David Welna, NPR News, Author at �鶹Ů�� Health News

Opponents Threaten Constitutional Challenge To Individual Mandate

David Welna, NPR News — Tue, 19 Jan 2010 09:02:00 +0000

This story comes from our partner

A major component of the health bills grinding through Congress right now is a new requirement that nearly everyone buy health insurance – a so-called individual mandate. But conservatives who oppose the health care overhaul have threatened to challenge this mandate on constitutional grounds.

“For the first time in the history of our country, 225 years, the federal government’s saying you’ve got to buy something,” Iowa Republican Sen. Chuck Grassley said. “That’s never been before. You as an individual can do whatever you want to, buy whatever you want to, when you want to, where you want to get it, but now the federal government’s saying you have to buy health insurance.”

Grassley’s position on the individual mandate has changed in recent months. Last June, he told Fox News Sunday he thought everyone should have to buy health insurance, because, as he put it then, “There’s no free lunch.”

“I believe that there is a bipartisan consensus to have individual mandates,” he said.

At the time, Grassley was still deep in negotiations with Senate Democrats on the Finance Committee over a health care bill. But by the time that panel’s legislation came to a vote, Grassley had turned against both the bill and the requirement that everyone buy insurance.

Since then, a lot of other Republicans have joined Grassley in questioning the individual mandate, including Florida’s Republican attorney general, Bill McCollum.

“I view the individual mandate as a living tax. I call it a tax on living,” he said.

To The Supreme Court?

Two weeks ago, McCollum wrote fellow state attorneys general and urged them to explore a constitutional challenge.

“I’m assuming there will be a bill that becomes law, and if it does include a individual mandate, or what I call a living tax, then at that point we have to make a decision: Do we challenge it in court?” he said. “The first step would be to go into federal court and seek that challenge, and I would expect, if that were to be the case, we’d have a sizeable number of attorneys general joining us.”

A legal battle could end up in the Supreme Court. Georgetown University law professor Randy Barnett is already gearing up for that. He maintains Congress would be overstepping its powers enumerated in the Constitution if it required people to buy health insurance.

“Never in the history of the United States has the federal government ever required someone to engage in an economic activity with a private party. It’s never been done, and anything that’s never been done before has no precedent for it,” he said. “It would have to be a new decision by the Supreme Court to uphold this new extension of power. And if they uphold this, then there’s pretty much nothing that Congress can’t do and that’s the end of the enumerated power scheme.”

But William Treanor, the dean of Fordham University’s law school, said he’s confident an individual mandate would be held constitutional if it went to the Supreme Court. Treanor said the mandate to buy health insurance would be seen by the high court as part of Congress’ power to regulate interstate commerce.

“The view that it’s not consistent with the enumerated powers is at odds with well-established precedent that runs back more than 70 years,” he said. “I think this is very clearly something that Congress can do under the commerce clause power.”

‘A First Time For Everything’

Wake Forest University constitutional expert Mark Hall says almost every legal scholar he knows considers an individual mandate for health insurance consistent with Congress’ power to regulate.

“An individual who goes out and tries to purchase health insurance cannot buy a policy that covers pre-existing conditions or that asks no medical questions. Such a product is simply not sold in most states, and it can’t really be sold economically unless we require most people to have insurance,” he said. “So the requirement is really part and parcel of the regulation of the structure and conditions of the marketplace that would allow a very desirable kind of product to be sold.”

And Yale legal scholar Akhil Amar said the fact that a requirement to buy health insurance would be enforced through fines shows Congress is exercising an even more fundamental constitutional power: its power to impose taxes.

Amar says courts should not be concerned that such a mandate has not been used before.

“There’s a first time for everything. Before there was a federal bank, there was no federal bank; before there was a Social Security Administration, there was no Social Security Administration,” Amar said. “Have we ever had a law just like this before? No. That’s why it’s being proposed. That’s true of many laws.”

Still, should the individual mandate become law, opponents are saying: See you in court.

