President Obama remains committed to comprehensive health care reform in 2009 and believes the declining economy emphasizes its urgency, a top White House official told hundreds of health policy experts Monday in Washington D.C.
“The current economic crisis has really highlighted the problems and put them under fluorescent lights," said Jeanne Lambrew, deputy director of the newly created White House Office of Health Reform.
The Academy Health conference is probably the wonkiest of meetings on the increasingly crowded health reform conference circuit. University PhDs and private sector policy analysts are here to discuss and assess the impacts of reform.
Lambrew provided a glimpse of the President's health agenda in the economic stimulus package, SCHIP and long-term reform efforts. She rapidly reviewed the litany of well-known health care problems: costs, access and quality, and then spoke specifically about health care funding in the stimulus bills working their way through the House of Representatives and the Senate.
About one in five dollars of the stimulus package will go toward health care, nearly matching the one in five dollars of GDP spent on health care.
As previously reported, the roughly $150 billion in proposed funding can be broken into three main categories:
- Immediate expansions to protect people who are losing their jobs from also losing their health insurance by increasing federal Medicaid match, subsidizing COBRA premiums, and allowing the newly unemployed temporarily to buy into state Medicaid coverage.
- "Downpayments" on longer-term reforms and job creation efforts in information technology, comparative effectiveness research, and health workforce expansion grants.
- Funding for health prevention services, such as tobacco and obesity prevention programs.
As for long-term reform, Lambrew reiterated Obama's commitment to offering people the option of buying into a public plan. She left it open as to whether this would be a Medicare-like single-payer plan or something more like the options currently offered to federal employees.
This aspect of the reform has already drawn the most criticism and raised alarm among conservatives, who consider it a step toward government-controlled insurance. Lambrew, however said that Obama believes in choice.
"If we really do believe in competition, why not give the public plan a chance?" she said.
The business perspective on reform
Peter Lee, the Pacific Business Group on Health's director for national health policy, emphasized employer's desire to move toward a performance-based, high value health care system.
To him, that means greater transparency on costs and quality, comparative effectiveness research, comparative information on clinician performance, payment reform, health system transformation and emphasis on prevention and wellness. That's a tall order, but his bottom line was that health costs are hampering American businesses' ability to compete globally and the value for money spent is far from optimal.
A good starting place, Lee said, is ensuring that everyone has health insurance coverage. Safeway CEO Steve Burd echoed that. Having 47 million uninsured people, he said, is a great inefficiency borne primarily by the employers who provide health coverage.
Moving away from a fee-for-service payment system is a must, as is balancing the board of physicians who advice Medicare on reimbursement, Lee said. Currently, it's dominated by physician specialists whose preference for technical interventions over primary care services is obvious in the current payment system, he said. Lee wants payers to be part of that decision making process.
Comparative effectiveness research on the horizon
The afternoon conversation moved to whether costs should be part of comparative effectiveness research. The payers want costs included. The pharmaceutical and device industries don't.
"To have comparative effectiveness research not used and to not consider costs is irresponsible from a patient’s and an employer’s point of view," Lee said.
Kathy Buto, vice president for health policy and government affairs at Johnson & Johnson, said the idea of having a centralized government agency doing comparative effectiveness research and including costs is scary.
“Cost-effectiveness analysis is used by countries to limit coverage of treatments – and is a poison pill,” she said.
Lambrew spoke briefly this morning about the $1.1 billion in the stimulus bill to fund comparative effectiveness research. She said lawmakers from both sides of the aisle recognize the need for better evidence to guide health decisions and there is strong bipartisan support to fund this research.
The legislation would allow for gathering information on costs but prohibit Medicare from using it to determine coverage. At this point, she said, the goal is to create legislation that allows for the maximum amount of flexibility in design and scope of the research.
Mark Gibson, of the Center for Evidence-based Policy at Oregon Health and Science University, spoke about how states are already using comparative and cost-effective research to make policy decisions.
He got his start in state health policy 20 years ago, during Oregon’s infamous Medicaid experiment to expand care to more people by limiting services based partly on their cost effectiveness. Gibson admitted to feeling a sense of déjà vu, particularly over the rising alarm about the prospect of rationing health care.
“At some point, we’re going to have to realize that we can’t do everything in the health care system for everyone who needs it or wants it,” he said.