The fate of the Medicare program, the effect of managed care on quality and incremental health system reforms took center stage last week in the second debate between President Clinton and GOP chall enger Bob Dole.
Both candidates used the San Diego event to reiterate their support for a bipartisan commission to address the long-term health of Medicare and short-term reductions in the rate of growth in the Medicare program.
The debate "underscores that in the 105th Congress, Medicare issues and Medicare cuts are going to be in the barrel, no matter who is going to be running the asylum," said Frederick Graefe, a healthcare lawyer with the Washington firm of Baker & Hostetler.
Using a town-hall-meeting format, the candidates fielded questions from an audience of undecided voters who clearly had healthcare on their minds. The second question came from a cardiologist who asked what bo th men would do to "address the problems with the healthcare system."
Clinton, who answered first, touted two already announced initiatives. One would increase insurance coverage for poor children by expanding Medicaid enrollment ; the other would offer federal subsidies for health insurance for the temporarily unemployed.
Clinton also attacked last year's GOP budget proposal, which would have reduced projected Medicare spending by $270 billion over seven years. He cited an American Hospital Association study showing that as many as 700 hospitals would have closed under the GOP plan.
Dole fired back that Clinton, whose own plan would have reduced Medicare spending by $124 billion over the same period, was misrepresenting the GOP plan and trying to scare senior citizens. Dole also blasted Clinton's 1993 healthcare reform proposal, calling it "an extreme medical plan."
The managed-care industry took its share of hits during the debate.
An audience member who identified herself as a health worker asked the candidates what they would do to address the "problem" of managed care. Managed care results in "many, many people who cannot get the tests that they need when they need them," she said. "And because of that they are dying needlessly."
Dole called managed care "a national problem" that "we need to deal with."
Both Clinton and Dole expressed support for legislation that would ban so-called "gag clauses," or restrictions implemented by managed-care plans on communications between physicians and patients.
An anti-gag-clause bill was introduced in Congress last year but was dropped at the close of the legislative year when lawmakers could not agree on how to structure the measure to ensure that plans could still collect quality data and implement care protocols.