The White House last week stood firmly behind its focus on consumer-directed healthcare amid growing pressure to adopt universal health coverage and questions about whether President Bushs agenda has grown outdated.
The gap between the presidents longstanding health policies versus those favored by proponents of universal health coverage was evident during a 24-hour period last week. The White House released a response critical of several key recommendations from the Citizens Health Care Working Group, a bipartisan commission that queried tens of thousands of Americans on their healthcare wants and needs. And the Senate Finance Committee geared up for the first of many hearings aimed at finding ways to best cover all Americans.
The working groups recommendations were largely seen as a call for health coverage for all Americans, but with a tilt toward more government involvement than less. While the Bush administration has always said it champions expanded health coverage as well, it disagreed with the group on how to get there.
The reaction from the administration and the opinions offered in the Senate committee hearing and in interviews provide a prime example of the diverging paths that industry and administration officials have taken.
I think the tens of thousands that we touched through our process are going to be pretty disappointed that a lot of the recommendations didnt get a more serious vetting by the administration, said Richard Frank, vice chairman of the Citizens Health Care Working Group.
Chip Kahn, president of the Federation of American Hospitals, said that the presidents health policy appears stuck at a time when many others have offered different approaches. I think the administration had some sensitivity for it in its budget proposal, Kahn said about the expansion of health coverage. But it is out of step with current discussions.
A group of studies published last week also supports the argument for universal coverage (See story, p. 14).
Earlier, with a GOP-led Congress, the administration had a chance to strike but instead sidelined parts of its domestic agenda. They had their proposals, but were never that serious about them, Kahn said. They had some proposals over the years for tax credits and placed some significant bucks behind them, but they never pushed.
To be sure, parts of Bushs policies have earned praise. Kahn points to the implementation of the Part D prescription drug benefit as one example. And few would argue that Americans have not become smarter consumers of healthcare and generally more aware of cost and quality.
But other components of the Bush plan, including the expansion of health information technologya key part of the administrations healthcare agendahave been slower to come to fruition.
Indeed, during the Senate Finance hearing, titled Charting a Course for Health Care Reform: Moving Toward Universal Coverage, never once did the lawmakers or the witnesses use the words consumer directed, which is a staple and much-used buzzword of the administrations plan. Instead, policy analysts tossed around other ideas.
Stuart Altman, a health policy professor at the Heller School for Social Policy and Management at Brandeis University, Waltham, Mass., and a Capitol Hill veteran, told members of the Senate Finance Committee they should keep current financing systems in place in order to improve the likelihood that a health reform bill gets passed. To do otherwise generates significant opposition from groups that are key players in the existing system, he said.
The more diverse dialogue is a result of a president humbled by one election, and sidelined for the next. Both the election and the coming election moved beyond the president, Kahn said.
Richard Pollack, executive vice president of advocacy and public policy at the American Hospital Association, said that the climate is right for new thinking on health policy, especially on the expansion of health coverage. The recognition that is rapidly developing is that the lack of universal coverage is the root cause of so much of the nations healthcare problems, Pollack said. That concept, he said, is really beginning to take root.
Overcrowded emergency departments, lack of preventive care programs and the erosion of the mental health system have all become symptoms of the uninsured crisis, Pollack said. People are connecting the dots.
But Pollack said he doesnt dismiss the administrations approach out of hand. Some components, like the reliance on state-based policy innovations and the idea of looking at tax policy for answers, are valid, he said. But the problem with the (Republican) approach is that Democratic players wont pick it up, he said. The second problem is that theyll admit that its reach is extremely limited it doesnt go very far.
Meanwhile, the final report from the consumer working group, which was delivered to the White House in September, had one overarching recommendationhealthcare coverage for alland offered five other actions for achieving it. Those recommendations included: protection against catastrophic healthcare costs, the fostering of integrated community health networks, the establishment of a public-private commission to define Americas core health benefits and services, promotion of quality improvement initiatives and a full-on restructuring of the way end-of-life services are financed and provided.
The groupchartered by Congress from the Medicare Modernization Act of 2003 and championed by Sen. Orrin Hatch (R-Utah) and Sen. Ron Wyden (D-Ore.)spent about a year and a half canvassing the country holding more than 80 town hall-type meetings with Americans. The group also received thousands of responses by way of an Internet survey.
While administration officials said they agree in principle with many of the working groups aspirations for the healthcare sector, it doesnt concur on what tack to take. In a letter to Vice President Dick Cheney, HHS Secretary Mike Leavitt said that Bushs overall healthcare proposals were put forward in his annual State of the Union address and in his proposed fiscal 2008 budget. The administrations approach, he reiterated, is based on consumer-centric decisions, competitive markets and state-based initiatives, Leavitt added.
Working group Vice Chairman Frank said he is disappointed in the White Houses near-wholesale dismissal of the groups recommendations and that, overall, he thinks the administration gave the report short shrift. It wasnt entirely unexpected, Frank said, adding that it wasnt a very careful discussion of the issues that we raised.
Frank said the group deliberately tried to make the recommendations appeal to the middle. My point of view, certainly if youre not interested in trying to cover everybody, then I understand why you wont like what were saying here, Frank said. I think that if you have that as a goal, then I think theres plenty in here to like, even if you dont buy any one of the particular recommendations.
Melissa Merz, communications director for Wyden, said in a statement that the White House has missed another opportunity. Merz said the working group, as well as many Democrats and Republicans, agree that the current healthcare system cannot be fixed unless every American is covered. I hope the White House will come around to this point of view as well, she said.
Senate Finance Chairman Max Baucus (D-Mont.), in his opening statement at the Finance hearing on March 14, railed against years of congressional idleness on healthcare issues and pledged to hold at least five hearings that would lead to a workable universal healthcare plan.
Baucus said the hearings would focus on the broad concept of universal health coverage, cost controls, the role of preventive health programs and ultimately on who should shoulder the burden. Standoffs must become a thing of the past, he said, referring to the competing interests that often grind action to a halt.
Still, few expect this to be an easy task. In testimony in front of the committee, James Mongan, president and chief executive officer of Partners HealthCare System, Boston, said broad support on health legislation has always been difficult to achieve because of revenue issues and split political ideologies.
With regard to the stalemate between advocates of government regulation and advocates of market forces to control costs, Massachusetts leaders demonstrated some admirable intellectual humility, he said, referring to the Bay States universal healthcare plan.