Which way to go for health reform? From Birkenstocks to pom-poms

The methods proposed to clean up the health care mess in the United States that leading voices pitched to hundreds of journalists Friday unsurprisingly were as varied as their Birkenstocks and patriotic tie.

David Himmelstein, co-founder of Physicians for a National Health Program and Birkenstock-wearing Harvard Medical School professor of medicine, unrelentingly pushed a single-payer system. "We need a reform that helps the insured as well as the uninsured," he said, adding that the system should "get rid of the insurance companies that provide no added value."

At the other end of the spectrum, Tom Miller, resident fellow at the American Enterprise Institute conservative think tank, wants more tax credits to put consumers in the driver’s seat and deregulation of the individual market.

Between those two ideologies, were Karen Davis, president of The Commonwealth Fund, and Julie Barnes, deputy director of the New America Foundation‘s health policy program.

Much like a high school cheerleader pom-pomming for a victory-less football team, Barnes pitched that optimism must reign in the forthcoming debate and all stakeholders must set aside their differences and work together to find a common solution. "It can happen. It will happen, but most importantly it must happen," she said.

She also said that New America believes incremental steps won’t work and that coverage expansions, cost reduction measures and quality improvement initiatives must all be implemented together because they are "inextricably linked."

Davis reiterated the Commonwealth Fund’s principles for reform: 1) cover everyone, 2) control costs, 3) reorganize the system so people have medical homes, 4) reduce variation in quality and efficiencies, and 5) have national leadership that can bring the public and private sector together.

"A mixed public-private system is the way to go," Davis said.

When Julie Appleby, a reporter at USA Today, asked them to name the single biggest impediment to reform, their answers varied.

Himmelstein: The profits earned by commercial insurance companies and pharmaceutical companies.

Miller: That health care is over-regulated, over-subsidized, and over-politicized.

Davis: How we’re going to pay for it. Where do we find the $100 billion required?

Barnes: Getting everyone to the table to talk — and talk fast.

While their opinions on the methods of reform and coverage varied, they all agreed on one thing: The United States must reduce costs and do so by keeping people healthy and out of the doctor’s office and measuring performance, which they said will improve quality and efficiencies.

"The population has to be healthier before they get to the doctor’s office," Miller said.

Himmelstein said the current system incentivizes too much unnecessary care.

The government must be willing to use its clout to realign incentives and determine cost-effectiveness, Davis said.

There is some agreement.