Published by the Students of Johns Hopkins since 1896
August 14, 2022

With the election less than three weeks away, the Hopkins Undergraduate Bioethics Society (HUBS) hosted an open forum titled “Who has a better vision for healthcare, Obama or Romney?”

The forum, attended by about 30 students from various majors and classes, was designed to inform, discuss and debate differing opinions and political perspectives on the presidential candidates’ healthcare platforms.

As costs accelerate and tens of millions of people remain uninsured, healthcare has become a very divisive ideological issue in America, rising as one of the most heated topics in the upcoming presidential election. For those who are registered to vote and are wondering about each healthcare platform, as well as the general liberal and conservative arguments, here is a quick overview of the ideas covered at the forum.

The Patient Protection and Affordability Care Act (PPACA), more commonly known as “Obamacare,” was signed into law on March 23, 2010, becoming the largest overhaul of our healthcare system since Medicare and Medicaid were established in 1965. It is also arguably the most significant legislative achievement of Obama’s presidency. The 2400-page bill includes the following provisions:

  1. A mandate for businesses and individuals to purchase a healthcare plan with penalties for those who do not;
  2. Subsidies for certain uninsured individuals and families in order for them to comply with the mandate;
  3. Prohibition on coverage exclusion for patients with preexisting conditions;
  4. Allowance of health insurance exchanges that allow patients to decide which insurers are the best investment;
  5. Dependent coverage for children up to the age of 26; and
  6. Elimination of lifetime caps on benefits.

Despite controversy, the Supreme Court upheld the constitutionality of the Act on June 28, 2012 in the case of National Federation of Independent Business v. Sebelius. Those who attended the forum generally agreed that the mandate was beneficial.

The PPACA and healthcare in the United States, in general, can be approached from a conservative or liberal/centralist political perspective as detailed below:

Conservatives:The architecture of PPACA is arguably derived from conservative ideologies of individual responsibility and the benefits of the free market, which gradually corrects structural flaws of the system. In fact, PPACA is very similar to the reform that Romney passed during his tenure as governor of Massachusetts. Conservatives believe that through the same organic process that drove the U.S. capitalist economy to burgeon, our healthcare system can achieve maximum effectiveness through trial and error and natural evolution.

Liberals/Centralists: While conservatives view healthcare as a business, the other side of the political spectrum believes it to be a fundamental right for all citizens. Since private firms are chiefly attracted to profit and naturally answer to patient health as a secondary priority, such firms will exclude older and ill individuals who may become a financial burden. Some firms have refused to accept patients with preexisting conditions, not unlike car insurance companies dropping clients who have gotten into multiple accidents.

Obama proposed a $716 billion cut to Medicare over a 10-year period, through reductions in hospital and private health insurance reimbursements. The reimbursements permit senior citizens to obtain a private health insurance policy while the federal government covers the bill.

By 2010, the average Medicare-per-patient cost was 117 percent of the regular fee for medical service. Obama’s cut on Medicare is intended to drive costs down to match the quality of care administered. Reimbursements for hospitals are also likely to decrease. However, with the influx of newly insured patients, hospitals generally agreed to the cuts.

If elected, Romney intends to immediately issue an executive order that allows states to waive Obamacare, and to eventually repeal the legislation. Romney disapproves of the “one-size-fits-all health system” and believes that a state-crafted system (similar to “Romneycare” in Massachusetts and healthcare in Oregon) will best suit individuals in respective states, while the federal government’s role should be to create an equal playing field for competition.

Romney proposes to change Obama’s entitlement programs into state block grants (large sums of money given to states) so that states can apply for reimbursement after experimenting with their own forms of healthcare. In this way, states can explore ways to deliver care that are specifically tailored toward their citizens.

The HUBS event channeled student opinion on these issues. Now it’s up to you and your vote! Who do you think has the better vision for America’s health care?

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