by Craig M. Klugman, Ph.D.
These recent weeks have been historical firsts in the U.S. The first time a billionaire with no political experience became a major party Presidential candidate and the first time a female became a Presidential candidate. Listening to the Republican and Democratic conventions feels like a tennis match not only for the personal lobs but also because they present such drastically different views of the world.
Part of the purpose of the convention (other than free prime time advertising and encouraging the base) is to lay out their platforms for the upcoming election. What does each party have to say about health and medicine? Quite a lot as it turns out.
The Democratic platform states that health care is a right: “We are going to fight to make sure every American has access to quality, affordable health care.” Their document holds that all people should have access to “public coverage.” The public option is the idea that states should be able to include a publicly run option on the state health exchanges (most of which are run by the federal government) including expanding Medicaid in every state (even the 19 that rejected that option). The platform urges that Medicare negotiate with drug companies for lower drug prices, putting caps on out-of-pocket expenses, and permitting people to import drugs from overseas. There is a nod to supporting mental health and substance abuse, medical research (specifically Alzheimer’s HIV/AIDS, cancer and chronic disease), gun control, public health (residency training, medical education, preventive medicine and health equity), and community health centers.
The platform supports women’s access to reproductive medicine including abortion. The statements also support combatting violence against women, Planned Parenthood, and preventing gun violence (by revoking immunities that gun manufacturers have, limiting assault weapons, and allowing the CDC to fund and conduct research on gun violence).
According to the Republican platform, “taking care of one’s health is an individual responsibility.” They would “foster personal responsibility” for health. Toward this effort, the GOP is ”fully committed” to the repeal of the Affordable Care Act. They will do this by have their candidate (if he wins) halting all actions of the law and then voting for a repeal in Congress.
Their alternative will be a free market for insurance and paying out-of-pocket for medical care. They seek to protect “the patient-physician relationship based on mutual trust, informed consent, and privileged patient confidentiality.” The individual responsibility and emphasis is echoed in supporting health savings accounts, individual choice and “putting the patient at the center of policy decisions.
In Medicare/Medicaid, they support removing a defined plan and moving toward competition by putting plans in private hands where people can enroll in the private health insurance plan of their choice (applying to people currently under age 55). They plan to “modernize” these programs by moving away from federal administration to block grants made to states. Modernization also means “price transparency” to encourage people not to “over-utilize services.”
A large part of the platform focuses on abortion and the sanctity of life. Among their ideas is to support a human life amendment to the Constitution and to reiterate that public funds will not subsidize health care “that includes abortion coverage.” The would ban sex-selective abortions, “protect from abortion un-born children who are capable of feeling pain” and “call for a ban on the use of body parts from aborted fetuses for research.” The platform supports parental consent for abortions in young girls to protect them from “exploitation” and requires physicians to save any infant born alive.
At the other end of life, “We oppose the non-consensual withholding or withdrawal of care or treatment, including food and water, from people with disabilities, including newborns, as well as the elderly and infirm, just as we oppose active and passive euthanasia and assisted suicide.” This would be partly accomplished by prohibiting the use of drugs for ending any life at any stage.
Several sections deal with permitting “faith-related institutions” to opt out of covering health services that violate their [the employers’] beliefs.” No heath care institution, in their words, should be required to provide, perform, or pay for a procedure to which they are morally opposed and should not be penalized for such refusals.
In other areas, the GOP also supports research into adult and blood cord stem cell research. They would reform the FDA because it currently “threatens” American’s leadership in medical innovation and advocate eliminating “frivolous medical malpractice lawsuits” which they claim have been partly responsible for the increased cost of health care.
The distinctions between the two are dramatic. The DNC takes an aspirational tone while the RNC takes a defensive position. The RNC views health and health care as an individual responsible (for being sick, for getting care, for paying for it) and the DNC sees health as a public responsibility. The DNC sees the federal government as having a role in promoting and supporting health whereas the RNC sees this as a state and individual role. The DNC emphasizes public health efforts and the DNC emphasizes free market. The RNC encourage a culture of life while the DNC encourage a right to choose. The RNC views faith as important in determining public policy while the DNC views faith as guiding individual choice.
Both platforms provide different visions for health, health care, and insurance in our society. I provided the links to both documents and urge you to read and consider them carefully.