On January 10, the Senate Health, Education, Labor and Pensions Committee held a roundtable, “Health Care Coverage and Access: Challenges and Opportunities.” The roundtable included participants from the business, nonprofit, and advocacy communities. The discussion touched upon a wide array of health reform issues, including the role of states in developing innovative coverage solutions, federal subsidies and tax policy, and the critical need to increase the efficiency and transparency of the health care system.
“Members of the House and Senate have a guaranteed health plan for ourselves and our families. It’s time to provide the same guarantee for every man, woman, and child in the nation,” said Chair Edward Kennedy (D-MA). “Nearly 47 million Americans lack even basic coverage, and for tens of millions more, their coverage provides little help if a major illness strikes…Costs are obviously heading in the wrong direction. National health spending has grown from $1.35 trillion in 2000 to an estimated $2.3 trillion dollars this year a trillion more in less than a decade. Those aren’t just numbers, they’re massive burdens for working families…The need for direct action has never been more urgent, and the consequences of failure have never been more dire.”
Ranking Member Mike Enzi (R-WY) said that the roundtable was starting off from a “thirty thousand foot perspective” as participants offered varied proposals for remedying the many problems plaguing the health care system and that future hearings would produce more detailed recommendations in the weeks and months to come. He said, “The challenges facing our health care system know no party label…One area where I believe there may be solid area for compromise is a combination of market-based small business pooling with targeted tax-based help for low-wage and small businesses and their employees…Today’s panel includes panelists who will discuss recent state-based health care reforms, particularly in Massachusetts and California. These deserve close watching, and Congress may learn much from them. “
Karen Davis, president of the Commonwealth Fund, said it is “instructive to review what we know about the U.S. health system compared with that of other nations, and to highlight examples of high performance and innovative practices that may provide insights relative to the current U.S. challenge of simultaneously achieving better access, higher quality, and greater efficiency.” She discussed system innovations implemented in Denmark and Germany, such as a “medical home” that serves as a patient’s source of primary care and is responsible for coordinating specialist care, computerized patient records, quality benchmarking to establish best practices with corresponding financial incentives for implementation, transparency in reporting quality data, and proactive management of patients with chronic diseases. Such implementations would save the U.S. money because they can streamline administration and prevent medical errors. “In 2005,” she said, “the U.S. health system spent $143 billion on administrative expenses. In 2004, if the U.S. had been able to lower the share of spending devoted to insurance overhead to the same level found in three countries with the lowest rates (France, Finland, and Japan), it would have saved $97 billion a year.”
Joseph Antos, a scholar with the American Enterprise Institute, made recommendations for improving the function of the health insurance market. Dr. Antos said that the “high cost of health care is driving efforts in both the public and private sectors to improve the performance of the health system.” He lauded recent federal initiatives, including establishing health savings accounts (HSAs) and allowing states the flexibility to “restructure their Medicaid and State Children’s Health Insurance Programs [SCHIP] [by] modifying enrollment, changing benefits, increasing beneficiary cost sharing, and providing financial assistance for the purchase of private health insurance.” HSAs “promote greater awareness of the cost of health care on the part of both consumers and providers,” he said. Despite advances in reform, Dr. Antos said that “there are no simple solutions. We need better information on what really works in health care, delivery systems that operate efficiently, and improved decision-making by patients, providers, and health plans.” He encouraged Congress to promote efforts by states to construct health care systems that best serve the needs of their populations and to consider the upcoming reauthorization of SCHIP as an opportunity to enhance states’ flexibility. Finally, he echoed Dr. Davis’ testimony and advocated the adoption of an “interoperable information system that could help improve the quality of care and avoid unnecessary spending.”
“The health care system now has the wrong incentives,” said Debra Ness, president of the National Partnership for Women & Families. She stated that “cost, quality, and coverage must be addressed as a package” in order to increase access to quality health care as those values are “inextricably linked.” Ms. Ness said that we have to “increase payments [for primary and preventative care], increase transparency, adopt a secure health information technology system, and ensure better information for consumers.” She expanded on her points, saying that the current health care system rewards specialists paying, for example, a gastroenterologist “274 percent more than a primary care physician for the same amount of time.” She further illustrated this concern by describing Elyria, Ohio. Patients in Elyria received stents to reduce the likelihood of a heart attack at a rate “four times the national average.” She said that Medicare provided cardiologists with an incentive to perform angiography (a medical imaging technique used to visualize the heart and surrounding blood vessels during which a stent may be inserted) by reimbursing at high rates for a procedure that takes little time; cardiologists who treated their patients with drug therapy received muchst lowerless reimbursement. Elyria, she said, was an example of why we need to collect information to define best practices; without better health information technology, there is “little to distinguish between good care and bad care.”
Both business and labor witnesses told the committee that the need for reform is overwhelming. Larry Burton, the executive director of the Business Roundtable, said that “high health costs are affecting job creation, hurting our ability to compete in global markets, and straining the household incomes of many Americans forcing them to go without health insurance…We urge Congressional leaders to enact legislation to reduce costs by bringing 21st century technology to our health care system, and legislation that will provide all Americans with actionable information about the cost and quality of the health care services they need.” President of the Service Employees International Union (SEIU) Andy Stern said, “We can’t compete in a global economy when we are the only nation that puts the price of health care on the cost of our products…Ever increasing costs are leading businesses to drop health coverage for their employees…We are in a race against time because our health care system is morphing from comprehensive to catastrophic in front of our eyes.”
During questions, Sen. Tom Coburn (R-OK) asked: “How do you squeeze out the one-third or one-fourth of the system that is waste?” Ms. Ness replied that “If we don’t measure, we’ll never manage,” meaning that without careful collection of health indicators and corresponding treatments, we will be unable to determine best practices for patient treatment. Ms. Davis said that we need to put more money into primary care and “reward physicians who take responsibility for patients.” She gave an example of Germany where insurers pay financial incentives to physicians to enroll patients in disease management programs. The programs ensure that patients receive timely care, preventing or slowing disease progression.
Sen. Richard Burr asked each of the panelists to answer, with a yes or no, whether or not they supported “a single payer health plan, liability reform [reforming medical malpractice lawsuits, including payment for damages], and transparency in cost and quality.” Each of the panelists answered in turn; although there was no consensus on the first two issues, all agreed that transparency in cost and quality for patients, physicians, and insurers was critical.
Also testifying were John Goodman, president of the National Center for Policy Analysis; Peter Harbage, a senior associate at the New America Foundation; Pat Vredevoogd Combs, president of the National Association of Realtors; Peter Meade, the executive vice president of Blue Cross Blue Shield of Massachusetts; and John McDonough, executive director of Health Care for All.