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On Health Bill, Reid Proves The Ultimate Deal Maker

David Welna, NPR News — Wed, 23 Dec 2009 08:33:00 +0000

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Senate Democrats are poised to pass their massive health care bill early Thursday. It’s a feat many doubted could be pulled off, given how divided they are on key issues. But in the end, all 60 members of the Democratic caucus closed ranks behind the bill. And the man getting the credit for bringing them on board is the leader of the Democrats’ supermajority, Nevada Sen. Harry Reid.

Reid got a hero’s welcome Tuesday as he walked into a rally at the Capitol. Applause came from health care advocates gathered for an early celebration of the all-but-certain passage of the overhaul bill.

“Harry Reid has the patience of Job, the wisdom of Solomon and the endurance of Samson,” Iowa Democrat Tom Harkin told the audience. “He has hung in there day after day, has put this together, and he is about to achieve what has eluded so many majority leaders going back over half a century. Truly with the passage of this bill, Harry Reid will have earned his place in the Senate’s history.”

Reid, as usual, tried deflecting the praise, saying he was simply batting cleanup.

“I appreciate the nice words everyone has said to me, but by the time that this thing got to me most of the hard work had been done,” he said.

Reid also sought to shoot down Republican charges that he’d simply pursued a win for Democrats. “This fight isn’t about politics; it isn’t about partisanship,” he said. “It’s about people, real people.”

The Art Of Compromise

Indeed, it has been about people – people like independent Connecticut Sen. Joe Lieberman, who threatened to join a GOP filibuster of the bill because he strongly opposed the public option Reid had included in his first version. Lieberman said Reid knew where he stood.

“He called me before the motion to proceed to the debate on health care reform, said that he had to include the public option in his merged bill,” he said. “He knew I was against it, but hoped I would vote to start the debate, and I said of course I will. But I said, ‘Harry, if it’s still in there, I have to do everything I can to get it out.'”

Connecticut’s other senator, Christopher Dodd, led the Health Committee’s drafting of a health care bill, one that did include a public option. Dodd said Reid agonized over how to lock in 60 votes.

“I remember several conversations where the first words out of his mouth were, ‘This bill’s dead.’ And we’d have to regroup and spend hours going back over ground, and I – that happened more times than I care to recall.”

In the end, Reid removed the public option and won Lieberman’s support. Another holdout, Nebraska’s Ben Nelson, got the tougher guidelines on abortion he’d sought, as well as a promise that the federal government would permanently pay for an expansion of Medicaid in Nebraska. On Saturday, the day Nelson announced he’d be the 60th vote for Democrats, Reid defended granting concessions to garner support:

“I don’t know if there’s a senator that doesn’t have something in this bill that was important to them,” he said. “And if they don’t have something in it important to them, then it’s – doesn’t speak well of them. That’s what this legislation’s all about: It’s the art of compromise.”

‘Sweetheart Deals’

But it also proved a turn-off for the only Senate Republican who’d voted for an earlier version of the bill. Maine’s Olympia Snowe said Reid did not deliver on the policy changes she needed to vote for it.

“We were about crafting good policy, but in the meantime, they were negotiating sweetheart deals in the dark of night,” she said. “Little did I know.”

Senate Republicans don’t have the votes to stop the health care bill, but they’ve made “sweetheart deals” their new refrain.

“Americans are outraged by the last-minute, closed-door, sweetheart deals that were made to gain the slimmest margin for passage of a bill that is all about their health care,” Minority Leader Mitch McConnell said on the Senate floor Tuesday.

University of Nevada political scientist Eric Herzik doesn’t think cutting such deals will hurt Reid, who is expected to face a tough re-election bid next year.

“Harry Reid is the ultimate kind of power politician, the backroom deal maker, again, which is why many people don’t like him,” Herzik said. “But at the end of the day, Harry Reid’s about getting the deal done. Getting things done in Washington, D.C., and you know, sometimes that’s not a pretty process.”

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Democrats Push To End Insurers’ Antitrust Exemption

David Welna, NPR News — Fri, 23 Oct 2009 16:35:03 +0000

This story comes from our partner

In the ongoing health care overhaul drama, the Obama administration and the health insurance industry have gone from uneasy allies to bitter adversaries.

