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.
Mongan said he worked in Washington for three decades and helped create President Carter's health reform plan in 1979. The Partners Healthcare CEO said he is impressed with health science, but troubled by health financing.
While science has improved patient care over the past decade, the economic system is "broken" because of the uninsured and fragmented system. The "chaotic delivery system" that features "uneven care" and large cost increases is not sustainable, he added.
"The secret to following health reform is to follow the dollar. The debate has never been about health. It has always been about finances," said Mongan.
This focus on dollars has led the health reform debate to become bogged down in mandates, taxes, state costs, and provider payment cuts, he said.
Mongan believes the eventual health reform package will include an individual mandate, but Congress will likely delude the mandate so that it doesn't cover all of the 46 million uninsured Americans. He is even more pessimistic about the fate of the employer mandate, public plan, payment reform, and adequate funding.
Altman and Mongan's comments sandwiched a talk by Rep. Edward Markey (D-MA), who spoke to the conference from Washington, DC. Markey, who said he couldn't physically attend the symposium because of the health reform debate on Capitol Hill, spoke positively that health reform will pass this year. He also discussed the need for privacy protections in healthcare and trumpeted portions of reform legislation he included that will protect patients' privacy.
He added that health reform will change the payment system so that doctors will get paid for services, such as remote home visits.
"The result will be one, better care for patients; two, savings to Medicare; three, an incentive payment for healthcare teams to produce savings," said Markey.
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Democrats lost a big test vote on healthcare legislation on when the Senate blocked action on a bill to increase Medicare payments to doctors at a cost of $247 billion over 10 years. By addressing doctors' fees in a separate bill, Senate Democrats could hold down the cost of the broader health legislation, and House Democrats are considering a similar tactic. Republicans said it was a transparent ploy to hide the cost of a healthcare overhaul, the New York Times reports. Democrats had hoped that by passing the Medicare bill they could appease doctors and secure their support for the broader legislation, according to this article from the Times.
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