Sacrifice is emerging as a recurring theme in President Obama's call for healthcare reform. At a half-day healthcare summit at the White House on Thursday, the president told a room full of key stakeholders on the issue that there should be no "sacred cows" in the discussion on healthcare reform, which he said will require sacrifices from everyone.
"Each of us must accept that none of us will get everything we want, and no proposal for reform will be perfect. If that is the measure we will never get anything done," Obama told about 150 people from the across the healthcare spectrum who were invited to the meeting. "But when it comes to addressing our healthcare challenge, we can no longer let the perfect be the enemy of the essential."
Bill Roper, MD, the CEO of UNC Health Care and the former director of CMS and CDC, says the public will most assuredly have to make adjustments in their own healthcare services to make the reforms work.
"Sacrifice is inherent in remaking the system," Roper says. "It's right to start talking about sacrifice because that is what is going to have to happen if we are going to have better quality and more cost-effective care. We've got to implement better information and better protocols and guidelines for the management of patients."
"We spend more per capita than any other nation in the world, so I would stipulate that we have plenty of money in the system. So, to cover those other approaching 50 million uninsured people means taking something that is currently being spent on you and me and spending it on a person without health insurance. That by any other name is a sacrifice."
Americans weren't willing to make that sacrifice in 1993, when President Bill Clinton tried unsuccessfully to push through sweeping healthcare reforms. "The Clinton reform effort ran aground when the average American realized that what was really being discussed was restricting their ability to do something and thereby save money from their care and use that freed up money to fund the care of somebody else," Roper says.
Roper says he has long been "deeply committed" to evidence-based medicine and he supports the $1.5 billion in Obama's stimulus plan that is earmarked for the process. "But what that means is we will come up with better information on what works in what setting and that means we will say 'no' to your request for knee surgery or x, y, or z procedure," Roper says. "That means a sacrifice. The American people are owed our honesty in this debate and I'm delighted that we are beginning to do that. To go around saying, 'We have the world's best healthcare system,' which we don't, and saying, 'You can keep every bit of healthcare you got if you want to keep it,' are just not going do it."
Helen Darling, president of the National Business Group on Health, told The News Hour with Jim Lehrer on Thursday that determining coverage levels and the affordability of any universal health plan would be problematic. "Someone will have to decide whether or not the package of coverage that is going to be offered and paid for is going to be very rich, or adequate and good but not totally comprehensive," she says. "The hardest decision for the people who want universal coverage is to say, 'We may not be able to immediately afford everything for everybody the first year out.' The packages right now in this country, unless somebody is going to give up some income, cost a family about $15,000. Coming up with that for families, and to finance that, particularly all the ones who will need subsidies, especially now, is going to be very hard."
Let Congress Write it.
Roper supports Obama's decision to let Congress write the bill. "The president and his team are wise to say they are going to articulate a set of principles and leave it to Congress to shape specific legislation. That is a far more promising way of going about it than the Clinton administration did 15 years ago," Roper says.
Brandon Edwards, president/COO of Davies Public Affairs, which focuses on three industries including healthcare, says Tom Daschle's withdrawal as the nominee at Health and Human Services has left many observers with a sense of uncertainty. The general belief was that Obama supported Daschle's plan. In the case of current, Kansas Gov. Kathleen Sebelius, there are questions about what she supports.
As a result, Edwards says, Sens. Max Baucus and Ted Kennedy are rushing to get their own reform proposal through Capitol Hill. "I think most people, including me, assume that this is a horserace between Baucus' plan and Kennedy's plan and who can get to [Arlen] Specter, [Susan] Collins, and [Olympia] Snowe first," says Edwards, referring to three moderate Republican Senators, who may support a major healthcare reform package.
Edwards says the toughest issue policymakers have to tackle is creating a standard benefit design. The feds can't mandate everyone have insurance and move the 47 million uninsured into existing commercial health plans because each state has its own required coverage mandates that require insurers provide certain services, such as maternity or cancer care.
Though state leaders have created the mandates as a way to assure residents are covered for such services as maternity and cancer care, the health insurance industry rails against mandates because it adds costs onto plans. Meanwhile, some states, including Florida, have created "mandate-lite" policies. These health plans limit the mandated services, which cuts costs and provides more affordable health insurance options for those uninsured.
To get the support of state delegations, such as New York and California, reform supporters will have to develop a richer standard benefit design, but that will also increase plan costs and raise the ire of those who oppose coverage mandates.
"I think this is their biggest challenge," says Edwards.
John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.
Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com.