One result is that health insurers stand to lose a privilege their industry has enjoyed for the past 64 years: They, like Major League Baseball, have been exempt from federal antitrust laws. Congressional Democrats are now pushing to strip the health insurance industry of that exemption.

Things turned ugly earlier this month after the health insurance industry rejected the health care makeover it once supported. President Obama dedicated his most recent weekly address almost entirely to blasting those insurers; he accused them of skimming big profits off ever-escalating premiums.

“They’re earning these profits and bonuses while enjoying a privileged exception from our antitrust laws, a matter that Congress is rightfully reviewing,” the president said.

It was Congress, after all, that in 1945 overrode a Supreme Court ruling that the insurance industry was indeed part of interstate commerce and thus subject to federal antitrust laws. Lawmakers that year passed the McCarran-Ferguson Act; the law has ever since shielded insurance firms from federal prosecution for price fixing, bid rigging and carving out protected markets.

This week, Senate Judiciary Committee Chairman Patrick Leahy declared the time had come to do away with that protection.

“The antitrust laws exist to protect consumers, but also to promote competition,” he said. “You remove the antitrust laws, you don’t protect consumers, and you don’t promote competition.”

‘Allow competition to have a greater role’

Leahy held a hearing last week on ending the antitrust exemption for health and medical malpractice insurers. Christine Varney, who heads the Justice Department’s antitrust division, testified for the Obama administration.

“Repealing the McCarran-Ferguson Act would allow competition to have a greater role in reforming health and medical malpractice insurance markets than would otherwise be the case,” she said.

Varney’s assertion was roundly rejected by University of Arkansas business professor Lawrence Powell, who testified on behalf of the medical malpractice insurance industry.

“The best possible outcome from repealing McCarran is continuation of the status quo,” he said. “However, it is also likely that repealing McCarran would have negative consequences for consumers, by decreasing competition and accuracy in insurance pricing.”

Rhode Island Democrat Sheldon Whitehouse pointed out that the professor was relying on outdated information.

“You cite for the proposition that insurance markets are highly competitive an article by Paul Joskow. Do I have the date of that article correct, it’s 1973?” he asked Powell. “I believe so,” came the answer.

Whitehouse noted that in 39 states, two health insurers control at least half the market, while in nine states, one insurer controls at least three-quarters of the market.

Possible backfire?

Still, some health economists question whether breaking up big insurance companies with federal antitrust laws will help consumers.

“What you may find is that it’s the opposite – that you break them up and they can’t bargain down prices and, therefore, while they’re competing at the margin, they’re all competing at a higher level of premium than you had before,” says Austin Frakt of Boston University’s School of Public Health. “That’s certainly possible.”

It’s the states that regulate the insurance industry. Still, almost all the nation’s state attorneys general want to repeal the federal antitrust exemption.

“This gives us another tool in our arsenal to combat higher rates – proposed and accepted by companies that have a stranglehold in the market – in states like Maine, where basically one company controls the market,” says Maine Attorney General Janet Mills.

The push to repeal the antitrust exemption has gained momentum. This week, three Republicans joined Democrats to vote such a bill out of the House Judiciary Committee. A similar measure is planned as an amendment to the Senate’s health care overhaul.

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Public Option Short On Democratic Votes In Senate

David Welna, NPR News — Wed, 21 Oct 2009 19:48:00 +0000

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Most polls show that a majority of Americans want a health care overhaul to include a public option – a government insurance program that competes with private insurers.

So it might seem logical that Senate Democrats, with their 60-vote majority, would include a public option in the bill that’s headed for the Senate floor. But no decision has been made yet, because it’s not clear how many Democrats would back a public option.

Earlier this month, Vermont independent Sen. Bernie Sanders and 29 Democratic colleagues sent a letter to Majority Leader Harry Reid, who is leading the effort to blend the bills of two committees – the Finance Committee and the Committee on Health, Education, Labor and Pensions.

The includes a public option, while the does not.

Sanders and the others, who make up half of the Democratic caucus, want any bill Reid sends to the full Senate to include a public option.

“This is an overwhelmingly Democratic bill,” Sanders says. “How, if you are the Democratic Party presenting your bill, do you say no to over 80 percent of the people in your own party, and expect there to be grass-roots support for real health care reform?”

