and 41% had no opinion. The students views on the law were colored by their political leanings.
As was stated last night, this election is about choices regarding many things, including health care. The Commonwealth Fund has analyzed both candidates position on health care delivery (found here) and has this to say:
President Obama supports the goal of near-universal health insurance coverage, by maintaining existing private insurance markets but also instituting tighter and more standardized regulations across the country to ensure a broad choice of comprehensive health plans to all who seek coverage.
Governor Romney, on the other hand, has not identified universal coverage as a goal. While also supporting a health insurance system based on existing markets, he believes that more limited regulation will ensure a broad choice of health plans for consumers.
Our department teaches medical students about the Affordable Care Act. We point out that the intent and effect of the law (as articulated by the President’s statement above) is consistent with the core values that they need to support as physicians. regardless of party affiliation.