Expectations are high in the healthcare industry that President-elect Barack Obama will do what few Democratic presidents have done before: deliver on comprehensive healthcare reform to fix a broken system.
To be successful, the Illinois senator who handily defeated Republican challenger Sen. John McCain last week, will have to ensure that healthcare remains a top priority in the wake of other pressing concerns such as the economy and wars overseas in order to enact meaningful healthcare reform.
In the historic battle that led to the first African-American being elected president, ending an eight-year Republican reign in the White House, Democrats also widened their majorities in Congress in an election that also could potentially reshape how healthcare is delivered and paid for in the U.S. At deadline, the Democrats had reportedly attained 254 seats in the House and 57 seats in the Senate (which include two independents that caucus with Democrats in the Senate). Republicans by comparison, have 173 seats in the House and 40 seats in the Senate. Eight seats were still undecided in the House, and three had yet to be determined in the Senate.
In addition, a number of state healthcare initiatives were passed last week (See story, p. 14).
A big question remains as to what approach reform will take. Already legislators are working on a broad healthcare bill for potential quick passage (See story, p. 16), an approach that is viewed with skepticism by some.
I think Obama has the potential to make some small gains in healthcare reform, said Barry Arbuckle, president and chief executive officer of MemorialCare Medical Centers in Long Beach, Calif., and board chairman of the California Hospital Association. Regardless of who was elected president, Im not one to believe we will see national healthcare reform in a big comprehensive way in the near-term, meaning in the next decade or so, Arbuckle said. Given the state of the economy, Arbuckle says reform in Obamas first term would be absolutely impossible. He added, Theres a black cloud over the economy.
Others agree that the Obama administration will encounter daunting barriers in trying to change the way healthcare operates. Whoever is elected cant do all the things they say they are going to do during the campaign, said Jim Nathan, president and CEO of four-hospital Lee Memorial Health System in Fort Myers, Fla. Its not humanly possible, and its not structurally possible because they cant do it all by themselves.
The new administration will be facing a host of obstacles, including a historically high deficit, a bailout package, a stalling economy and two wars, said Robert Doherty, senior vice president of governmental affairs and public policy at the American College of Physicians. For those reasons, it will be very easy for Obamas attention to turn to issues other than healthcare, he said.
Reforming healthcare, nevertheless, has been the holy grail for Democratic presidents, and Obama with this new administration has the unique opportunity to seize the moment and create major expansions to coverage, enact insurance market reforms and make other improvements to the system, Doherty said. His ambitious plans to reform the healthcare system include signing a universal healthcare bill that offers affordable coverage by the end of his first term. The new plan would expand upon public-health programs; offer a tax credit to help people in small businesses; expand and accelerate patient-safety initiatives; and improve access and affordability of generic pharmaceuticals.
Theres a reason, however, why prior attempts to reform the healthcare system have failed, Doherty said. First off, healthcare reform is expensive to implement, and its difficult to achieve from a political standpoint, especially if partisan battles are taking place over solutions.
Richard Pollack, executive vice president at the American Hospital Association, said that its too early to tell what impact the Senate and House margins will have on Obamas healthcare agenda. While theres no question that the Obama administration will make healthcare reform a major priority, Pollack and other industry sources stressed that Obama faces a big in-box when he takes office.
The post-election jockeying for healthcare reform comes just as U.S. community hospitals last week reported record profits of $43 billion in 2007.
Whom Obama chooses to lead HHS and the departments within the top healthcare agency may in part determine how effectively Obamas healthcare agenda will progress, Washington insiders said. At deadline, most industry sources had few leads on Obamas picks for HHS secretary. In my experience, the people being mentioned (as top contenders) are the people that never get it, said Alexander Vachon, a Washington-based healthcare consultant.
If theres any name that stands out as a contender for Mike Leavitts post, its Tom Daschle, the former Senate majority leader whos currently a special policy adviser at the law firm Alston & Bird in Washington. Daschle has been campaigning for the job, so well see if he gets it, Vachon said. Daschle was unavailable for comment.
Kansas Gov. Kathleen Sebelius is another potential candidate for a top healthcare post in the new administration, said Ron Pollack, executive director of Families USA, at a news briefing last week. Sebelius in particular would be qualified to head the CMS, said Teresa Brooks, a partner at Epstein Becker & Green, a law firm in Washington that specializes in healthcare and other issues. Shes managed a state, understands insurance very well and also understands Medicaid, Brooks said.