What PTs need to consider for the 2008 Presidential Election

By Rob Senior and Lauren Fritsky

With major happenings ranging from Wall Street to Hurricane Ike in recent weeks, it seems there is no better time for a presidential election. The country is at a crossroads, and what happens on Nov. 4 may determine the path followed for the foreseeable future.

With that in mind, we summarize the important issues in the world of health care, and more specifically, the physical therapy profession for this election. How will John McCain or Barack Obama handle the pressing issues?

Sen. John McCain

At Sen. McCain's signature town hall meetings, health care came up again and again. At a gathering in Pipersville, PA, cost of health care plagued the minds of attendees. One woman in the audience said therapy rates for her autistic nephew had increased. Another wondered if she would be forced to pay more for health care should a universal system be implemented.

Rather than focusing on government-run health care, Sen. McCain's reform plans are governed by a single aim: restoring control to patients themselves.

"The problem with health care in America is not the quality of care," Sen. McCain said at the meeting. "It's the affordability and the availability."

He seeks to empower individuals to afford and acquire treatment and preventive care, no matter their income, family size or location. One tenet of his plan involves promoting competition amongst insurance companies by allowing families to purchase health insurance out of state through a $5,000 refundable tax credit. Sen. McCain also hopes to increase the portability and accessibility to health care and supports walk-in clinics and home health.

"I think we need outcome-based treatment," he told attendees at a town hall meeting in York, PA. "I think we need incentives for home health care as much as possible as opposed to institutionalized health care. I think we need to practice wellness and fitness in America."

With the soaring obesity rate, Sen. McCain believes the next administration needs to do a better job of instilling healthy behaviors in young people. He also acknowledges some people, regardless of income, struggle to get health insurance because of medical conditions or risks. He wants to create Guaranteed Access Plans (GAPS), which will combine state and federal resources to help.

"We're going to have to pool our assets so we can provide health insurance to people who can't get it," he said at the Pipersville, PA, meeting. "They are 'uninsurables.' They are people who are unable to get coverage under any circumstances because of previous medical issues."

In terms of specific populations, Sen. McCain supports more autism research and in-house, long-term care for seniors.

How This Affects Providers

Physical therapists and other health care professionals could be affected by several of Sen. McCain's additional health care plans.

Foremost, Sen. McCain hopes to reform Medicaid and Medicare to cut costs. "We must reform the payment systems in Medicaid and Medicare to compensate providers for diagnosis, prevention and care coordination," Sen. McCain states on his Website. "Medicaid and Medicare should not pay for preventable medical errors or mismanagement."

Another aim involves passing medical liability reform to squash lawsuits launched at doctors who follow clinical guidelines and adhere to safety protocols.

Patients should be able to use legal remedies in cases of bad medical practice, his Website states, "but that should not be an invitation to endless, frivolous lawsuits."

Sen. McCain also advocates coordinated care and the use of technology to streamline treatment. A single bill for high-quality disease care and implementing technology allowing medical professionals to practice across state lines are components. He also hopes to increase access to care for chronic disease through touting prevention, early intervention, new treatment models and a new public health infrastructure.

Sen. Barack Obama

"We now face an opportunity—and an obligation—to turn the page on the failed politics of yesterday's health care debates. My plan begins by covering every American," said Sen. Obama in a speech in Iowa City, IA, May 29, 2007. "If you already have health insurance, the only thing that will change for you under this plan is the amount of money you will spend on premiums. That will be less. If you are one of the 45 million Americans who don't have health insurance, you will have it after this plan becomes law. No one will be turned away because of a preexisting condition or illness."

The largest component of Sen. Obama's health care plan is his commitment to making affordable health care coverage available to all Americans. This includes 46 million—at least 8 million of whom are children who are currently without insurance.

Under Sen. Obama's plan, all Americans will be afforded the opportunity to buy a plan—at affordable rates—that mirrors the Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. No American will be turned away from Sen. Obama's plan due to pre-existing diseases or conditions. The plan will cover all essential medical services, even such instances as maternity and mental health.

Gone will be complicated enrollment procedures and confusing paperwork that Sen. Obama believes is plaguing the current system. Those recipients who change jobs will be able to do so without fear of compromising or altogether losing their health care coverage.

For those who still wish to purchase a private insurance plan, Sen. Obama plans to create a National Health Insurance Exchange that will act as a watchdog group while hopefully reforming the private market by ensuring fairness and making individual coverage more affordable and accessible. Each applicant will receive a policy charging fair and stable premiums. Under Sen. Obama's guaranteed eligibility plan, those rates would not depends upon current health status.

