In an attempt to guide the healthcare debate that has veered off the tracks in recent weeks, President Obama spoke to a joint session of Congress July 22 about a comprehensive health reform bill.
Obama discussed the need for cooperation and improving the current healthcare system rather than creating a new one, such as a single-payer system. The president’s plan would include three basic goals:
Obama didn’t touch upon one of the more controversial parts of the healthcare reform debate, the public insurance option, until 30 minutes into his speech. He described a public option as part of an insurance exchange.
Throughout his speech, Obama took aim at the health insurance industry, such as its costs to consumers and employers, insurers not providing coverage to those with preexisting conditions, and the subsidies given to private insurers that provide Medicare Advantage.
The 45-minute speech was Obama’s first in-depth national speech about healthcare reform after spending the previous few months on the sidelines as Congress worked on multiple reform proposals. So after finally hearing directly from the president, what do health leaders think? Following are thoughts from nine health leaders.
Ken Graham, CEO, El Camino Hospital
President Obama’s message reminded us all that health reform is crucial to the economic health of America, and that the goal is not to reinvent the system, but to improve upon what is working and fix the inefficiencies that exist.
As such, we embrace reform and the opportunities it presents for innovation, which not only leads to a higher quality of care and healthier lives, but also has the ability to decrease waste in the system. Closely tied to innovation is the adoption of evidence-based measures.
This will allow us to identify the inefficiencies, correct them, and reduce variation in the system, thereby reaching a level of care that works for both providers and patients. Embracing innovation, I believe, will be essential to finding a solution that achieves the larger goals: cutting costs, raising quality of care, and advancing healthcare delivery.
Doug Hawthorne, president and CEO,
Texas Health Resources
Obama did an excellent job of assessing the current landscape and acknowledged that fixing healthcare is central to fixing our economy. He clarified for the audience his interest to build on what works with our system and fix only what is broken. He provided a clearer definition of a public plan, although it is still not convincing. He attacked the insurance industry and stated that it would have to comply to certain changes or it would be out of the picture.
In summary, the president was determined in his words, but it is not definite what a plan would do and very unrealistic as to how it will be paid for. His most effective statement for me from a provider point of view was his desire to create safer care and a more coordinated and integrated model.
Tim Size, executive director, Rural Wisconsin Health Cooperative
The president made it clear he stands on common ground for our country by “building on what works.” A new government-run plan that undermines the private sector now seems less likely. A major shift of patients into
a plan paying Medicaid- and Medicare-type rates would harm rural patients’ access to local healthcare. Reform affecting rural communities must and can be built on quality outcomes and efficiency while delivering care locally. As the president concluded, “I believe we can replace acrimony with civility, and gridlock with progress.”
Karen Ignagni, president and CEO,
America’s Health Insurance Plans
We agree the status quo is not sustainable. That is why health plans last year did something industries rarely do: stepped up and offered solutions to address the healthcare concerns raised by the American people. We proposed health insurance reform to guarantee coverage to all Americans, eliminate preexisting condition exclusions and rescissions, and no longer base premiums on a person’s health status or gender. To keep coverage as affordable as possible, these reforms must be paired with an effective coverage requirement to get everyone into the healthcare system.
New health insurance reforms and consumer protections will solve the problem without creating a new government-run plan that will disrupt the quality coverage that millions of Americans rely on today. We share the concerns that hospitals, doctors, employers, and patients have all raised about the significant unintended consequences of a government-run plan.
Healthcare reform must also include a serious commitment to cost containment to ensure that coverage is more affordable and to put our healthcare system on a sustainable and fiscally responsible path. New taxes on healthcare coverage will have the opposite effect by making coverage less affordable for families and small businesses across the country.
Health plans will continue to work with policymakers and stakeholders to advance comprehensive, bipartisan healthcare reform. The nation cannot afford to let this historic opportunity pass us by.
