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