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Health Reform Brings Hope Coupled with Pessimism

Les Masterson, for HealthLeaders Media, October 22, 2009

Two health leaders who spent years crafting health policies for the White House in the 1970s are hopeful that healthcare reform will insure more Americans, improve quality, and reduce costs, but they are also worried that reform will, in fact, do very little.

Stuart Altman, PhD, professor of national health policy at Brandeis University's The Heller Graduate School for Social Policy and Management, and Jim Mongan, MD, CEO of Partners HealthCare in Boston, spoke at the Center for Connected Health's sixth annual symposium Wednesday.

Altman, who worked in the Nixon administration, said the current plans on Capitol Hill feature health insurance reform and will increase the number of insured Americans, but there is little talk about containing health costs.

Altman said health reform as presently constructed will have little—if any—impact on healthcare costs.

"Dealing with the cost of healthcare is the issue that needs to be dealt with," he said. "If we don't deal with it, we are going to have troubles . . . If you strip away the rhetoric, there really isn't a lot of controlling healthcare costs in the legislation that is being debated."

When Altman helped the Nixon administration create a health reform policy in 1974, U.S. health costs were $75 billion, or 7.5%, of the gross domestic product.

Administration leaders at the time were concerned the nation would face financial disaster if health costs increased to 8% of the GDP. Now, 35 years later, after three failed health reform plans, health costs account for about 17% of the GDP, Altman said.

"Our way of life hasn't deteriorated, but we do have problems," he said.

Altman said the reason policymakers are not tackling health costs is because doing so would offend powerful groups—including physicians, hospitals, and pharmaceutical companies—who prefer the status quo to a health reform plan that could hurt them. So instead, lawmakers have gone after health insurers with more proposed regulations. In fact, health insurance is the only area of healthcare that would be hurt by the current reform plans while other sectors would gain, he added.

Altman promoted the idea of payment reform, including a new framework that emphasizes care coordination, pay for performance, and chronic care management.

"We need to change the delivery system, but we will not and we cannot seriously change it without changing the fee-for-service systems," he said.

Mongan, meanwhile, predicted President Obama will sign a health reform bill in the next few months that will cover millions of more Americans, but he's worried that it will fall short of universal coverage and will not improve the delivery system or lower costs.

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