Monday, June 15, 2009
President Obama yesterday addressed the American Medical Association (AMA), which has expressed skepticism about some proposals to reform health care. The Post asked experts if the health care industry will derail the president's full reform agenda. Below are contributions from Robert E. Moffit, Thomas A. Daschle, Linda J. Blumberg, Thomas Miller, Len Nichols, Henry E. Simmons, Ralph G. Neas and Rick Scott.
ROBERT E. MOFFIT
Director of the Center for Health Policy Studies at the Heritage Foundation
The disconnect in the president's speech to the American Medical Association was remarkable.
He reiterated the key elements of his health policy agenda: a new government-run health plan to compete with private health plans in a government-run national health insurance exchange. It would include a government mandate on employers to offer government-approved coverage, as well as a government mandate on individuals to buy government-approved insurance.
Yet the president warned the doctors about the unnamed "naysayers" who claim he's trying to bring about "government-run" health care. Gee, where would they get that idea?
The president repeated his previous promises that if you like the health care coverage you have today and the relationship you enjoy with your doctor, nothing will change. That is, as long as your employer doesn't dump you into the government-run health plan.
And he told the assembled doctors that his $1 trillion health plan will be properly financed, and it will not add to the deficit.
For some physicians, no doubt, it was all very convincing. Except for those naysayers.
THOMAS A. DASCHLE
Former Senate majority leader (D)
Great transformation occurs when there is a convergence of crisis and leadership. The crisis is clear -- our current health care system is failing. And as President Obama demonstrated yesterday, health care reform remains a top priority for his administration.
But there is another group who wields influence in this debate: the stakeholders.
During the last major health care debate, stakeholders used scare tactics and slogans to undermine reform efforts. The biggest difference this time is that these same interest groups have remained at the negotiating table. They recognize that the status quo is untenable.
Make no mistake, as the debate heats up, tough decisions must be made. Stakeholders have a choice. They can guard their own slice of the pie, which will do nothing to control skyrocketing costs, improve quality or provide access to the uninsured. Or they can work with policy-makers on a comprehensive solution that will give Americans the high-value, high-performance health care system they deserve.
Former Sen. Claude Pepper (D-Fla.) once gave me an invaluable piece of advice. It isn't important whether you are an R or a D, but rather whether you are a C or a D -- a constructive or a destructive participant in the political and legislative process. Reform can pass if the stakeholders remain constructive.
LINDA J. BLUMBERG
Senior fellow at the Urban Institute; adviser for health policy in the Office of Management and Budget, 1993-1994
Sustaining comprehensive health care reform will require not only making adequate affordable coverage available to all, but also improving the efficiency of how we deliver care. But cost containment is a political minefield. The only way to lower costs is to reduce the use of services, pay less per unit of service, or some combination of the two. Whichever the route, this means reducing the income of some of those who provide healthcare.
We know that there are efficiencies to be had without compromising quality of care. Most insurance and provider markets are simply not competitive, largely due to the consolidation in both markets in recent years. These market failures fuel the rapid growth in spending. Among other things, the presence of a public competitor, perhaps one like Medicare except it pays somewhat more and offers benefits like those in typical employer plans, can catalyze competition among private insurers and lead to significant savings.
Though sensible reform would increase the insured population, offsetting cost containment-related losses, any such cost containment approach will engender opposition from the insurance and provider sectors. So it will take the collective efforts of disease-specific groups, consumer groups, labor, and business to overcome this opposition. While the chances seem better than ever before, it is still an uphill battle.
Resident fellow at the American Enterprise Institute; senior health economist for Congress's Joint Economic Committee, 2003-2006
President Obama's speech continued his efforts to seduce the main organized interest groups of the health industry to listen to the magic words rather than pay attention to the content of imminent health legislation. Many of the doctors in the audience, no doubt, liked the non-controversial parts of the president's speech, as well as the flattery he extended when he talked about defensive medicine. Nevermind his straw men and his denials that grew loudest when they concerned the most accurate and telling criticisms of his current plans.
Even so, the health care industry alone, even if combined with employer groups, could not, should not, and would not derail the president's health reform agenda. But the broader public could and might as the actual details and future implications of how Congress will try to hammer round patient pegs into square political sinkholes unfold more transparently. While the teleprompter is shut off, we should get back to the realities of accountable and affordable patient-centered health reform. It is, indeed, imperative, but we haven't seen it offered to us yet as responsible adults.
Director of the Health Policy Program at the New America Foundation; senior adviser for health policy in the Office of Management and Budget, 1993-1994
President Obama is clear: health care reform is not a choice. We must achieve greater value for our health care dollars to make insurance affordable for families and stabilize our nation's long-run fiscal future. Health care providers know that our current system is unsustainable. This is why they want to get paid for coordinating care and making people healthier, not just for ordering more tests.
Still, achieving provider support for health care is critical. So we must protect doctors from unwarranted lawsuits while defending patients when a medical error does occur. We can pay providers for spending more time with patients while ensuring that coverage and care are affordable. And we can make investments in prevention and early detection while expecting Americans to take more personal responsibility for their health in return. Promisingly, the president's speech at the AMA signals Washington's willingness to work with the medical community.
HENRY E. SIMMONS and RALPH G. NEAS
The authors are, respectively, the president and the CEO of the National Coalition on Health Care
Yesterday, two signals were exchanged. The AMA made it clear that it intends to participate fully in shaping and debating health care reform this year. And the president underscored his commitment to an inclusive, bipartisan process to achieve sustainable reform. That spirit of constructive collaboration, from all quarters and both parties, needs to be maintained in the coming months. The stakes -- for the quality and cost of care and access to it -- are too important for any of us to succumb to short-sighted political calculations.
Chairman of Conservatives for Patients' Rights
Meaningful health care reform is needed but only achievable if it is rooted in principles that have proven to work. Any plan that does not will collapse on its own with no one group responsible. And whether it was in his remarks to the American Medical Association or in meetings with congressional leaders, President Obama -- so far -- has embraced principles that do not work.
There is no need for a "public option" to compete with private insurance plans. It will simply run insurance companies out of business and create a government-run health care monopoly. The AMA understands this, which is why it has expressed opposition to versions of a public option.
If the president wants to diminish opposition to his plans, he should focus on increasing competition by, for example, allowing consumers to purchase health insurance across state lines, from anywhere in the country, which Americans do right now when purchasing life insurance.