But centrist Democrat Mary Landrieu of Louisiana says, “I’m not for a government-run national taxpayer subsidized plan, and never will be.”

Landrieu says it makes no sense to create a third government health care program when Medicare and Medicaid are already headed for insolvency.

Still, Landrieu sounds as if she could eventually be persuaded to back some form of a public option.

“In some states at the end of the line, they don’t believe they’re going to have the kind of choice that we think consumers and businesses need,” Landrieu says. “If the costs are still too high, then perhaps a fallback or a trigger, but something that is on a level playing field.”

Another Democratic holdout has been Arkansas’ Blanche Lincoln. She voted against including a public option in the Finance Committee’s bill.

She faces a potentially difficult re-election bid next year, and hesitates when asked whether she’d vote for a health care bill that has a public option.

“It all depends on how it’s gonna be written,” Lincoln says. “I think the most important thing we can do is provide choice and competition, and that’s gonna help us bring down the price and make sure everybody’s got good options.”

But Lincoln says she has ruled out a government-funded and a government-operated plan.

Max Baucus, the Democrat who chairs the Finance Committee, also voted against putting a public option in his panel’s bill. Asked Tuesday whether the bill the Senate takes up should have such an option, Baucus said his aim is to get legislation that passes.

“What provisions help push it over the goal line should be in,” Baucus adds. “Provisions that don’t allow us to get 60 votes should not be in.”

Other Democratic senators say the only public option they’re interested in would be run by each state.

Among those holdouts is Nebraska’s Ben Nelson, “It makes a lot more sense to me to have the states involved in this than not to have them involved, and try to do it all at the national level.”

And then there’s Connecticut independent Joe Lieberman, a member of the Democratic caucus who opposes a public option. Lieberman says he’s inclined to vote with his caucus against any GOP filibuster aimed at blocking a health care bill with a public option from coming to the Senate floor, “because our country needs health insurance reform,” he says. “But if I decide in the end the bill that is about to leave the Senate is gonna do more harm than good, then I won’t vote for cloture at that point.”

In other words, Lieberman might be willing to help Republicans filibuster a health care bill when it comes up for a final vote.

Further complicating matters is Illinois Democrat Roland Burris, who says he won’t vote for a health care bill unless it does have a public option.

“If it doesn’t have a public option, it’s not a bill,” Burris says. “It’s not going to solve any problems. If it doesn’t have that, it isn’t gonna help anybody but the insurance companies.”

However Democratic leader Reid decides on a public option, he’ll have his work cut out finding 59 other senators to back him up.

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Health Care Overhaul Rests On Senator Harry Reid

David Welna, NPR News — Sun, 18 Oct 2009 10:50:00 +0000

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Senate Majority Leader Harry Reid hails from the hard-rock-mining town of Searchlight, Nev. He once made a name for himself there as an amateur boxer. But in what may be his biggest fight yet, Reid is playing referee. He is leading the effort to combine two sharply different health care bills.

Reid must please both liberals and centrists to garner the 60-vote majority needed to fend off filibusters. Even his fellow Democrats shake their heads in wonder at the task he’s set himself.

“I heard one of my colleagues today say, ‘Is he Harry Reid or Harry Houdini?’ ” Sen. Mark Pryor of Arkansas said.

On Wednesday, a day after Maine Sen. Olympia Snowe became the first Republican to vote for a health care bill, Reid stopped to talk to reporters. He was on his way to the first of what will very likely be many closed-door meetings with top White House officials and the two Democrats whose committees produced the bills.

Reid took a swipe at his Republican colleagues when told they wanted to spend months debating the bill he’s trying to hammer out.

“I believe that the Republican leader and all of his colleagues, with the exception of a couple there – one of whom is Sen. Snowe, and there are a couple others – want to do anything that they can do not to have a bill,” he said.

One-On-One Approach

Such blunt questioning of Republicans’ motives is vintage Reid. Georgetown University’s Stephen Wayne says it serves to foster us-versus-them solidarity in a Democratic caucus that’s divided over key health care issues.

