The Health Reform Dialogue Group Recommends Health Care Overhaul

Photo by Jeffrey Beall via Flickr

Throughout the country, newspapers are reporting on the meeting of the Health Reform Dialogue Group (the “Group”).  The diverse group has been meeting to discuss the overhaul of the current national health care system.

The Associated Press reports:

Eighteen groups representing consumers, business, insurers, doctors and hospitals say they have reached agreement on how they would like to see the nation’s health care system overhauled.

The groups, calling themselves the Health Reform Dialogue, say the uninsured should be covered through a combination of expanded government programs and subsidies to purchase private health coverage.

The 18 organizations in the group have been meeting for six months. While they failed to resolve several major issues, their agreement could serve as a starting point for lawmakers trying to craft a plan this year that can win broad support.

Some of the major health care players within this 18-organization group includes: AARP, American’s Health Insurance Plans, American Hospital Association, American Medical Association, Blue Cross and Blue Shield Association, and U.S. Chamber of Commerce.  This group represents both private and public interest groups.

As a result of the Group’s meetings, the Group issued a Report (PDF) containing multiple recommendations.  The Report states that the meetings have been productive:

These facilitated, structured discussions have yielded fruit, identifying shared views on many policy issues, including methods of expanding meaningful health coverage for everyone, system reforms to promote more effective and efficient health care, and the need to lower the health cost growth curve.

The Report focuses on specific goals: increasing coverage and access, strengthening wellness and prevention, and ensuring quality and value.  The Report also discusses ways to finance and reach each goal.

The Reports states:

We should seek to ensure coverage for all; strengthen public safety-net programs for low-income families; make private health coverage more affordable; and provide fair and adequate reimbursement for care.

This “coverage for all” has been characterized as an “individual mandate” for universal health care insurance coverage.  The Washington Post reports:

Most notably, the group, known as the Health Reform Dialogue, calls for creating an “individual mandate” that would require every American to have some type of health coverage. Anyone who cannot afford insurance would be eligible for subsidies or expanded government programs such as Medicaid.

To facilitate this first goal of  “universal coverage,” the Group recommends expanding coverage of Medicaid and SCHIP.  The Hill reports:

Among the more specific recommendations made by these groups and their partners are that Medicaid and the State Children’s Health Insurance Program should be expanded, that tax credits be made available to help people buy health insurance, that small businesses get subsidies to provide benefits to their workers and that insurance regulation be changed to make it easier to buy policies.

The second goal of the Group is to strengthen wellness and prevention.  The Report states that “. . . America must dramatically increase its focus on health promo­tion and disease prevention in order to reduce illness, disability, and premature death.”  The Report points to a Center of Disease Control and Prevention estimate that states that “eliminating three risk factors - poor diet, inactivity, and tobacco use - would prevent 80 percent of heart disease and stroke, 80 percent of Type 2 diabetes, and 40 percent of cancer.”

The Group’s Report states:

Their recommendations would significantly help ensure that more people received the most effective preventive services; provide incentives to communities and providers to use health information technology to help more people receive the right preventive services; establish health promotion and disease prevention as core priorities for health systems, businesses, and the public sector; and work with individuals and stakeholder groups to share information on how best to improve people’s health behaviors.

The third goal is ensuring quality and care.  The Report states:

The ultimate public policy goal is to increase value for America’s health care consumers and the system as a whole, that is, the highest quality of care delivered in the most efficient manner possible: significantly improving treatment of chronic disease; researching the effectiveness of comparative treatments; paying for quality care, not quantity of care; providing relief for patients, clinicians, and providers caught up in the web of medical liability processes; encouraging public reporting of information that clarifies the performance of individual clinicians and providers; creating a robust health information technology infrastructure; and beginning to significantly transform the health care delivery system through some much-needed payment reforms.

There have been many critics of the Group’s  recommendations.  The first line of criticism relates to the fact that the “universal coverage” is only a basic level of coverage, and the insured would have to pay more for a more-inclusive service.

The Los Angeles Times reports:

Yet if you read the fine print in their plan, it turns out that they’re reserving the right to charge different prices for different levels of coverage — a practice that would effectively keep us where we are, with sick (or potentially sick) people paying more for insurance.

The loophole was included — “hidden” is a more apt word — in a letter sent to prominent senators from a pair of industry leaders: Karen Ignagni, president of America’s Health Plans, an industry group; and Scott P. Serota, president of the Blue Cross Blue Shield Assn.

The letter featured insurers’ willingness to adopt a more inclusive coverage policy in return for “an effective, enforceable requirement that all Americans assume responsibility to obtain and maintain health insurance.”

The Washington Post also reports a similar criticism relating to the “universal coverage”:

The coalition’s report is silent on whether employers have a responsibility to contribute to the cost of care, and it does not address the idea of creating a government-sponsored insurance program that would be available for anyone having difficulty buying coverage.

The Hill also brought up the concern relating to the government’s involvement in this push for “universal coverage”:

Among other things, the report is silent on whether health reform should include the creation of a new, government-run health benefit, whether individuals should be required to obtain insurance or employers required to provider it, or on how to pay for reforms on the scale proposed by President Obama, which could cost upward of $1 trillion.

Although the Report gives “context for financing health care,” such as recommending that cost efficiencies can be gained by improving health care delivery, and that methodologies for quantifying long-term cost savings can be improved, the Report concedes that additional investments will be needed:

The participants in this dialogue recognize that the recommendations are not fully financed. Additional sources of funding will be required at least in the short-term, and, in order for health reform to be successful, costs must be spread equitably across stakeholders.

Of course, funding is an issue.

Kaiser Family Foundation reports:

The Senate Budget Committee’s Thursday approval of a five-year budget resolution that would allow 10 years to offset the cost of health reform shows that “lawmakers are hoping they can find a way to make the health care overhaul pay for itself, even though any substantial savings are likely to take years,” the Wall Street Journal reports. Experts estimate that President Obama’s proposed overhaul would cost more than $1 trillion over the next 10 years. Sources of savings that have been suggested include reducing incentives for health care providers to deliver unnecessary care, addressing regional disparities in costs, providing doctors more information about comparative effectiveness of treatments and promoting prevention (McKinnon/Bendavid, Wall Street Journal, 3/27).

It will be more than interesting to see whether the health care goals promulgated by  Congress and the current administration will be deemed to coincide with the goals of the Group.  Currently, President Obama has expressed interest in the creation and/or expansion of a “public plan” to compete with private insurers, but has also expressed a desire to maintain the employer-based system as well.

The LA Times reports:

President Obama has said he’s interested in the idea of the federal government offering some sort of public insurance program that would compete with private insurers.

But in an online town hall Thursday, he said he favors keeping the employer-based system that has provided coverage for most Americans since World War II. “I don’t think the best way to fix our healthcare system is to scrap what everybody is accustomed to,” he said.”

However, according to a recent Kaiser.org article, conservative interest groups have launched a campaign in an attempt to show the two interests to be mutually exclusive:

The Health Policy Consensus Group, a coalition of conservative interest groups spearheaded by the Heritage Foundation, listed the creation of a public insurance option as the No. 1 “deal killer” for health care reform. The group argues that the government would use its “regulatory, pricing, and taxing authority” to make it nearly impossible for private insurers to compete, leaving U.S. residents without a private alternative.”