Health Care Reform 2009: Required Reading

Health care reform will be painful enough without requiring home work, but such is life. Here then is the required reading list for understanding the 2009 health care reform debate, where it’s going, and why.
(Note: a second list of health care reform required reading was added June 2, 2009 and a third list was added on August 11, 2009)

1. Critical: What We Can Do About the Health-Care Crisis by Tom Daschle withScott S. Greenberger and Jeanne M. Lambrew.

Former-Senator Daschle will be leading President Barack Obama’s health care reform effort, both in his position as Secretary of Health and Human Services and as Director of the Office of Health Reform inside the White House. Ms. Lambrew will be serving as Deputy Director of the Office of Health Reform. That there even is an Office of Health Reform highlights the importance of this issue to the incoming administration. That the Director of this office is also a Cabinet Secretary enhances the prestige — and clout — of both the office and its leader.

This makes understanding soon-to-be Secretary Daschle’s outlook on health care reform, well, critical. His book, Critical serves as a blueprint to his thinking.  Although the book was written before the identity of the Democratic nominee would be, Senator Daschle was an early supporter of Senator Barack Obama. It’s not surprising that his proposal ties-in well with the then presidential candidate’s health care reform proposal. Senator Daschle’s book, however, goes further.

Core to his solution for what ails America’s health care system is the creation of a Federal Health Board. Modeled after the Federal Reserve Board, it’s aimed at removing effort to control health care costs one step away from the day-to-day politics of Capitol Hill. “I believe a Federal Health Board should be charged with establish the [health] system’s framework and filling in most of the details. This independent board would be insulated from political pressure and, at the same time, accountable to elected officials and the American people. This would make it capable of making the complex decisions inherent in promoting health system performance. It also would give it the flexibility to make tough changes that have eluded Congress in the past.”

Specifically, Senator Daschle would have the Board set the rules for the national health exchange he would create. Through its own research and helping to prioritize research by other federal agencies, the Board would help promote “high value” medical care by “ranking services and therapies by their health cand cost impacts.” Senator Daschle would also have the board “align incentives with high-quality care.”  This would be done through evaluating new technologies as well as by aligning provider payments made by the federal government with health outcomes, rather than with services delivered. Finally, Senator Daschle would ask the Board to assist in “rationalizing our health-care infrastructure” by issuing an annual report identifying where investments are needed across the country — and where they’re not.

In addition to providing a blue print for the Obama Administration’s future health care reform proposals, Senator Daschle does an exceptional job of describing the history of America’s health care reform efforts from 1914 through the present day. As a participant in much of that history, his review can’t help but reflect his own biases, but Senator Daschle ably places today’s debate in an appropriate context.

What’s most encouraging about Critical is that it signifies a clear understanding of the central role controlling medical costs holds in reforming the system. This doesn’t mean Senator Daschle won’t seek to change the health insurance industry. He calls for expansion of federal programs, including a government program that would insure most individuals and small groups. For insurance agents, what is most disconcerting is that Critical never once mentions the role agents play in the current system nor what role Senator Daschle foresees agents playing in his vision for a future system.

 Nonetheless, Critical is important reading as Washington prepares to address America’s health care challenges.

2. Key Issues in Analyzing Major Health Insurance Proposals, by the Congressional Budget Office, published December 2008.

The Congressional Budget Office provides critical input to lawmakers on the expected impact of their legislative proposals. A negative analysis ruling can — and probably should — kill a bill; a positive one can help build momentum and support. Key Issues is not aimed at instructing members of Congress what to do about health care reform. Instead, it lays out how the CBO intends to evaluate whatever proposals Congress generates. As the report notes, “This document does not provide a comprehensive analysis of any specific proposal; rather, it identifies and discusses many of the critical factors that would affect estimates of various proposals.”

The budgetary impact of any health care reform proposal will be critical to its eventual success. The CBO document lays out in significant detail how it will go about measuring that impact. In doing so, the CBO provides a host of statistics, graphs and data that will be bandied about during the debate.

As if all this wasn’t enough to make Key Issues  a must read, Peter Orszag was Director of the CBO when the report was prepared. Mr. Orszag will be Director of the Office of Management and Budget in the Obama White House. In that role, he will have a great deal to say about the financial impact of various reform plans. Given his involvement, it’s not unfair to expect the Administration’s analysis to closely mirror the Congressional analysis described in Key Issues.

