The realization seems to be slowly sinking in among the nations policymakers that we cant solve the growing crisis of the uninsured and underinsured without simultaneously and just as seriously addressing the worsening healthcare cost problem. The powers that be are seeing that these issues are two sides of the same coin: The reason we have so many people lacking sufficient coverage is mainly because of high costs, and only through fundamental reform of the way care is delivered and paid for can we begin to afford covering millions more people.
You hear all the right words about cost containment coming from Barack Obama, but they dont seem quite as heartfelt as his eloquent concern about the plight of the uninsured. John McCain is the flip side of the coin, with a plan centered on vigorous cost containment and a notable lack of heart when it comes to covering everyone. If there is a middle ground between their vastly differing approaches to these issues, it would have to be found on the cost side.
The rest of Washington and many states seem to be grasping the enormity of the challenge. The Senate Finance Committee is holding a series of hearings on healthcare reform that have been heavy on the spending side. Late last week, the AARP convened a forum titled What Should Our Next President Do About Healthcare Costs? It brought together Obamas health policy adviser, David Cutler of Harvard University; Chris Jennings, Hillary Rodham Clintons main health aide; and Thomas Miller of the American Enterprise Institute, McCains top health policy adviser.
The hearings to date have been revealing, and not just because of the scary numbers being tossed about. Senators heard that premiums for employment-based private insurance leapt 114% from 1999 to 2007, outpacing wage growth by more than 6 percentage points per year. From 2007 to 2017, healthcare spending could nearly double to $4.3 trillionroughly one-fifth of our economy.
There were ironies in the testimony, a sign of how desperate things are. Ron Williams, chief executive officer of Aetna, pleaded with senators to create new pools for health coverage without regard to risk factors so that insurers can afford to stop underwriting practices that toss out people who have any history of illness.
The most eloquent quote about what is needed from Washington came not from a healthcare provider or health policy analyst but from Felicia Fields, Ford Motor Co.s group vice president of human resources and corporate services: Much recent discussion on healthcare reform has justifiably centered on the uninsured population. However, we believe too much of that discussion focuses on mechanisms to expand coverage such as financing, modifying insurance markets and mandates. Simply subsidizing excessive healthcare spending does not offer a long-term solution to our healthcare problems. In fact, it may well exacerbate them. Instead, by first making healthcare coverage more affordable, the entire healthcare populationuninsured and insured alikewould benefit both immediately and over the long-term.
Paul Ginsburg of the Center for Studying Health System Change said that efficient, equitable rationing of care may be one way out of the current morass. He thinks that one way to achieve that is through evidence-based practice guidelines and critical assessments of the value of all of the new technology being deployed around the country. This can help in the design of new health benefit packages, including more sophisticated cost-sharing with employees, who would be able to more rationally choose care that meets their budget and health needs.
There will be many more hearings on reform throughout this year. Teddy Kennedy says he is anxious to return to the Senate later this year following cancer treatment so he can write the template for next years healthcare legislation. Covering the uninsured is a noble task, and it seems that there is hope that the debate may be becoming more reality-based.