With Senate and House committee markups on health care reform legislation rapidly approaching, there is palpable optimism that, after decades of frustration, comprehensive health care reform may be within reach.
Indeed, there is reason for optimism. By inviting all relevant stakeholders to the table, encouraging bipartisanship and driving for enactment of a comprehensive health care reform measure in 2009, President Barack Obama and key Members of Congress already have made remarkable progress.
The confluence of political change and economic necessity has created a favorable environment for action. First, just about every American understands that the current health care system is seriously broken and must be fixed. Second, most economists believe that addressing the current economic crisis requires that we rein in skyrocketing health care costs. And third, many opponents of past health reform efforts now are actively participating in discussions because they realize that the status quo is not an option.
Yet despite these positive indicators, successful health care reform this year is not inevitable. We are very concerned that too many of the proposals now being drafted may mandate health care for every American while lacking the critical elements to make such a law both achievable and sustainable.
The National Coalition on Health Care, a nonpartisan broadly representative coalition of 75 organizations representing 150 million citizens, supports five basic principles for health care reform: covering everyone, containing costs, improving the quality of care, simplifying administration and financing equitably.
The NCHC believes that these five principles are interdependent and all must be included in any meaningful reform measure. When the nation is projected to spend $2.5 trillion on health care this year and $5.2 trillion by 2020, we cannot secure coverage for everyone without simultaneously addressing cost containment. Comprehensive health care reform must be systemic and system-wide. Reforming health care requires adoption of cost management and funding provisions adequate to ensure the sustainability of reform.
There is no question that the Obama administration and Congressional leaders have publicly supported a number of important cost savings initiatives including comparative effectiveness, prevention, health care information technology and improved coordination of care.
However, the Congressional Budget Office is likely to conclude that the initiatives under discussion would not generate significant cost savings in the first decade of a new law. Something more is needed.
An analysis done for the coalition indicates that substantial additional savings could be generated quickly if lawmakers act to:
Define a core package of health coverage.
Adopt short-term constraints to slow the rate of increase in the costs of that coverage until it grows no faster than the economy as a whole.
According to the analysis conducted by Kenneth Thorpe, a leading health care economist who teaches at Emory University, constraints on increases in reimbursements and on premiums for the core package could generate substantial savings quickly. Using projection methods similar to the CBO’s, professor Thorpe found that such measures could save as much as $1.3 trillion over the first decade of implementation.
We are confident the pace of increase in health care costs can be slowed dramatically if lawmakers draw on methods such as these that other industrialized nations have used to manage costs while guaranteeing health coverage for all their people.
Such provisions would also have the salutary effect of diminishing how much revenue must be raised to offset the type of CBO scoring that we anticipate. Moreover, it could help to win the support of the many fiscally conservative Democrats and Republicans whose votes are needed to enact sustainable health care reform.
Our second concern is whether there exists the bipartisanship that is essential for the passage of legislation of this magnitude. While a number of Republican Senators, including Sens. Chuck Grassley (Iowa), Mike Enzi (Wyo.) and Orrin Hatch (Utah), appear to be working closely with their Democratic counterparts, there seem to be too few Republicans committed to a bipartisan effort in the House of Representatives.
Failure to achieve a bill supported by a bipartisan majority would be a tragedy. First, bipartisanship ensures there will be the requisite majority in the House of Representatives and a possible supermajority in the Senate. But bipartisanship means more than obtaining the necessary votes.
If a measure is enacted with the support of only one party, especially a law that affects one-sixth of the economy and every American, it will not inspire the trust and confidence that such a law demands.
History has shown repeatedly that to implement, oversee and enforce successfully a transformative new law requires more than a signing ceremony; it requires winning the hearts and minds of the American people.
There is still ample time to address these concerns. But in the months ahead, there must be a concerted effort by Congress, the administration and advocacy organizations not only to address the health care crisis, but to ensure the reform’s sustainability.
To do less would be irresponsible.
Dr. Henry E. Simmons is president and Ralph G. Neas is CEO of the National Coalition on Health Care.