My prediction about the effect of the upcoming Presidential election on healthcare is that, because neither candidate can change reality, both of them will be forced to resort to similar solutions for healthcare reform.

The healthcare system is an economic and access disaster. We are at the tipping point: forty million people have no medical insurance. The cost of providing medical care for our aging population is increasing.  The practice of medicine itself is becoming more complex and expensive.  And still, the cost of medical care continues to increase and is becoming unsustainable for our economy.

President Obama was willing to admit this and take some steps to fix it. Courageous and laudable, but very ambitious. Obama's healthcare reform increases healthcare insurance coverage for a lot more people. It also seeks to address the problems of how to deal with the ever increasing costs of those already insured and how to pay for the additional 30 million newly insured. So far, the ways to pay for this are: reduce fraud, increase access to data and technology, reorganize delivery systems (ACOs, etc.), increase the number of people purchasing medical insurance, and reduce costs of insurance companies, drugs, and hospitals. In theory these are reasonable ideas.  The execution is another matter. (Another cost-savings measure championed by physicians that Obama did not include is malpractice reform. But that’s a whole other topic.)

Yet whoever wins the election, the challenges will remain the same: how to pay for the healthcare we need without bankrupting the country. I am glad it is not me!

No matter who the next president will be, he will have to solve this dilemma, and he will most likely have to select most of the same tools that Obama has used. So, I don't expect the results of the election to create many differences, except I think more taxes will eventually be required. The main difference between Obama and Romney will be who pays the taxes. Guess who?