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Health Care Reform – The view from Washington

Yesterday my colleague Elaine Mejia and I went to our nation’s capital and met with the offices of as many members of our Congressional delegation as we possibly could. This meant seven meetings (actually one was more of a brush-off than a meeting, but more on that in a later post) over the course of the day, mostly with key legislative staff although we did talk in person with Senator Kay Hagan and Representative Mike McIntyre.

Overall, we found broad support for the idea of health reform, which was little surprise. Of course, as we are seeing right now, the devil is in the details and that’s where it got interesting. Health care bills in both the House and Senate would provide substantial tax credits to small businesses to help them buy insurance, give sliding-scale help to families with income up to around $70,000 to reduce premium costs, create a public health plan option to compete with private insurance plans, and make some efforts at controlling costs.

Despite these great bills, there were two main messages we heard in Congressional offices on health care. First, many members of Congress are not hearing from their constituents who support health care reform right now. Of course, these members have been hearing from many people over the last two years that want health reform, but opponents are out in force at the moment. Hearing from more people who support reform is critical.

Second, we heard from NC Congressional members and staff that they are worried about the efforts to control general health care costs in the bill. This doesn’t apply to the federal budget cost of the bill. Let me explain this apparent contradiction. The full cost of the House reform bill is covered by a tax on high income earners and sharply reducing payments to Medic are private plans and other costs. But what has members concerned is that some feel the bill doesn’t do enough to reduce overall health spending – which is growing a 9 to 10% a year. The Congressional Budget Office has agreed and said that the extensive prevention measures in both the House and Senate bills will do little to reduce overall health costs.

The problem is, of course, that when you seriously talk about reducing health costs, then someone is going to be making less money. And that someone likely has some very, very highly paid lobbyists in DC right now. That’s why proposals on doing comparative effectiveness research to figure out what drugs and treatments actually work and are worth paying for don’t include provisions to actually require this research be put into practice. By the same token, payment reforms where we pay doctors based on the overall health of the patient, rather than the number of procedures they do (and are paid for) are simply pilot programs.

While we need to get a little stronger on controlling health costs, but we also need to get serious about passing reform. Doing nothing is not an option. We can tweak these cost provisions in what are now very good bills to save more money. Other compromises will likely have to be made about the level at which tax credits kick in and just what a public plan option might look like. However, in the end, North Carolinians will be vastly better off with health reform than without it. In a state with an over 11% unemployment rate, over 1400 people in NC are losing health coverage every week [1]. Let’s hope the President makes that point in his press conference on health care tonight.