This Time Around, Health-Care Revamp Has Wings

by Lesley Politi on November 25, 2008

This Time Around, Health-Care Revamp Has Wings

WASHINGTON — The effort to overhaul the nation’s health system will begin next year with one clear advantage over previous attempts: A wide variety of interest groups are rooting for it to succeed rather than plotting to kill it.

That is a stark contrast to the last big health-care initiative in the early 1990s, when many of the same groups helped block any major change.

In addition, Barack Obama’s choice of Tom Daschle, a former Senate Majority Leader, as Secretary of Health and Human Services, puts a skilled navigator of Capitol Hill in charge of the president-elect’s bid to establish universal health care, which he has made a top priority.

[Tom Daschle] Getty Images

Former Senate Majority Leader Sen. Tom Daschle is interviewed by Tim Russert on Meet the Press in March 2008.

He goes in with good will from key interest groups that have been working behind the scenes to build momentum for health reform, an effort not seen since 1993-94 when President Bill Clinton tried and failed to pass a universal-coverage initiative. The groups include lobbyists for both the insurance industry and small businesses who led the fight against the Clinton effort.

On Wednesday, the insurance industry’s Washington trade group issued a statement saying it could accept new rules requiring companies to cover sick people, as well as healthy ones, as long as all Americans were required to have insurance, with subsidies for those who need them. The declaration by America’s Health Insurance Plans is a switch from the industry’s long-time opposition to rules that bar the common practice of weeding out customers who are likely to rack up too many bills.

In another sign of an early push for change, the powerful prescription-drug lobby has a new television ad out this week. “Early diagnosis and preventative treatment can save lives and lower health-care costs,” spokesman Montel Williams says in the ad. “That’s why everyone should have affordable health insurance.”

Motivations vary depending on the interest group. Business groups want to reduce the cost and improve the quality of care. Consumer groups and labor unions want subsidies to help people afford insurance. Doctors and hospitals would benefit if more patients had insurance and could pay their bills.

“You see a range of diverse stakeholders trying to work together to achieve health-care reform,” said Karen Ignagni, president of America’s Health Insurance Plans. “You see it on [Capitol] Hill, off the Hill, in various coalitions. And that’s very different than what we saw in the early ’90s.”

It is far from a done deal. For starters, the various players find it much easier to support a general concept than to support legislation creating a vast array of winners and losers.

“Talk is cheap on the front end of this thing,” said Robert Laszewski, a health care consultant and former insurance industry official. “The rubber hits the road when that 1,000-page document comes out with specifics.”


Sen. Edward Kennedy, center, was joined by Sen. Max Baucus, right, and Sen. Charles Grassley to discuss health care on Capitol Hill Wednesday.

Mr. Laszewski pointed to the issue of physician payments. Many in both parties want to boost quality and reduce costs by measuring the quality of health care delivered and tying payments to results, but there is no consensus on how to do that. Once doctors see the details of this idea, Mr. Laszewski predicted, “you’ll see the ugly side of health-care reform.”

Further, the nation’s dire financial situation makes any big spending plan difficult. During the campaign, Mr. Obama estimated his plan would cost some $100 billion per year. Some argue that the tough economic times make a major health-care initiative, particularly efforts to reduce costs, all the more urgent.

Veterans from the 1993 effort say they see more hopeful signs this time around. Substantively, there is more — though far from total — consensus on approaching the problem. The leaders in the Senate, Democrats Max Baucus of Montana and Edward Kennedy of Massachusetts, are both moving toward the sort of plan Mr. Obama proposed in his presidential campaign.

[Ailing System]

The basic concept is this: A government-organized exchange would let individuals and small businesses buy coverage from private companies, or from a new government-run, Medicare-like plan. Subsidies would aid lower-income people. Large employers would be required to offer coverage or pay into a fund. Small employers would get a tax credit if they provided insurance. And a host of initiatives would be launched to reduce costs and improve quality.

Procedurally, both Sens. Baucus and Kennedy have signaled that they will push the issue early next year, not waiting for Mr. Obama. In 1993, a months-long delay in introducing the Clinton health plan was one of many factors later blamed for its demise.

Sen. Baucus met Wednesday with the Democratic and Republican leaders of the relevant committees, and they issued a statement promising to work together to “achieve comprehensive health-care reform.”

The insurance industry may provide the best case study of how things have changed. Two years ago, America’s Health Insurance Plans proposed a coverage plan, and since then the group has worked with other interests to help build momentum for action.

The group’s board made a conscious decision to be a “productive participant” in the debate this time, said Ms. Ignagni. She said members are excited by a variety of aspects of the Democratic approach, including the idea that every American would have coverage.


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