What do "the people" really want when it comes to healthcare reform?
And when will they likely get it?
As healthcare providers entered 1995, the general consensus was that the heat was off in Washington, allowing managers to concentrate on local markets and state issues.
Fat chance. If the recent activity in Washington is any indication, then this year will be every bit as tumultuous as 1994. But instead of Hillary Clinton, Ira Magaziner and the Democratic social engineering cabal, it's the likes of House Speaker Newt Gingrich (R-Ga.) and House Way and Means health subcommittee Chairman William Thomas (R-Calif.) who will ride herd on Capitol Hill.
This go-around, maybe we should call it social re-engineering. At the American Hospital Association's annual meeting, the new kids on the reform block shocked hospital administrators with talk of overhauling the Medicare system and giving states block grants and full responsibility over the acute-care portions of Medicaid.
Those are sobering thoughts for hospital executives who depend on those programs for more than half their revenues. Excuse me, but Newt pontificating about "rethinking Medicare from the ground up" is akin to Rep. Jim McDermott (D-Wash.) and Sen. Paul Wellstone (D-Minn.) endorsing a nationalized single-payer healthcare system. Reductions in the growth of Medicare and Medicaid spending are likely to pass this year, but drastic overhaul of major social programs is nearly impossible in such a short time frame.
Not that there's anything wrong with Newt and his uncanny ability to make things exciting. After all, fresh ideas were at the core of last November's Republican landslide. And giving all those Republican governors the PIN number to the Medicaid cash station card with few strings attached is enough to give Pat Buchanan goose pimples.
However, a few major icebergs stand in the way of Newt's Navy. The fabled "Contract with America," for instance, pays scant attention to healthcare reform. Sure, there's mention of tort reform and equity relief for senior citizens, but not a heck of a lot relating to providers.
The planks of the Contract with America will preoccupy the members of the 104th Congress, at least for the First Hundred Days. Like everything else in Washington, the timing and money available will determine if and when reform efforts will see the light of day.
As we know, there isn't much money. And if you think about it, there's not much time either. The reason is the presidential primary season, which will crank up by Labor Day in anticipation of New Hampshire's traditional first-in-the-nation primary election (tentatively scheduled for Feb. 20, 1996). That leaves only a few months to seriously debate the issues and vote on a reform package.
The brief window of opportunity also makes doggone good political sense. Moreover, William McInturff, a top-drawer Republican pollster, assumes the GOP will focus on incremental changes in healthcare because that's what a majority of voters favor. That answers the what and when. Any more questions?
Well, inquiring minds within the provider community do want to know what changes are likely. McInturff, a Public Opinion Strategies partner, says his research indicates political as well as popular support in two main areas:
Government taking a leading role in spearheading efforts to stop or reduce fraud, abuse, waste and greed in the healthcare system. The public wants policymakers to find obvious ways to squeeze costs out of medical services without disrupting access and quality. The body politic will be more than happy to oblige.
Limits on malpractice rewards could be part of this scenario; so might tighter restrictions on physician self-referrals. An invigorated Sen. William Cohen (R-Maine) already has reintroduced his bill to crack down on healthcare fraud and abuse. The bill would create an all-payer national healthcare fraud control program through HHS and the Justice Department. The legislation also would extend some Medicare and Medicaid fraud penalties to similar violations to all payers and would create a new healthcare fraud statute in the criminal code. Sen. Bill's bill is a bit ambitious but will get a fair hearing on Capitol Hill.
Insurance market reforms that promote portability and outlaw pre-existing condition clauses. That could require some type of limited community rating. Efforts to improve the availability and cost of long-term-care coverage also might fly. Americans, McInturff claims, are frightened that they are "just one sickness away from the poorhouse."
Actually, that's the crux of the entire healthcare debate and the reason President Clinton called his bill the Health Security Act. Momentum for large-scale healthcare reform peaked during the recession of 1990-91 when millions of workers faced uncertain futures. By the time Congress began debating the president's proposal, the economy and employment opportunities had improved immensely. As public opinion waned for major change, the Democrats lost control of the reform issue.
But the Dems aren't about to easily capitulate by allowing Republicans to take credit for passing incremental changes with solid public support. This will become especially clear when the 1996 presidential election campaign begins to percolate. Thus, the clarity of the theory about the tiny opening in the window of opportunity. It will slam shut long before the New Hampshire primary.
The message to providers is to position their organizations' response to the 1996 fiscal year budget battle. The debate likely will focus on Clinton's vow for no broad reductions in Medicare or Medicaid vs. the Republican desire to whack and possibly overhaul the programs.
Oh, and by the way, it's still best to concentrate on your local market and state political/economic issues.