Academy Grid Provides Insight into Candidate Positions on Health Care

The AAFP has added a key component to its Web-based resource on the Democratic and Republican presidential candidates by unveiling a grid (40-KB Excel file; About Downloading) detailing the candidates' positions on issues that pertain directly to family medicine.

The Academy launched its "2008 Presidential Campaign" Web page in May and has added various features during the ensuing months. The online resource now includes information on the candidates' health care positions, a side-by-side comparison of those issues, fact sheets and a list of questions to ask the candidates at campaign events. With the addition of the grid, Academy members can learn even more about the candidates' positions on issues that directly affect family medicine.

The grid, which is based on information from various Web sites, provides data on a variety of issues, including the candidates' positions on physician payment under Medicare, the patient-centered medical home model, preventive and primary care, chronic disease management, pay-for-performance programs, workforce shortage issues, and medical liability and tort reform. The grid distills this information into an easy-to-read format, allowing for quick review and comparison of candidates' stances on family medicine and primary care issues.

"It is a very useful tool for Academy members," said Kevin Burke, director of the AAFP's Division of Government Relations, about the presidential grid. "It allows (members) to cut through the mainstream press and other media to find out how the candidates are looking at health care and (family medicine's) issues in particular."

The grid shows, for example, that both Democratic and Republican candidates have made preventive care the cornerstone of their national health care plans, a strong indication that preventive care will be a major component of future health care reform efforts.

Democratic front-runner Sen. Hillary Rodham Clinton, D-N.Y., would require insurers "who already participate in federal health programs to cover prevention in order to do business with the federal government," according to the grid. Clinton's plan also would "provide financial incentives to ensure higher quality, more coordinated care for patients and physicians."

Sen. Barack Obama, D-Ill., would "expand funding of prevention and public health activities, including worksite promotion programs." His health care plan also would "increase funding for community-based preventive interventions," requiring federal plans and new public plans to employ "proven disease management programs."

Former Sen. John Edwards, D-N.C., who was the 2004 Democratic vice presidential candidate, has put forth a plan offering "comprehensive coverage for all Americans," allowing everyone access to preventive and primary care, according to the grid.

On the Republican side, former New York Mayor Rudolph Giuliani would tie Medicaid payments to a state's success in promoting preventive care and tracking obesity for children. Like some of the other candidates, Giuliani would provide incentives to promote wellness and better health outcomes for chronic disease.

Former Sen. Fred Thompson, R-Tenn., calls for building a health system "centered on preventive medicine rather than curative medicine." Thompson's plan would shift "to a system that promotes cost-effective, chronic care management and personal responsibility."

Former Massachusetts Gov. Mitt Romney's health care plan does not specifically address preventive care and chronic disease management, according to the grid. But the plan put forth by Sen. John McCain, R-Ariz., would reform Medicare payment systems to compensate providers for diagnosis, prevention and care coordination.

The leading Republican presidential candidates do not specifically address the patient-centered medical home as part of their health care plans. But three of the Democratic candidates -- Clinton, Obama and Edwards -- mention the medical home as part of physician payment under Medicare. Clinton, for instance, calls for providing "chronic care coordination models, including medical 'homes' accessible under federally funded plans."

Obama's health care plan encourages "team care through medical 'home' models to improve care coordination," according to the grid.

Edwards, meanwhile, would "implement new payment systems for Medicare to ensure patients have a medical 'home' with a doctor to coordinate their care."