Health Reform Dialogue

March 27, 2009

A Time for Reform:

…several widely diverse, national organizations began a series of unique discussions six months ago to exchange ideas and see where their agreements and differences lay.

This health reform dialogue was never intended to cover every issue likely to arise as health reform is considered in the ensuing months. Some issues currently elude consensus.

Increasing coverage and access:

Regarding coverage, reform should build upon the key pillars of health care coverage today — employer-sponsored insurance and public safety-net programs for low-income people and families.

* Improve Medicaid and Children’s Health Insurance Program (CHIP) outreach and enrollment.

* Establish a nationwide floor for Medicaid eligibility for all adults no lower than 100 percent of the federal poverty level.

* Give individuals eligible for Medicaid and CHIP the option to utilize those dollars to purchase employer-sponsored insurance…

* Provide advanceable, refundable tax credits or other subsidies on a sliding scale for individuals and families to purchase adequate and affordable coverage…

* Provide subsidies for small businesses to provide health insurance for their employees.

* Enact reforms necessary so that all individuals will purchase or obtain quality, affordable health insurance.

Strengthening wellness and prevention:

The Centers for Disease Control and Prevention estimate that eliminating three risk factors — poor diet, inactivity, and tobacco use — would prevent 80 percent of heart disease and stroke, 80 percent of Type 2 diabetes, and 40 percent of cancer.

* Identify effective clinical preventive services.

* Encourage clinicians and providers to deliver effective clinical preventive services and follow-up treatment, as indicated.

* Ensure a sufficient primary care workforce through an ongoing, dynamic, national planning and development process.

* Continue to invest in health information technology (HIT) that supports wellness and prevention, both on the individual and community levels.

* Further encourage businesses to support healthy behaviors.

* Encourage communities to be healthy.

* Eliminate disparities in health.

* Help individuals improve their health.

Ensuring quality and value:

* Conduct comparative clinical effectiveness research (CER) studies via a public-private partnership to provide additional information that can help improve care decisions.

* Expand and accelerate the development of meaningful quality measures.

* Fund state demonstrations of alternative medical liability reform models.

* Improve billing efficiencies to reduce confusion and duplication for patients, clinicians, and providers.

* Reduce administrative costs.

* Work to reduce geographic, racial, ethnic, and gender disparities in health care delivery.

* Ensure an adequate health care delivery workforce, including funding for training and loan forgiveness programs and payment reforms directed at primary care, public health and nursing, and other high-priority areas facing imminent shortages.

Context for Financing Health Care:

* Cost efficiencies can be gained by improving health care delivery.

* Methodologies for quantifying long-term cost savings can be improved.

* To jumpstart health reform, additional investments in U.S. health care will be needed.

Enacting meaningful health reform requires a careful and balanced approach of fiscal prudence, accompanied by efforts to contain costs, increase savings, and enhance efficiencies. Such investments will enable transformational changes to be achieved — and those transformational changes will ultimately place the United States on a path toward greater financial and health care security.

Organizations endorsing this document include:

AARP
Advanced Medical Technology Association
America’s Health Insurance Plans
American Cancer Society Cancer Action Network
American College of Physicians
American Hospital Association
American Medical Association
American Nurses Association
American Public Health Association
Blue Cross and Blue Shield Association
Business Roundtable
Catholic Health Association of the United States
Families USA
Federation of American Hospitals
Healthcare Leadership Council
National Federation of Independent Business
Pharmaceutical Research and Manufacturers of America
U.S. Chamber of Commerce

http://www.advamed.org/NR/rdonlyres/42134469-D897-4AE8-B48E-DBB46B84255F/0/HRDCommonGroundFINALEMBARGOED32709.pdf

This report, “Health Reform Dialogue,” contains a few modest but obvious recommendations that any reasonable reform effort must include. Much more important is that the primary theme of this report, as exemplified by the sampling of recommendations listed above, is that we should continue with the status quo, dumping more of our dollars into our dysfunctional, wasteful, inefficient, fragmented system of financing health care.

So why should we pay any attention at all to this worthless contribution to the national dialogue on health care reform? It is because it exposes the blatant lie that we are close to agreeing on reform that would bring affordable, high quality care to all residents of the United States.

This highly touted, closed door process has been taking place over the past half year. Theoretically all important stakeholders were included (except patients). They agreed that we have finally come to the time that reform is an absolute imperative. Through intensive negotiations behind closed doors in a (symbolically) smoke-filled room, they finally agreed… that smoking is bad for your health (and a couple of other points of less significance).

There is absolutely no mention of a single payer national health program, or Medicare for All. That option was discarded before anyone walked into the room.

The compromise position to which the progressives had agreed would be to offer a public, Medicare-like insurance program to compete in the market of private plans. “Health Reform Dialogue” remains silent on such an option.

In a decision to exclude the progressive community from playing any serious role in reform, moderates are now proposing a government-sponsored, managed care PPO program, insulated by a double firewall from the government, so that it must compete on a “fair playing field” with the private plans. “Health Reform Dialogue” even remains silent on the possibility of offering a government PPO that would be required to include the same perverse policies that are inherent features of the private health plan models.

Look again at the organizations that signed on to this report. Two organizations that participated in the process are conspicuously absent: American Federation of State, County and Municipal Employees (AFSCME) and the Service Employees International Union (SEIU). At the end of this process, they refused to sign on to a document that would have even less impact than a no smoking pledge.

Look again at the list and decide which organizations actually controlled the process. Yes, those are the same organizations that have an ownership position in the Congress of the United States.

Unless Americans are ready to march on Washington, both literally and figuratively, the reform process is dead. Yes, dead!