3.  Roadmap for Implementing Value Driven Healthcare in the Traditional Medicare Fee-for-Service Program,” by the Centers for Medicare & Medicaid Services.

The upcoming reform debate will be peppered with calls for “transparency,” paying for “value, not services” and for making commercial coverage as cost effective as Medicare. So it makes sense to see what the folks who run Medicare are thinking about concerning these issues. This report is CMS’ effort to help lawmakers “create rationale approaches to lessen healthcare cost growth and to identify and encourage care delivery patterns that are not only high quality, but also cost-efficient.”  The report describes the programs and demonstration projects already put in place by CMS to “foster joint clinical and financial accountability in the healthcare system.”

The CMS report is a tougher read than the other’s on this list. But given that any reform proposal will need to tackle skyrocketing medical costs, the report is worth the time.

I’ll add to this list in later posts, but these three items are a good place to start. And remember, if you think the reading list for health care reform is bad, just wait until you see the final exam.

Dashcle Appointment Puts Obama Health Care Reform on Fast Track

In case there was any doubt, President-elect Barack Obama made clear today that reforming the nation’s health care system will be an early priority for his Administration.  Hhealth care reform won’t wait while President Obama first focuses on fixing the country’s economic mess, but will instead be an integral part part of that effort. As he said during a press conference announcing the creation of a White House Office of Health Reform, to be led by his nominee for Secretary of Health and Human Services, former Senator Tom Daschle, “If we want to overcome our economic challenges, we must also finally address our health care challenge.” (Here’s a  video of the press conference — the comment is made at roughly the 2:40 mark).

The need to move quickly on health care reform was a central theme of the press conference. After reciting the usual litiany of the current health system’s shortcomings, President-elect Obama said, “We’re on an unsustainable course. The time has come, this year, in this Administration to modernize our health care system for the 21st century, to reduce costs for families and businesses and to finally provide affordable, accessible health care for every single American.” (This statement begins at about the 1:40 mark).

He then directly tied health care reform to addressing the current financial meltdown.  “Now, some may ask, ‘How at this time of economic challenge we can afford to invest in reforming our health care system’. And I ask a different question: ‘How can we afford not to?'” (About the 2:00 mark).

The creation of a White House Office of Health Reform, and the appointment of Senator-soon-to-be-Secretary Daschle as it’s Director is especially telling. By placing the locus of health care reform inside the White House, President-elect Obama elevates the importance of achieving meaningful change. By placing the leadership of the Office in the hands of his HHS Secretary he makes it easier for his Administration to speak — and negotiate — with one voice. By making that HHS Secretary Senator Daschle he assures the reform effort will move forward in a nuanced fashion, sensitive to the legislative process. 

This approach stands in stark contrast to the Clinton Administration’s health care reform initiative.  That fiasco, led by then First Lady Hillary Clinton, was a textbook example of insularity and insensitivity to political realities. It discouraged vigorous debate and excluded Congressional input.

Senator Daschle, who led Democrats for 10 of his 18 years in the Senate and who served in the House for eight years, will take a far different approach. First, he can’t help but reach out to members of Congress — it’s in his DNA. Second, at the press conference he pledged to work with “people from across the country to find a path forward that makes health care in this country as affordable and available as it is innovative.” As a member of the Obama Transition Team he is already coordinating thousands of small meetings across the country on the topic to bring the American people “into this conversation” in order to make “an open and inclusive process that goes from the grass roots up.”  (Beginning at the 7:10 mark).

Senator Daschle is no newcomer to the health care reform debate. He’s studied, and written about, the issue as a Senior Fellow at the Center for American Progress. He is co-author of Critical: What We Can Do About the Health-Care Crisis along with Dr. Jeanne Lambrew, who President-elect Obama named today as the Deputy Director of the White House Office of Health Reform.  Their prescription for reform is not dissimilar from that put forward by Senate Finance Committee Chairman Max Baucus which, in turn, reflects many of the principles put forward by candidate Barack Obama during the presidential election.

During the press conference, both President-elect Obama and Senator Daschle emphasized the many problems apparent in today’s health care system. This shouldn’t be a surprise. When rallying the nation to change a complex and critical component of government service reminding voters of its flaws and the need for reform is standard practice.

It would have been nice, however, if a bit niaive, to hope they would have noted, even in passing, that much of the current system works and is worth preserving. Such a statement would have been as refreshing as it would have been unexpected. And it might even have underscored the new kind of politics President-elect Obama promises to bring to Washington.