“He’s appealing to Democratic unity, and the one thing all the Democrats can agree on is that the Republicans seem to be naysayers in this,” Wayne said.

But Reid also needs the support of at least some Republicans, if only to provide political cover for fence-sitting Democrats to back whatever bill he comes up with. By Thursday, Reid had softened his rhetoric, saying he was confident more GOP senators would end up on his side.

“I’ve spoken to two other Republicans today on health care and who knows? We may yet have help from one of those two or both of those, so we’re not writing off the Republicans,” he said.

It’s the same one-on-one approach that Reid used successfully earlier this year to get three Republican senators behind President Obama’s stimulus package. Wayne says Reid is no hard-charging Lyndon Johnson; rather, Reid strikes a soft stance to make a hard sell.

“He has a tenacity,” he said. “He also tends to have a low-key approach; he tends to be a person who wants to placate others.”

Bringing People Together

Reid declined to be interviewed for this report. But Max Baucus, who is one of the two committee chairmen whose bills Reid is blending, says the majority leader is indeed the right man for the job.

“I mean, he’s conciliatory. I mean, he’s a moderator. He’s – look, he’s been leader. As leader, you’ve got to bring people together,” Baucus said. “That’s the nature of leader and he’s very good at it.”

Indeed, one of the first concessions Baucus made on the centrist health care bill his Finance Committee produced was to Reid. The majority leader demanded, and got, a multiyear exemption from higher Medicaid rates for his state and three others with high unemployment.

Republicans, including Arizona Sen. John McCain, cried foul.

“Who pays?” he said. “The other states, duh.”

But Reid stood his ground: “The people of Nevada are hurting and I make absolutely no apologies, none, for helping people in my state, in our nation, who are hurting the most.”

‘Oblivious’ To Election Problems

As it happens, Reid is also up for re-election next year. Republicans have him in their crosshairs. But West Virginia Democrat Jay Rockefeller, who’s in the liberal wing of his party, insists Reid is entirely focused on health care.

“I think he’s made of steel,” he said. “I mean, he’s oblivious to whatever election problems he has. I’ve never seen anybody quite like that, be so oblivious. “

Reid, who has raised close to $10 million for his re-election and is on track to meet a $25 million goal, on Thursday sought to play down home state approval ratings that hover in the upper 30s.

“All my polling numbers are fine, and I’m continuing to do the best I can for the people of this country and the people of Nevada,” he said.

David Damore of the University of Nevada, Las Vegas has been tracking Reid’s political fortunes. He says the four-term senator’s handling of the health care powder keg is being watched closely back home.

“I think a lot of people are looking to him to exercise his leadership, to show his value to Nevada, to show that he is a key player – not only can he deliver the pork for Nevada, but he can also have a huge say in shaping policy in a manner that may be beneficial to Nevada interests, so I think it’s a big test for him,” Damore said.

“It’s gonna be Harry Reid’s bill,” said Tennessee Republican Lamar Alexander, a member of the GOP leadership team. He thinks Reid is making a mistake not inviting Republicans in to help merge the two health bills.

“The difficulty Sen. Reid has is, if he writes it in his back room with just the Democrats, he’s going to lose support in the country for the bill, and eventually, he’s going to lose votes,” he said.

But if Reid does have any misgivings, none were apparent as he emerged from a meeting with his fellow Democrats on Thursday.

“We must succeed in reform,” he said. “It’s something the American people deserve, and we’re going to complete that for them.”

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Minnesota Experiment Puts Patient Health First

David Welna, NPR News — Thu, 03 Sep 2009 09:00:00 +0000

This story comes from our partner

This is the second of a two-part report about the search for a more cost-effective health care delivery system.����

Dr. Dave Yehl (left) meets with nurses and a scheduler for a twice-a-day hallway huddle. Under the experimental payment scheme, the team is taking a more wellness-oriented approach. (David Welna/NPR News)

In the health care debate, many agree that the payment system for doctors and hospitals doesn’t work. They’re paid for each procedure they perform, giving them a perverse incentive to perform more.

Yet that system – known as “fee for service” – is what prevails nationwide, and it is a major driver in rising health care costs. The health care bills before Congress may do little to change that. But on the state level, Minnesota may have found its own way to move doctors off of the fee-for-service treadmill.

