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Government News
Senator Says Health Reform to Come in Baby Steps
Psychiatric News
Volume 43 Number 21 page 9-25

Permanent solutions for getting health care to the millions of uninsured U.S. residents and being able to gain control of the spiraling cost of health care are unlikely next year, regardless of who wins the presidential election, according to both those who run and influence Congress.

Some leaders in Congress, business, and health care agree that comprehensive change to the U.S. health care system will likely take much longer than even the four-year term of the next president.

The caution flag waved by government and private-sector leaders at a media briefing in Washington, D.C., in September ran counter to the charged atmosphere of presidential and congressional campaigns that have frequently touted the need for sweeping changes in how health care is delivered and accessed.

"This is not going to be solved in four years because it took 60 years to get here," said Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions, a health care research firm in Washington, D.C.

Among the chief problems that need to be addressed as part of any health care reform effort, he stated, are the lack of widely used and mutually compatible electronic medical record systems, the increasing shortage of primary care physicians, and a payment model that does not reward clinicians for improving their patients' health.

Steps to address these problems and reduce the number of uninsured Americans from 47 million will require specific steps next year, said Sen. Max Baucus (D-Mont.), at the media briefing, which was organized by the AMA.

Significant change is constrained by the conflicting desire of Americans to expand access while opposing any changes that might disrupt their own access to health care through increased costs.

"The problem is much worse than most Americans think," said Baucus, referring to statistics that the United States spends nearly twice what other major industrial countries do on health when public and private spending is totaled.

Baucus, who is chair of the Senate committee with lead jurisdiction over health care reform, said that high among the areas of health care that need to be addressed is finding a way to lower barriers to coverage in the individual insurance market so that it comes closer to the level used in employer-provided plans. Critics said many applicants with chronic health problems are unable to qualify for insurance.

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Although Baucus was critical of the health care reform plan offered by Republican presidential candidate Sen. John McCain, which would depend in large part on encouraging competition that McCain believes could lead to lower prices among major insurers, he said major reform and long-term solutions will require both parties to unite behind a compromise approach.

"Everyone needs to step back and not put forward solutions that are anathema to the other side," he said.

An eventual health care overhaul is likely to blend aspects of the Democratic-backed plan to boost government involvement in health care policy and Republican-supported market-based approaches, said Keckley.

"The economic reality will force us to address these [challenges] in a centrist way," Keckley said.

Mary Grealy, president of the Healthcare Leadership Council, which represents major health care businesses, agreed that a wide variety of approaches needs to be considered. Among the approaches she urged is for Congress to consider use of Medicaid funds to encourage more small businesses to cover low-income workers and their families (see Medicaid Back in Spotlight as Remedy for Insurance Crisis).

The AMA, which has urged coverage of all of the nation's uninsured, favors a reform approach that would expand access to private insurance through the use of tax credits (see Single Payer or Individual Tax Credit: Which Reform Proposal Is Best?). But fights over the best approach to reform need to give way to real changes that will increase health care access in the short term, according to AMA President Nancy Nielsen, M.D., Ph.D.

"These are not simple problems, but we must get beyond talking about them and get to some real solutions," Nielsen said.

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The challenges facing supporters of a major health care overhaul have grown more daunting in recent months as the economy has deteriorated, and the government has committed huge sums to rescuing it. For many congressional leaders, the issue has taken a back seat to the need to address the economy and climate change, said Baucus. However, major changes in the health care system will be his committee's leading priority in 2009, he noted.

"Health care has become so complicated that it's hard to even see the crisis," he emphasized.

Baucus has begun talks with the chairs of the other congressional committees with jurisdiction over aspects of health care policy regarding ways in which they can move incremental reform legislation quickly. Although Baucus has not yet written the "incremental" health care overhaul bill he plans to push, his criticism of others' bills to expand health care access may indicate directions in which he will not move. One such bill introduced by Sen. Ron Wyden (D-Ore.), the Healthy Americans Act, would, for example, replace the tax incentives for employer-provided health insurance with a mandate that workers buy their own insurance.

"People are comfortable getting their health care from their employer," Baucus said about his opposition to Wyden's approach.

Baucus's legislation will aim to cover all Americans; encourage prevention efforts; better spread the costs of health care among individuals, employers and the government; and reduce the rapidly rising costs of such care, he said. Possible "solutions" to health system problems include creation of risk pools for small employers to join, thus lowering their costs, as well as reform of the individual and small-group insurance markets to eliminate practices such as rejections based on preexisting conditions.

The scope of any measure that could pass next year is unknown, but for now Baucus is not setting his sights too high.

"It took many years to get here, and we can't solve it immediately," he said. "But at least we can take incremental steps."

The text of the Healthy Americans Act can be accessed at<http://thomas.loc.gov> by searching on the bill number, S 334.

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