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What's the Prescription for Health Care Reform?

September 24, 2009 // 8:00am10:00am
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Program on America and the Global Economy
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On September 24, 2009, the Wilson Center on the Hill, Program on America and the Global Economy (PAGE), and Boston University's Washington Center brought lawmakers and experts together on Capitol Hill to discuss the current health care system and the debate over its reform. Linda Killian, director of the Boston University Washington Center and a senior scholar at the Woodrow Wilson Center, moderated the event.

One of the primary issues in the discussion was how to make health care affordable. Congressman Joe Courtney (D-CT) said that as more people get health insurance the market widens which leads to lower costs. He proposed a "purchasing exchange" where people could have a choice of multiple affordable options, possibly including a public option. This exchange could be similar to what is currently offered to Members of Congress. A key goal, he said, is to lessen insurance monopolies and induce competition in the market. Furthermore, he held that people in his home state have reacted positively to health reform because a widening market will be good for the insurance business, an important industry in Connecticut.

Democrats and Republicans disagree on only one of the three main points of health care reform, according to Congressman John Shadegg (R-AZ), who serves as a member of the House Energy and Commerce Committee and is the former Chairman of the House Republican Policy Committee. Prohibiting insurance denial based on pre-existing conditions and the need for universal coverage are the two areas of bipartisan agreement. According to Rep. Shadegg, the area of disagreement comes with the appropriate role of government. He believes that the government should give money to those who need it to purchase health care on the free market, rather than play a direct role in the market.

One point of debate was whether reform should include high-risk pools. Rep. Shadegg stated that these pools would be an effective way to reduce overall cost. He proposed a system whereby people who are at high risk would enter the high-risk pool and their cost of insurance would be capped at 120 per cent of the cost of standard-risk insurance. The remainder of the cost of providing care for these high-risk people would be provided by government subsidies. Rep. Courtney disagreed on the need for high-risk pools. He said that they already exist in some states and that they are unsustainable because they don't spread the cost of insuring sick and poor people over a wider market.

Congressman Jason Altmire (D-PA), co-chair of the New Democrat Coalition's Health Care Task Force, said that the pressing question in the debate was how to offset the price of the reforms. He also said that it is unnecessary for reform to add to the deficit. For health care reform to work, he said that the costs of helping sick people must be offset with the gains of insuring healthy, young people. Currently, people without health insurance still get treated at the emergency room, as mandated by law, but people with insurance shoulder the costs associated with doing so. Rep. Altmire said that he is for health care reform but voted against the house bill because he saw it as punitive for small businesses that cannot afford to pay for health care for their employees. Furthermore, he rejected the incremental approach saying that they have to pass health reform all or nothing. The most terrible outcome, he said, is to pass a bill making things worse but the next to worst outcome is to do nothing at all.

Congressman Michael C. Burgess, M.D. (R-TX), a doctor with nearly three decades in the field before becoming a Member of Congress, noted that other legislation such as the stimulus plan and cap and trade were introduced before health care, which may have made more Americans hesitant of further increasing the deficit. Another major mistake with the proposed reform is that the crafters of the legislation omitted medical liability reform. According to Rep. Burgess, the biggest problem in health care presently is defensive medicine. The unnecessary actions and over-testing associated with defensive medicine significantly raise health care costs. Another slip-up made by this administration was that it should have moved earlier when it had more popularity.

According to Charles M. Brain, President of Capitol Hill Strategies and former Hill staffer, there are three relevant lessons for Obama in this big, emotional debate. First is timing, the so-called "lesson learned." Unlike the push in the 1990s, Brain said the goal from Obama's first day was to move very quickly and get the reform passed early. The second, the "lesson over-learned," is how much detail the administration put in the plan they submitted to Congress. During the health care reform efforts of the 1990s, the Clinton administration submitted a detailed plan to Congress. Because of its vast detail and the lack of congressional input, Members of Congress could easily find problems with it, and struggled to identify with it as their own. According to Brain, the Obama administration over learned this lesson and didn't provide enough specificity in their plan. The third lesson for Obama is the "lesson not learned"—not anticipating the opposition. While the administration did extensive outreach to certain key groups, such as doctors and the pharmaceutical and hospital industries, they didn't anticipate the high levels of vocal opposition by the public. According to Brain, a majority of Americans today, and over 95% of voters in the last election, have insurance and are concerned about how the health care reform will affect them. The administration made a mistake by focusing on the uninsured instead of reassuring people who have insurance that reform will be good for them.

Barry Jackson, former Assistant to President George W. Bush for Strategic Initiatives and External Affairs, agreed with Brain that the White House underestimated the opposition. Jackson said that most people are happy with their plans. He added that a lot of seniors are satisfied with the current form of Medicare and believe that Medicare Advantage Plans gives them meaningful health care choices. The best approach, in his opinion, is incremental. Reform should start with the small pool of uninsured people and move from there.

Looking at the polls, Gerald Seib, Assistant Managing Editor and Executive Washington Editor of The Wall Street Journal, discussed the arc of public opinion. He said that there are two myths in regards to the attitude towards health care reform. The first myth is that support has slipped. Seib said that supporters of health care reform still support the effort, but the people who earlier didn't know if they supported the effort have generally become opposed. The second myth about public opinion is that support collapsed in August. Seib dismissed this notion, because he said, the polling numbers haven't changed in that time. That left the question of where health care reform is now. Seib held that people are in favor of doing something as opposed to doing nothing, as the data indicates that there is continuous, solid support for doing something. Moreover, about half the country is set in their opinion, whether for or against any reform. The other half of the populace is unsure, and of that half, about 20% have no opinion.

Drafted by Matthew Clarkson, PAGE
Edited by Kent Hughes, PAGE

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