Because of increasing problems with access, cost, and quality, healthcare reform is back on the table. Presidential candidates from both the Republican and Democratic parties have proposed reform plans, and Democratic leaders in the House and Senate are ready to make reform a legislative priority after the November election.

"It is one of the top priorities," said Josh Cooper, senior director of government relations at the American College of Radiology.

Republican John McCain supports a market-driven plan (see accompanying article). It proposes replacing tax cuts for employer-sponsored healthcare insurance plans with tax breaks for individuals to choose their own coverage. Various pooled options would increase choice and control costs. Analysts say the elimination of corporate tax breaks would probably lead to the end of employer-sponsored plans and would shift the responsibility for acquiring health coverage to individuals and families.

McCain's plan calls for cost-containment, disease prevention, and the adoption of electronic medical records. He supports policies that encourage competition among health insurers, the re-importation of prescription drugs as a cost-saving measure, and tort reform to address medical malpractice abuses.

Democrat Barack Obama emphasizes universal healthcare access and insurance coverage in addition to many cost-containment strategies also supported by his opponent (see accompanying article). He plans to expand Medicaid and the State Children's Health Insurance Program (SCHIP) to guarantee insurance coverage for all children. He would spend tens of billions of dollars for a new public insurance program for self-insured individuals and employees of small businesses, and for subsidized premiums for low-income individuals and families.

Obama intends to save billions of dollars by authorizing Medicare to negotiate with pharmaceutical companies for drug prices. Driven by the buying power of its 42 million beneficiaries, Medicare could negotiate deep discounts that would reduce pharmaceutical company profitability, he contends.

Like McCain, Obama would invest heavily in healthcare information technology to subsidize adoption of electronic medical records and other IT systems, such as barcoding, to reduce medical errors. He supports increased funding of the National Institutes of Health for biomedical research.

Obama is likely to fall on the side of healthcare consumers (and trial lawyers) regarding medical malpractice reform, and he has called for a national institute for comparative healthcare effectiveness as a mechanism to assess emerging and competing technologies.

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