Visions for Change in U.S. Health Care — The Players and the Possibilities (New Eng Jour Med)

[pinto]

Visions for Change in U.S. Health Care — The Players and the Possibilities
John K. Iglehart

Under the incoming presidential administration, U.S. Democratic leaders are determined to achieve a long-elusive goal: securing "affordable, accessible health care for every single American," as President-elect Barack Obama put it recently. Recognizing the blunders that doomed the reform effort of President Bill Clinton 16 years ago, the new administration is working closely with Congress to craft a bill that will attract sufficient support to ensure enactment.

Although some critics argue that we can ill afford the costs of expanded coverage and other reforms with the economy in recession and an ever-growing federal deficit, Obama counters that these are pocketbook issues, integral to recovery efforts. At a December news conference, when he introduced Tom Daschle as his choice for secretary of Health and Human Services, Obama said a major health care initiative "has to be intimately woven into our overall economic recovery plan. It's not something that we can put off because we are in an emergency. This is part of the emergency."

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Obama's proposal would enable people with employer-sponsored health insurance coverage to retain it, if they prefer, and would require large employers either to offer their workers "meaningful coverage" or to contribute a certain percentage of their payroll to support a new public plan. The proposal would also create an insurance exchange through which people without employer coverage could select private coverage or the public plan at rates similar to those offered through large employers. Obama has pledged to "lower costs by taking on anticompetitive actions in the drug and insurance companies," to support disease prevention and health promotion efforts, and to invest $50 billion over the next 5 years to accelerate adoption of health information technology.1

A number of health-related items are being considered as elements of the early stimulus package, largely to prevent people who lose their jobs from losing their coverage and to begin investing in the infrastructure for a more efficient delivery system. These items include increased federal support to states to maintain or expand their Medicaid enrollment, reauthorization of and increased funding for the State Children's Health Insurance Program, grants to states to speed adoption of health information technology, and expansion of the Consolidated Omnibus Budget Reconciliation Act (COBRA) to give certain laid-off workers the right to temporarily continue insurance coverage at group rates.

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Five congressional committees will be instrumental in refining any reform plan. Three of Pelosi's California colleagues, all liberal Democrats, hold leadership positions on the three key House panels: Henry Waxman is the new chair of the House Energy and Commerce Committee, George Miller chairs the House Education and Labor Committee, and Pete Stark chairs the House Ways and Means Subcommittee on Health. The relevant Senate committees are the Finance Committee, chaired by Max Baucus (D-MT), and the Health, Education, Labor, and Pensions Committee, chaired by Edward Kennedy (D-MA).

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Source Information
Mr. Iglehart is a national correspondent for the Journal.

An interactive graphic on key players in health care reform is available at http://www.NEJM.org .

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http://content.nejm.org/cgi/content/full/360/3/205?query=TOC

The New England Journal of Medicine is owned, published, and copyrighted © 2009 Massachusetts Medical Society. All rights reserved

[exboyfil]

1. Why should only large employers be burdened with health care?

If a federal plan is available, then it should have sufficient buying power to kill any arguments about economies of scale?

It is going to get interesting defining meaningful coverage. My employer and I pay $12K per year for a high deductible plan ($4500 deductible). Just think about it, except for paying for annual exams the insurance does not start paying its own dime until $16,500 is spent for a family.

We should look at a percentage of payroll as a better solution. The Germans pay 16% of their income into such a plan. Right now the U.S. pays about 24% of total income for health care.

I would like to see Universal Health Insurance along the German model using a 50%/50% split with employer/employee.