Posted on National Review Online: The Corner, 03/30/09
“Strange bedfellows” have been meeting for years in Washington to try to hammer out compromises on health reform. The latest is the “Health Reform Dialogue,” composed of 18 groups from the AARP to the U.S. Chamber of Commerce, who’ve been working with a professional mediator for six months to develop a five-page statement released last week.
But they disagreed on as much as they agreed on, and the group lost several members along the way, including the Service Employees International Union. The SEIU quit because the group refused to endorse a government health-insurance plan for working Americans — which would mean millions of potential new union members but would put private insurers out of business, leaving people with only the “choice” of the government plan.
In addition, business members couldn’t endorse an employer mandate, which is basically a new, uncontrollable tax on their companies. And the group couldn’t agree on how to pay for reform.
Their difficulties reflect the problems members of Congress are having in trying to forge a consensus on sweeping health reform. There is broad support for health reform, and each constituency group supports most of the provisions on the table. But they also have 20 percent they can’t support. The problem for reformers is that someone is going to fall on their sword over a different 20 percent of the plan.
A word of advice: Step away from the sweeping reform agenda and focus on those things that members of this very diverse group did agree on, from America’s Health Insurance Plans, to the American Medical Association, Blue Cross and Blue Shield Association, Families USA, the National Federation of Independent Business, and Pharmaceutical Research and Manufacturers of America.
Here are some of their ideas that build on the current health system and begin to move it into the 21st century:
“Provide advanceable, refundable tax credits or other subsidies” to purchase health insurance. The Health Reform Dialogue group proposes making these subsidies available on a sliding scale. However they are structured, this is a much-needed reform that would expand access to coverage for the uninsured, and it would give individuals and families portability and greater control over their health care and coverage.
“Give individuals eligible for Medicaid and CHIP the option to utilize those dollars to purchase employer-sponsored insurance, so long as full Medicaid or CHIP wrap-around coverage is available.” This idea is a step in the direction of giving people choices in their health coverage, including those on government programs. Allowing them to choose private coverage would give them more choice and control over their health care and coverage.
“Conduct comparative clinical effectiveness research studies . . . ” The operative word here is “clinical.” While we oppose government getting into this area at all, it is encouraging that this report specified the research should focus on clinical effectiveness — not cost effectiveness, which would lead to rationing of drugs and treatments.
“Consider the potential effect of new payment methodologies on medical innovation.” This is vital. Everyone agrees we need payment reform, but we must be careful not to change our health system in such a way that it would constrain the medical innovations the United States provides to the world. Government limitations on how much doctors and other providers can make, or how much the innovators can collect for their life-saving treatments, would be treacherous.
The report also acknowledged that “Americans enjoy the best clinical outcomes in the world, and life expectancy is rising.” It’s refreshing to hear that they don’t think we should give up on the American health-care system, as so many others in Congress appear ready to do.
— Grace-Marie Turner is president of the Galen Institute, a non-profit research organization focusing on market-based, patient-centered health policy. Amy Menefee is communications director.