Bruce McPherson, president and CEO, The
Alliance for Advancing Nonprofit Health Care
We are pleased that the president is seeking to exercise greater leadership in crafting healthcare reform legislation, and many of the principles he outlined,suchas health insurance market reforms,are needed and appropriate. Clearly,more details of his plan need to be unveiled, including medical malpractice tort reform, healthcare delivery reforms,and precisely how to pay for his $900 billion plan. Our one major disappointment in his speech was his apparent unwillingness at this pointtoremove from the tablethe public health plan option or similar ideas. Hopefully, he will drop this unnecessary and inappropriate concept in the weeks ahead, and in the process achieve bipartisan support and substantially enhance the odds of the passage of reform legislation this year.
His claim and example in the speechof a lack of adequate private insurance competition in many states is not supported by the facts, nor common sense.
If there are real competition problems that wouldn’t already be resolved through the insurance market reforms he outlined, then there is an existing, appropriategovernment solution—referral of any allegations to federal or state antitrust regulators for investigation.
Tracey Moorhead, president and CEO,
DMAA: The Care Continuum Alliance
We welcome the president’s support for expanded coverage of preventive care and his recognition of prevention and wellness as important tools for controlling the cost of chronic illness. But improving quality and reducing costs require broadscale reform that moves our system from reactive care to promotion of health as a shared national resource. This will require payments and incentives aligned across all providers, purchasers, and consumers toward a goal of improved health.
Joseph Kvedar, founder and director,
Center for Connected Health
I have never heard President Obama give a poor address. He gave a fine address. It was, however, long on discussion of improving access. He gave great detail on access. When it came to cost reduction, the details were frighteningly lacking. For instance, there are credible data that screening tests he referred to do not in fact reduce costs but probably add to them.
My other observation is that the whole speech was based on the construct that illness is the accident. I tend to be more concerned about the 50% of costs that are based on unhealthy behaviors or the part of healthcare that is less of an accident and more from irresponsibility. Any program that will truly affect cost must address this.
I’d say a very compelling case was made for health reform 1.0. These are important reforms and hard to get done, but they should only be viewed as a first step.
Bob Stone, cofounder and executive vice
The president outlined a clear set of principles for what has now clearly been acknowledged as health insurance reform rather than healthcare reform. Arguably, a bill that included these provisions would go a long way toward addressing the issues of the uninsured, the underinsured, and those with insurance who have been treated less than scrupulously by bad actors among the insurance industry. It is less than clear, however, whether this plan will do anything to lower healthcare costs.
In fact, the absence of any reference to meaningful health promotion, prevention, or chronic care management plans was disappointing given the years of evidence that supply-side and financial fixes—other than price controls—don’t work (and even price controls didn’t work long). Without a commitment to making America
a healthier country—not just one where illness is more affordable to treat—it is unlikely that real cost savings or quality improvement will manifest. Unfortunately, that commitment was absent from the president’s speech.
There are also clearly inappropriate and unnecessary costs in the current system, and all should support the president’s call to weed those out so that those dollars can be applied to the cost of his proposed plan. I am less than sanguine, however, that such an effort will have any great or sustained success. Even if it does, you can only capture those dollars once.
Although that may help defray costs over the next decade, what happens after that if the plan doesn’t actually reduce cost? And while we’re on the financial points, if my math is right, the $1,000/year currently being paid by the insured to subsidize care for the uninsured totals about $1.5 billion per year (assuming 155 million commercially insured, which may be a little light), or about $1.4 trillion over the next decade. Are all the insured folks going to get that money back? If not, what will it be used for? Are the insurance companies going to pay it to the government to fund the new plan?
Stan Nowak, CEO, Silverlink
The president delivered a powerful speech on the critical need for healthcare reform. He’s right to focus on the issue of access and the costs of doing nothing. But it’s just as perilous to our country to do nothing about the true drivers of healthcare costs—the personal health decisions made daily by all Americans.
By incenting individuals to make better health decisions, we can save our country millions of lives and billions of dollars, ultimately bending the cost curve to make real progress in healthcare reform.