Employers who choose not to make a meaningful contribution to their employees' health care plans will be charge a percentage of payroll toward the cost of the national plan.

Small businesses may be the sector that benefits most from the plan. Not only are they exempt from the conditions outlined in the preceding paragraph, they will also receive a Small Business Health Tax Credit that reimburses the employer for up to 50 percent of premiums paid on behalf of their employees. By doing this, Sen. Obama hopes to provide a strong incentive for small businesses to offer top-notch healthcare to their employees while increasing those businesses' viability in the marketplace.

Catastrophic illnesses and their treatments account for a huge percentage of health care costs, so Sen. Obama plans to offer reimbursement to employers for a percentage of the costs incurred by the treatment of such illnesses. This is done on the condition that the employer guarantees to put the funds received toward lowering premiums for those employees.

Finally, Sen. Obama hopes to lower health care costs through such means as investing in electronic health information technology systems and increasing competition in the insurance market.

Important Issues for PT

Tim Schell, PT, is a private practice owner in Western Pennsylvania who is also actively involved with the APTA's Political Action Committee (PT-PAC). He outlined a few issues that are key to the profession in the upcoming election:

Therapy Caps—"I think the biggest thing to all of us is to be rid of these arbitrary caps that serve to restrict the services available to senior citizens," said Schell. Currently, the cap is temporarily restricted until the end of 2009, but that doesn't really settle the issue. "We've been dealing with this [cap] for 12 years now," Schell pointed out. "It's best for our profession if we can just get rid of it."

Direct Access for Medicare Patients—"It would be ideal for senior citizens not to have to go through a physician to receive our services," explained Schell. That's a big step, however, so Schell proposed an alternative. "Even if they approved a pilot study with direct access in maybe 5-6 states," he proposed. "That would show whether this can be cost-effective. I think outcomes will improve with more timely access to the system, when patients aren't as heavily involved."

Fee Schedule—If not for a last-second veto, a measure would've gone into effect earlier this year to cut reimbursement rates by 10 percent.

"In this market, a 10 percent cut would make quite an impact," said Schell. "We need to ensure there will always be adequate payment."

Schell also touched on smaller issues, like the possibility of offering student loan forgiveness for those PTs who work in underserved areas following graduation. n

Rob Senior is senior associate editor at ADVANCE and can be reached at rsenior@advanceweb.com Lauren Fritsky is assistant editor at ADVANCE and can be reached at lfritsky@advanceweb.com

The Navy Pilot and the Therapist

Sen. John McCain endured injury after injury during his military service as a pilot in the Vietnam War. He experienced six years of torture and starvation in a prisoner of war camp. He broke both his arms and legs, shattered his knee and suffered bayonet wounds.

Still, McCain dreamt of piloting a plane again. He knew he required rehabilitation for his knee, which needed to bend at least 90 degrees, to fly. Legal Capt. Joe Baum, who commandeered McCain's naval vessel, referred his shipmate to a physical therapy clinic outside Washington D.C. There, McCain began working with Diane Lawrence, PT. She called the candidate's knee "probably the worst injury I'd ever seen" and "far beyond anything I'd ever treated before."

"I had told him, 'For you to achieve those goals, it's going to be so painful,'" she told ADVANCE. "'I don't know if you can handle it.' He said, 'Yes, I can handle it.'"

Lawrence worked with McCain twice a week for nine months for two hours each session. The therapy proved arduous and agonizing, but the politician plodded on.

"He essentially had a frozen right knee," Lawrence explained. "He had to be able to flex to 90 degrees to go for his pilot's license. We did mobilization and manipulation degree by degree, because it had been frozen for many years."

Despite the grueling sessions, McCain still kept a smile on his face and engaged other patients, Lawrence recalled. One, a 10-year-old girl with terminal cancer, adored him. He even went to visit her at her home when she became too sick to attend clinic. "There were other people in the clinic, and he'd take time to talk with them," Lawrence said. "He was very people-oriented."

After therapy ended, McCain took his flight physical at the Naval Air Station in Pensacola, FL, and passed. He also repaid Lawrence for the treatment through introducing her to her late husband, Vice Admiral William Lawrence. McCain and Mr. Lawrence had spent time together in the POW camp.

—Lauren Fritsky