Obama Has Good Idea: a Bipartisan Health Summit

Posted February 25, 2009 at 2:44pm

A wave of paranoia ripped through the right and left wings earlier this month over health initiatives in the economic stimulus package. It was just a small demonstration of struggles to come.

[IMGCAP(1)]First, the right declared that two widely supported initiatives — digital health records and research on comparative effectiveness of medical procedures — was part of a Democratic plot to socialize and ration medicine.

Then, the left interpreted that paranoia as part of a plot by the pharmaceutical industry and medical device manufacturers to undermine efforts to control medical costs.

To prevent scare tactics and suspicion from torpedoing health care reform before it gets launched, it’s a good idea for President Barack Obama to convene a broad-spectrum “health care summit” to begin a public bipartisan dialogue.

A “secret” dialogue has been under way on Capitol Hill, according to the New York Times, between the staff of Sen. Edward Kennedy (D-Mass.) and lobbyists for big and small business, the insurance and pharmaceutical industries, AARP and unions.

But that’s not a substitute for public airing of options to help educate voters and build support for any plan that the Obama administration finally backs.

There’s no way a Democratic Congress and administration are going to opt for traditional Republican health initiatives — private health savings accounts and such — but the dialogue could ensure that other market-based solutions get considered.

And two people who should surely be invited are former Speaker Newt Gingrich (R-Ga.) and Progressive Policy Institute’s David Kendall, both advocates of making the U.S. health care system as efficient as the best private health centers such as the Mayo Clinic.

Kendall argues in PPI’s idea-rich book, “Memos to the New President,” that Mayo-like reforms in the government’s Medicare and Medicaid programs could save enough money to fund health insurance for America’s nearly 50 million uninsured, and then some.

“The total U.S. health budget is $2 trillion,” Kendall told me. “Fifty percent of it is government. There are studies showing you can save 30 percent of health care costs by becoming more efficient.

“That’s $600 billion a year — or $300 billion for government. Covering all of the uninsured will be $100 billion, which leaves a lot left over for the rest of the economy.”

It’s not that simple, of course — by a long shot. But it’s a glimpse at how the United States could begin to get out of its status of the developed nation with the highest per capita health outlays and far less than the best health outcomes.

Gingrich calls his reform concept “health-based health care,” which rewards providers for keeping people healthy instead of performing procedures or charging for office visits, and using health information technology to judge and spread the word about best practices.

Gingrich associate David Merritt, author of the book “Paper Kills,” helped knock down the right-wing paranoia about health IT and comparative effectiveness — while arguing that private-sector actors had to have a role.

“Modernizing our healthcare system through information technology and robust comparative research will push our health system into the 21st Century,” he said in an analysis of the stimulus package.

“Getting the latest technology into the hands of doctors, providers and patients is essential to transforming health,” he said. “While fears are justified that this kind of research could be a slippery slope to rationing care, that argument is not currently justifiable in the specific language of the bill.”

Kendall recommends that the federal government set an overall budget for public health programs, including tax breaks for employer-provided insurance, and set targets for controlling costs.

He’d set up a “Health Fed,” modeled on the Federal Reserve, to analyze data and recommend methods of keeping to the budget — such as cutting payments to Medicare providers or asking holders of expensive insurance policies to pay more in taxes.

The Health Fed is an idea also advanced by ex-Sen. Tom Daschle (D-S.D.), Obama’s former nominee for Health and Human Services secretary. In Kendall’s model, Congress would vote on its recommendations.

Kendall also recommends an idea that ought to appeal to Republicans: establishment of specialized “health courts” to hear medical malpractice claims, a step to reduce frivolous lawsuits and expensive “defensive medicine” and keep malpractice insurance costs from driving doctors out of business.

But the core of his program is to “spread the mayo — the Mayo Clinic model, that is.”

“A big chunk of our medical bills goes to pay for unnecessary care,” he said, including duplicative tests and examinations.

“The scale of waste is shocking,” he said, quoting Peter Orszag, now Obama’s budget chief, as estimating that 5 percent of gross domestic product — $700 billion a year — goes to tests and procedures that don’t improve health outcomes.

Modern providers such as Mayo, Intermountain Healthcare in Utah and the Veterans Affairs Department save money and improve health by committing to “integrated care,” including a lead doctor who coordinates all specialists and treatment.

At each institution, digital health records prevent errors and duplication and, according to Kendall, “each pays health care professionals for the value, not the volume, of the services they provide” — a difference from HMOs that control costs but ration care.

Another certain participant in an Obama health summit will be Chris Jennings, a former Clinton White House health adviser, who says that “all the stakeholders — and not just consumers, labor and business but pharmaceutical companies, the insurance industry, providers and medical device manufacturers” are ready for reform.

“They all say, ‘Let’s play here,’ because they see that the consequences of not doing something are very negative — cost controls that will hurt them all. The stakeholders are ahead of the policymakers and they are all ready to compromise,” Jennings said.

So, it’s time for Obama to get them all together — before paranoids and ideologues get into the act and ruin the chances for change.