An Unlikely Partnership

Watching health care costs soar has David Tilford increasingly worried. As president and CEO of Medica, Minnesota’s second-biggest health insurer, Tilford fears medical-expense inflation is too much of a burden on employers, who are Medica’s main customers.

Transforming The Model

Read the first in this two-part report on the search for a more cost-effective health care delivery system:

“Some employers, especially on the smaller end, are dropping coverage altogether, because it’s simply become unaffordable,” Tilford says. “So we had an obligation to do something. We couldn’t simply sit idly by, while our customers were struggling.”

So about a year and a half ago, Tilford met for drinks with Mark Eustis. Up until then, the two men were adversaries – Tilford’s firm, Medica, was paying ever-higher bills on claims from Fairview Health Services, the not-for-profit that Eustis heads. Fairview has seven hospitals and 49 clinics. Eustis says he was tired of trying to defend a broken system and wanted to do something different.

The challenge, Eustis says, is that “if you do something different in today’s reimbursement world, you’ll generate less funds, because we’re in a fee-for-service world that actually pays you to do more. If you really manage utilization appropriately, if you try to reduce costs, be more efficient, more effective, you get paid less.”

So Eustis and Tilford struck a deal. The insurance company agreed to provide an undisclosed amount of money to help Fairview – Minnesota’s second-largest health care provider – move from fee-for-service billing to a system based on fixed payments. Tilford says it was by no means a gift to Fairview.

“I was very clear that we would make investments, and that those investments should produce changes in the way care was delivered,” Tilford says.

Eustis, for his part, says Medica took a carrot-and-stick approach with Fairview: “If we don’t perform, we’re going to get less. If you perform at a higher level, you’ll be able to get additional payment.”

The idea, says Eustis, was to keep patients well – by spending more on them when they’re healthy, with the aim of reducing costly illness.

“It may sound simple, but getting physicians and practitioners to think about that, versus just thinking about people when they’re sick and generating production units, is a huge, huge change,” Eustis says.

Experimenting In ‘The Sandbox’

Fairview’s clinic in Eagan, just south of Minneapolis, resembles most big health clinics. But this facility, with its 10 physicians and 12,000 patients, is known as “the sandbox” – it’s where Fairview began a number of new approaches in patient care this spring.

One of its patients is a 43-year-old father of three who, for fear of losing his job, asks that only his first name, John, be used in this report. Dr. Jamie Gaul sits down with him in the exam room and gives him a physical. John says he ran out of Lipitor, a cholesterol-lowering medication, but that’s not the only reason he has come to the doctor’s office.

John also complains of constant chest pains, which he links to stress he has been feeling due to layoffs at his workplace. Later, Gaul says he has adopted a new approach for identifying such a patient’s concerns. He calls it “motivational interviewing” – essentially, letting the patient do most of the talking during an exam.

“I think if we can catch ourselves, so we don’t jump in with our own agenda too quickly, I think it really does help, and I think that overall, the care ultimately is more effective,” he says.

Were Gaul being paid by the number of patients he sees, as most doctors are, it might not have been worthwhile for him to sit and listen at length to his patient. But Gaul and all the other doctors at the Eagan clinic are now on salaries and feel more at liberty to consult with each other about patients.

“It’s kind of interesting that Washington is reforming health care, when they’re not the ones in the room with the patient, and that’s really what this project is about: letting the people in the room with the patient reform health care,” says nurse practitioner Val Overton, who helped oversee the redesign of care at the Eagan clinic.

Being Responsible For Patient Health

One new goal for Lynn Fiscus, the Eagan clinic’s medical director, is to get more patients to do cancer screenings.

“Under the old model, it didn’t matter whether I did a good job counseling them or talking to them about colon cancer risk. We were all reimbursed the same, just for that face-to-face visit,” Fiscus says. “Under this new model, we’re accountable for how many of our patients are up to date on their colonoscopies, how many have had their mammograms. It’s really a different way of looking at it.”

It’s still too soon to know whether the more collaborative, wellness-oriented approach is more cost-effective at Fairview’s Eagan clinic.

