Health Politics

Ten years ago we couldn't even agree on the ultimate goal for health reform. Just a day ago, at the American Medical Association's National Advocacy Conference, I heard a whole lot of agreement on where we want to be -covering all Americans, providing better care, and reducing costs. Two very interesting perspectives on how to get there came from from Senators Ron Wyden (D-OR) and Tom Coburn, M.D. (R-OK).

Wyden and Coburn are of course far apart ideologically. But as I listened to them give their separate speeches, I was struck by how similarly they viewed our health reform challenges (if not how to achieve solutions). In particular:

Finally some proof that fewer and fewer people believe that "America has the best health care in the world!" This claim simply doesn't resonate with Americans who have experienced (or heard about) distressing personal encounters with swamped emergency rooms, medical errors, specialists who don't talk to each other, nursing shortages in hospitals, high prices, etc. etc.

According to a new poll from the Harvard School of Public Health and HarrisInteractive, only 45 percent of those surveyed agreed with the statement "the U.S. has the best health care system." Republicans were most likely to agree (68 percent) compared to Democrats (32) and Independents (40). That's a pretty sharp discrepancy - but it also mirrors the approaches and slogans we've heard on the campaign trail this year.

Across the political spectrum, respondents said that the United States does a worse job than Canada, France or Great Britain in making sure that everyone can get affordable health care and control costs. Among Republicans, 40 percent said our country does better than other countries on providing affordable care, but only 19 percent of Democrats thought so. (This particular poll did not test their views on possible solutions to the system).

Brief update - As expected, the Pennsylvania House did approve a scaled-back version of Gov. Ed Rendell's health coverage plan this week. Rendell has now embraced the compromise and strongly urged the state Senate—which has been more skeptical about the finances—to pass it. As coverage expansion needs to go hand in hand with insurance market reform, particularly to help small businesses and individuals purchase policies, Rendell is also pushing for an insurance package in the House. AP has the details.

Ezra Klein posts today about what health care wonks seldom talk about - how all the grand blueprints for overhauling U.S. healthcare don't mean much if they can't gather 60 votes in the U.S. Senate. But if you've been following our work at New America, you know that "60 votes" could be our middle name. Health reform requires bipartisan compromise. (Klein is only joking when he says that his secret health reform plan is to invade France and take their health care. Although the scenario does have some pretty amusing possibilities for bipartisanship on the beaches of Normandy...).

Musing about his imminent appearance at "Take Back America," Klein writes, "What you never hear about are votes. Political strategy. Getting to 60. Because that, fundamentally, is what's at issue here. Getting to 60 in the Senate. Health care is not so much a policy problem as it is a political problem. The policy questions are nearly solved. The political obstacles, however, seem nigh insurmountable. But if you have a plan without a strategy, you have nothing at all. If you can't tell me how you'll get to 60 in the Senate, what you have isn't a plan, it's a position. And no one in this country gets medical care from a position."

Michael Tanner of the Cato Institute pointed out that health care costs are out control and spending, projected to rise from about 17 to 20 percent of GDP in less than a decade, is unsustainable. We agree. No health reform proposal will be sustainable without serious efforts to reduce costs and improve quality. However, because the uninsured are inextricably linked to the cost of care for the insured, we cannot solve the cost problem without covering the uninsured.

Think of it this way. The uninsured have a harder time paying medical bills. When medical bills go unpaid, providers—hospitals and doctors—need to find a way to recoup the lost revenue and raise the rates they charge insurers for services. The insurers, now faced with larger bills for enrollees, raise premiums. End result: the insured end up paying more for health care.

It is great to see candidates on both sides of the aisle talking seriously about cost-containment and a high-value delivery system and we cheer Tanner's conclusion: "Regardless of who becomes president, we can expect major changes for the American health care system."

It's no surprise that the economy was the top issue for Mississippi voters in Tuesday's Democratic primary, but health care still resonated. Just over half the voters surveyed by network exit polls cited the economy as their top concern. But one in five said health care was their number one issue -- the same number as the Iraq war. (We would argue that health cost and coverage can be a component of economic anxiety as well). Voters who cited health as their main concern voted for Barack Obama over Hillary Clinton by a nearly two to one margin (64 to 35 percent).

The Mayo Clinic held a health reform conference this week -- New America's Health Policy director Len Nichols was there and he'll post about it momentarily. But Mayo also released a survey about what the public is thinking about health care. The Health Blog at the Wall Street Journal summed it up, but here are a few interesting snippets:

Just about everyone surveyed - 90 percent --think health care costs too much. No surprise there. Four out of five wanted "freedom of choice" to pick insurers, hospitals and doctors. There was also broad support, more than 70 percent, against denying coverage for people with pre-existing health conditions.

What struck us is who they expected to fix the problems-- slightly more than a third (36 percent) picked insurance companies. Following close behind were doctors and other health care providers (32 percent), Congress (31 percent) and consumers (29 percent). They didn't have much faith in the state government's ability to solve what is after all a national problem (16 percent).

We read Senator Tom Coburn's (R-OK) piece in the New York Sun yesterday. While we applaud Senator Coburn’s commitment to reforming our struggling health system and his bill, S. 1019—which contains many creative proposals, including efforts to improve and promote preventative services—we believe that with a few market reforms we can make markets work more efficiently and effectively for all Americans.

So in order to truly turbo-charge competition, we must take markets a few steps further:

The Kettering Foundation, along with Public Agenda and the National Issues Forum Institute, held what they billed as a novel experiment in public thinking about health care and the environment this week. We attended the health care event -- a half-hour film of focus groups around the country of ordinary people talking about the trade-offs of health reform, followed by a panel discussion by nine experts in public opinion or public policy (but not necessarily in health policy). They plan on holding more discussions across the country in the coming months.

We certainly laud dialogue on health care -- particularly recognition upfront that it involves tough choices and tradeoffs. One of the pitfalls of previous reform efforts, we think, is that people were asked if they wanted to improve the system but not immediately confronted with all the implications of that choice -- and then they backed off in a panic.

We just spent two days at AHIP’s (America’s Health Insurance Plans) 2008 National Policy Forum, an annual gathering about the challenges facing the industry. Despite the multitude of speakers with markedly different world views, the similarity of the themes was remarkable – and telling. We may have finally reached a point in the health care conversation where we are forced to agree on the fundamentals. Hallelujah.

The common refrains from the choir:

1. No matter who is elected President, he or she needs to present a solution to the health care crisis very early on in their administration.

2. This country is not ready for single payer, nor is it ready to hand everyone a check and wish them good luck in the free market.

3. We need to stop focusing on lowering prices and premiums and start focusing on how to manage care better to cut costs. We can save money by taking better care of patients.

4. The uninsured have many faces – they are not simply the poorest segment of society.

5. Health IT (information technology) may not save money, but it will improve care. IT will also allow us to develop comparative effectiveness studies, so we can finally figure out what treatments are medically effective and cost efficient, and avoid treatments that are only marginally effective.

6. Wellness is good. Obesity is bad.