A multipronged effort to reshape the U.S. healthcare system took center stage last week in Washington, with everyone from President Barack Obama on down pitching a vision of a new health sector even as positions became more entrenched and alliances started to fray.
Manning the battle stations
Healthcare factions try to protect separate interests as reform plans are sketched out
From the White House to Capitol Hilland many points betweenWashington experienced a rare week in which the idea of changing how care is delivered and paid for not only dominated the conversation, but did so at a time when many believe it will finally move from talk to action.
One of the debates most visible players, Sen. Max Baucus (D-Mont.), chairman of the pivotal Senate Finance Committee, took the healthcare-heavy schedule in stride.
This is just part of (an effort) to keep the ball moving, he said. Well keep putting the pieces together to forge compromises and to take advantage of the one opportunity we have this decade to get meaningful health reform legislation passed.
The senator added: Its going to take a lot of work and a lot of cooperation.
Few may understand this as well as Baucus. In consecutive weeks, he has led committee-level discussions with dozens of healthcare stakeholderseveryone from payers and providers to economists and analysts. And twice now his hearings have been interrupted by a vocal contingent of protestersmany of them advocates for a single-payer healthcare systemwho have lashed out because the health insurance lobby has had a seat at the table while they have not.
As the week played out, it became clear that they were not alone in that sentiment. Republican lawmakers, too, expressed outrage over being held at bay as many House Democrats held meetings meant to help shape a final bill without Republicans advice.
Controversy over pledge
It was a week that saw controversy over a high-profile pledge to lower healthcare costs made by a number of groups, including the American Hospital Association, and one that ultimately ended with a somewhat contentious, private meeting between lawmakers where usually collegial senators butted heads over what should be included in a reform package.
Weve got a lot of work to do, and were going to find a way to do it, Baucus said. Its important to keep momentum going, but its also important to do it right. Thats the balance here.
The jockeying for a bill has been framed against a looming deadline set in a very public way by House Speaker Nancy Pelosi (D-Calif.). Sharing a podium with Obama, Pelosi promised that a reform bill would be passed by July 31. Its a timetable that has been stressed before, but seldom in such a public manner.
While the Senate isnt on that exact timeframe, its close enough. Senate leaders have said that they want to pass a bill before August, and legislation there is expected to be negotiated in the committee in June.
On May 12, Baucus and Iowa Sen. Chuck Grassley, the Finance Committees senior Republican, oversaw a hearing that examined a number of cost options that could be included in the reform effort. It was the second broad discussion the committee held in as many weeks and, similar to the first, saw its deliberation time shortened by protests.
While the committee has sketched out a rough outline of ways to change how providers deliver care, members remain hard-pressed to find a way to finance it. Senators rifled through a number of different tax options, including ones that would tax tobacco and alcohol, and another that would cap the exclusion for employer-sponsored coverage.
Separately, the hospital sector weighed in on a handful of the solutions. Wayne Sensor, president and CEO of nine-hospital Alegent Health in Omaha, Neb., and a frequent adviser on Capitol Hill, said that the $2.5 trillion per year now spent on health could be trimmed or redirected to help pay for the overhaul.
We completely agree that reform is needed, he said. And we believe there is enough money in the system already, we just need to be spending it more effectively, focusing on preventative healthcare, wellness, lifestyle change and the management of chronic disease.
One hospital executive pointed out that providers have long tried to keep costs down.
The industry has always made a concerted effort to control costs and be more effective and efficient, said John Bluford, president and CEO of two-hospital Truman Medical Centers in Kansas City, Mo.
On his end, Bluford has used a combination of energy conservation and personnel decisions to help shave annual in-house expenditures. All of us collectively have to concede something, he said. The question is, whats the right formula? The hospital industry should not be overtaxed and carry the entire burden of the healthcare system.
Worries over sacrifice
Yet thats what many hospital organizations fear. On a May 14 conference call held by the AHA, hospitals from across the country expressed concern about how much they would have to give to the overhaul effort.
The call was prompted because of questions and concerns regional hospitals had about a partnership the AHA had joined with five other payer and provider groups.
The partnership caught many of the associations member hospitals off-guard, and only three days after word had leaked, the AHA set out to clarify its position.
At issue was a pledge made by the coalition to help reduce national healthcare costs by about $2 trillion over 10 years. AHA President and CEO Richard Umbdenstock, as well as executives from Americas Health Insurance Plans, the American Medical Association, Pharmaceutical Research and Manufacturers of America, the Service Employees International Union and others, met with Obama to pledge support to his reform cause.
But the outline for how they planned to go about doing it became blurred over a combination of miscommunication, misinformation and, to some extent, old-fashioned gamesmanship, Umbdenstock said.
Theres been a tremendous amount of confusion and frankly, a lot of political spin, and I want to assure you that the American Hospital Association is at the table and a responsible part of this, but weve been very clear on what we have committed to, he told the members at the start of the call.
The coalition said it would work toward the White Houses $2 trillion savings goal. Hospitals, however, were concerned that the majority of those savings would come from them.
Umbdenstock said that Obama asked the groups to target areas where they could make an immediate impact on savings without a legislative mandate. Hospitals, Umbdenstock said, could look at reducing readmission rates and other hospital-associated complications that add up to higher costs. So right now we have to show that we are on the right side of that issue, doing everything we can, he said. Thats whats being asked of us in the short term.
Yet many policy analysts who viewed the groups letter said that it was more a symbolic move rather than a fiscal one.
The fact the big actors were willing to go to White House and make that pledge shows the gravity of the problem, but theyll have to make structural changes that achieve results, Robert Greenstein, founder and executive director of the Center on Budget and Policy Priorities, said during a teleconference on the Medicare trustees report.
The grousing, uncertainty and misfires from the reform debate have been happening since at least last year, and are partly because of the enormous size of whats being considered, coupled with the fact that a bill has yet to emerge from the key committees.
Nevertheless, those panels last week inched closer toward that goal.
On the House side, the Energy and Commerce Committee cobbled together a proposal that reportedly would call on individuals, families, employers and government to contribute to a new way to address coverage. The House plan reportedly includes a public health option that would compete with private insurance companiessomething AHIP and Republicans have called a
Committee Democrats met on May 13 to review some of the options.
As for the July 31 deadline from Pelosi, lawmakers are as confident in meeting the deadline as the industry is wary of it.
How quickly we achieve reform is not as important as is creating the right reform, Alegents Sensor said. In our haste to fix our system, lets not miss the opportunity to address the consumption side of healthcare. By making people partners in their healthcare, we can improve their overall health; more effectively manage chronic conditions; and drive down healthcare costs.
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