The Obama and Romney campaigns contributed dueling perspective pieces to the New England Journal of Medicine this week. In it they offered their diagnoses of the current system's problems, they laid out their vision of the path forward, and took some shots at each other. Obama's: "Securing the Future of American Health Care" Romney's: "Replacing Obamacare with Real Health Care Reform" Here are their diagnoses of the problem. Obama: Romney: And parts of their suggested approaches to solving them: Obama: Romney: I was struck by a few things in reading these. 1. The two candidates agree on the need to fix the individual insurance market for people who don't have employer-sponsored insurance. They're both interested in seeing a competitive market with "strong consumer protections," to borrow Romney's words. This shouldn't be surprising as the mechanism for doing that (new marketplaces dubbed "exchanges") was pioneered in Massachusetts under Romney and is now being disseminated around the country by Obama. 2. Romney missed his audience. In a piece aimed at doctors and other readers of the NEJM, Romney identified changing the tax treatment of health insurance and changing the rules around HSAs as the big reforms that are needed. He wrote of a world in which "everyone — providers, insurers, and patients — has incentives" that work, which sounds great. But it's not clear that he actually understands or wants to address the bad incentives that providers currently face. 3. Only one candidate seems interested in fixing health care. The current system is broken and not just because so many people don't have health insurance (obviously that will be less of a problem in a few years), but because the ways we pay for and deliver health care are flawed. Obama, to his credit, has been focusing on encouraging better models of care that pay doctors and hospitals for the right things not the wrong things, and encourage quality over quantity. Fixing the deficiencies in the insurance system is important, but so is building a health care system that gives doctors the support they need to provide patients with the kind of care they need, in the way they need it. So let's talk. Who do you think has the better all-around approach to reform?