Ex-Lawmakers Spar at AHIP Conference

Former Sen. Tom Daschle (D-SD) says that one way or the other "we will have a coverage mandate" as part of health insurance reform in America. "Either every individual will be required to take responsibility for their healthcare or the rest of us – who do take care of ourselves – will continue to be required to pay for those who don't."

He made the remark Thursday during a session about building a sustainable healthcare system at the annual conference for America's Health Insurance Plans in San Francisco. Daschle shared the stage with former Sen. Judd Gregg (R-NH).

The two made separate presentations and then settled in for a Q&A from the audience of insurance professionals.

Daschle focused on the upside of healthcare reform noting the "transformational opportunities" presented for innovation and collaboration especially in the areas of payment reform and transparency. "We have 21st century operating rooms and 19th century administration" in the healthcare industry, he said. Daschle credited government reforms with helping kickstart administrative changes that will speed the adoption of technology to enable providers and payers to collect information that can be used to improve care and engage the patient at meaningful levels.

Judd Gregg delivered a more somber message. "Debt is the issue and healthcare is the problem. The patient is in serious fiscal trouble." He said healthcare reform will become just another unfunded liability. "Our unfunded liability for Medicare, Medicaid, and Social Security is already at $81 trillion and healthcare reform will just add to that."

Gregg, who served on the bipartisan National Commission on Fiscal Responsibility and Reform, said he is disappointed that Congress has ignored the commission's recommendation for a Medicare premium support program. The commission was appointed by President Obama to recommend policies to improve the U.S. fiscal situation over the long run. "If we can't address Social Security or Medicare in a serious fashion then we really have no hope of improving America's fiscal well-being."

Daschle countered that there are other systemic changes that can make a difference. "We need to move away from fee-for-service, volume-based medicine to quality-driven medical care. We need to deal with unnecessary care and we need to create an infrastructure that integrates care."

Gregg said he favors giving states more freedom to develop Medicaid programs and moving from the federal government's one size fits all mindset. "I think we'll see some effective creativity in creating the healthcare delivery system because each state will be looking at how to meet the needs of its population."

"Right now states have to choose between funding Medicaid or funding their schools and universities because they have to do what the feds tell them to do rather than what they should be doing," he added.

Both former senators agreed that Congress needs to move away from the healthcare business. Daschle noted that "Congress can't make tough decisions" about healthcare while Gregg said "partisanship means real healthcare change will never have a chance in Congress."