The clinic’s goal this year is to cut costs by 20 percent, while increasing the number of patients by 50 percent. Physician Dave Yehl says he has no idea whether he gets a bonus if that happens.

“This is a faith-based initiative,” he says with a laugh. “We’re kind of taking it on faith that our higher-ups will kind of kick in that incentive once we’ve established that we have good ways of making quality care.”

And if they do, the Medica-Fairview venture could be a model for revamping fee-for-service health care.

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Taking Doctors’ Profits Out Of Medical Care Decisions

David Welna, NPR News — Wed, 02 Sep 2009 09:26:04 +0000

This story comes from our partner

This is the first of a two-part report about the search for a more cost-effective system for delivering health care.

In the national debate over health care, a key factor driving up costs seldom gets discussed: the payment system for doctors.

At present, the more procedures doctors perform, the more they get paid. The health industry calls this practice “fee-for-service.” Many consider it a perverse system – one which lacks incentives to hold down costs. Yet the legislation pending before Congress may not do enough to change it.

Prioritizing Quality Over Profit

At a recent White House news conference, President Obama gave a succinct diagnosis of the nation’s health care ills: “We spend much more on health care than any other nation, but aren’t any healthier for it.”

The remedy the president prescribed, though, was not health care reform – it was health insurance reform, a term he and fellow Democrats have lately begun using to describe Congress’ effort to overhaul health care regulations.

But one Democrat warns the problem goes well beyond health insurance. Tennessee House member Jim Cooper says the real issue is a system bent on telling consumers that more is better.

“The message of our medical system has been to ‘sell, sell, sell, buy, buy, buy,'” Cooper says. “And the real message should be, ‘What’s really going to help me live longer and healthier?'”

With the fee-for-service model for health care, Cooper says, doctors have little reason to discourage the demand for more and more health procedures.

“I liken fee-for-service medicine to the situation if we paid lawyers by the word, or by the paragraph,” he says. “We would have the longest legal documents in the world, and essentially, that’s what we do with our doctors, but most of us don’t realize it.”

Republican Sen. Olympia Snowe of Maine agrees with Cooper. Snowe is one of three Republicans working with three Democrats on the Senate Finance Committee to forge a bipartisan health care bill. She wants legislation holding doctors and hospitals accountable for both the cost and quality of their treatment.

“The fact is, right now, we encourage volume over value,” Snowe says. “And so we’ve got to really analyze what is the net outcome, you know, in the procedures and the testing and the care that is provided [to] individual patients, and by whom.”

Other lawmakers say incentives for cutting health care costs should be directed more toward the patients themselves.

Wyoming Republican Sen. John Barrasso, who is also an orthopedic surgeon, says there is nothing in the legislation now before Congress to motivate people to live healthier lifestyles – “nothing that’s aimed at helping people individually and gives an incentive to that person to eat less, exercise more, and quit smoking.”

Changing An Unsustainable System

Even outside experts say that while the health care payment system encourages waste, it’s not clear what the fix is.

“I think the truth of the matter is, we don’t know exactly what would be the best way to reform payments,” says Karen Davis, a health care expert who is president of the nonpartisan Commonwealth Fund.

Davis says the legislation pending before Congress does offer some incentives for more cost-effective health care: Medicare would crack down on excessive hospital re-admissions, and there would be bonus payments for Medicare providers to improve the quality of their health care. Pilot projects would also be funded.

“There are pilots for medical homes for primary care; there are pilots for accountable-care organizations, which certainly cover the continuum of care. But there are also pilots for bundling hospital payments,” Davis says. “I think all of those are very important for laying the groundwork for fundamental payment reform.”

Arkansas House Democrat Vic Snyder, who is also a physician, believes the fee-for-service model is unsustainable. But, he says he has hopes for the health care legislation before Congress, which he calls a work in progress.

“Whatever the final version is,” Snyder says, “we’ll have this discussion maybe after the president’s ink is drying on the document. Then we’ll say, ‘Well, was it a little nudge? A big nudge?’ But it will be a nudge in the direction of more efficient delivery of health care services in a way that rewards quality [and] fairly reimburses providers.”

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