Missing in action: The National Coalition on Health Care

Browsing through some 2007 entries in Bob Laszewski’s Healthcare Policy and Marketplace Review blog recently, I came across Bob’s rave review for a health care reform proposal from the National Coalition on Health Care.

The National Coalition, for anyone unfamiliar with the organization, is (or ought to be) a health care reform powerhouse. Members of the Coalition listed on its website include the AARP, General Electric, Duke Energy, UnitedHealth, the AFL-CIO, Michigan Blue Cross Blue Shield, the American College of Surgeons, the California Public Retirement System, the Episcopal Church, and the Salvation Army—a remarkable cross-section of business, health care, and social and community organizations.

Individual supporters listed include such BIG political names as former Presidents Jimmy Carter and George H. W. Bush and former Senate majority leaders Bob Dole, George Mitchell, and Tom Daschle, as well as health economics luminaries Henry Aaron, Stuart Altman, Arnold Relman, Donald Berwick, and Uwe Reinhardt. It’s hard to imagine a more impressive list, or one with more potential firepower in the battle for reform.

The Coalition was formed in 1990, just as reform was becoming one of the top items on the national political agenda. It was established as a non-profit, non-partisan organization, with—in the words of its early materials—“members united in the belief that America needs better, more affordable health care and that all Americans should have health insurance.” 

The Coalition made an effective start with a fine series of papers co-authored by the Institute for Healthcare Improvement, but even more impressive was its success in attracting to the cause of reform close to a hundred of the most powerful –and diverse—organizations in the United States.

So, now the mystery.  The Coalition reform proposal that Bob Laszewski was so enthusiastic about in 2007 was published in 2004, with a follow-up study by Ken Thorpe on potential reform costs and savings published a year later. Since then, the only Coalition publication has been a brief paper on prevention by a Rutgers researcher, useful but not exactly system-changing. Stranger still, given the powerful membership, its website lists no media references to the Coalition in the past two years.

It’s not only mysterious, it’s deeply disappointing. The 2004 paper and the2005 follow-up study could and should have provided a policy launching pad for reform. Although Bob’s description of the 2004 paper as a “reform plan” seems a little excessive, given its lack of detail (very like Tom Daschle’s “Critical,” in fact), its five Principles look just as good today as when they were published five years ago. Coverage for all, cost management designed to tie health care inflation to GDP increases, a national board to set basic benefits and care guidelines, equitable financing and elimination of cost-shifting, and simplified administration and a national IT infrastructure, all are even more desperately needed now than in 2004.

For all the value and force of the 2004 paper and its five Principles, almost all momentum seems to have been lost, and those outside the Coalition can only guess why, although explanations might include the debilitating effects of the health care wilderness years of the George W. Bush administration, the problems of getting a large and diverse group of members to back anything more specific than principles, and the shifting of the health care spotlight to party politicians’ proposals.

Can the Coalition’s efforts be revived? With the Obama administration’s reform strategy currently in some disarray and what I call the BOD (Baucus/Obama/Daschle) proposals more focused on short-term political acceptability than long-term practicality, and with reform in Massachusetts teetering on the brink of financial disaster, the need is urgent. Back in 2004, the Coalition showed that it could produce authoritative, balanced, and pragmatic recommendations. Now it needs to do so again, but this time utilizing the five Principles as the basis for a true reform plan—or at least a comprehensive analysis of alternatives.

The Coalition is not dead, and its staff continue to make occasional presentations around the country. However, as Henry Simmons, the Coalition’s President, said in a 2007 interview with the San Francisco Chronicle, “It’s not enough to just say that we ought to work on this problem.”

Roger Collier was formerly CEO of a national health care consulting firm. His experience includes the design and implementation of innovative health care programs for HMOs, health insurers, and state and federal agencies.

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  1. On Feb 27th at 2:00 PM EST we are hosting a free Webinar on the Dangers Facing Managed Care
    you can log on and sign up at bioplusrx.webex.com using passcode Care1234

  2. How timely! It’ll be interesting to see what comes of having this new leader at NCHC.
    “Health care coalition gets new CEO”
    WASHINGTON (AP) — Ralph Neas made his mark fighting conservative judicial nominations. Now he’s moved on to health care reform as the new chief executive officer of the National Coalition on Health Care.
    The coalition consists of unions, business groups, patient groups and others. Neas said his appointment marks a shift for the coalition from “think tank mode to campaign mode.”
    He said that the coalition grew markedly in recent months and that members believe the coming year marks the best opportunity since 1994 for improving the health care system.
    “Organizations inside and outside the coalition have been rejuvenated and the prospects for success are so much better now,” Neas said.
    Neas resigned 18 months ago as president of People for the American Way, a liberal organization that has fought President Bush’s conservative judicial nominations.
    The health coalition is nonpartisan and will remain that way, he said.
    National Coalition on Health Care: http://www.nchc.org

  3. I also have observed the inaction of NCHC for years and agree with Brian Klepper’s analysis of why that is and what might make sense to do differently, he says::
    “..I’ve come to believe that a coalition of non-health care business interests, unsullied by the self-interested motives of the health care industry, probably has the best shot at overwhelming the opposition mounted by the health care lobby and getting through changes that can actually drive down cost while improving quality.”
    There are 2 national health reform coalitions with the composition that Brian recommends that have formed over the past year or so, and in case readers aren’t familiar with them here are the links:
    http://www.guaranteedhealthcare4all.org for single-payer reform
    http://healthcareforamericanow.org for public insurance option reform, the “Obama Plan”
    On the state level, the Massachusetts law that mandates purchase of private insurance (while lacking any serious cost controls) has indeed been teetering on the brink of financial disaster since it was signed by Mitt Romney in April 2006. In fact, one could argue that the mandate law is contributing to the disasters being experienced at a number of human service programs that have experienced severe cuts in public funds over the past year. I’m a nurse in MA who works in the inner city and I also happen to have children in the public schools. Public health programs are being slashed, mental health programs too, and statewide public schools are now facing average 10% budget cuts due to Massachusetts’ $2Bil budget shortfall–all while the state continues to spend close to $1Bil in new public money to subsidize purchase of private insurance policies (of questionable quality) under the individual mandate insurance law.
    Final thought: Follow the money trail when you hear anyone sing the praises of the Massachusetts mandatory insurance law…. e.g. Mr Rosman’s employer “Health Care For All MA” receives large amounts of funding from insurance company Blue Cross and Blue Shield of Massachusetts.

  4. It should be noted that Mr. Rosman is the Propaganda Minister–umm–Research Director, for Health Care For All of MA. He is an incessant cheerleader for the disasterous Massachusetts plan and thus, can not be taken seriously. Mr. Rosman, trust me the mandate backlash is coming and coming hard…

  5. Mr. Collier, you write “and with reform in Massachusetts teetering on the brink of financial disaster…”
    I don’t know any basis for claiming this. The health reform plan in Massachusetts continues to progress, with strong support from political leadership and the public. There’s no financial disaster on the horizon, as far as anyone here can see.
    Despite a massive drop in state revenue, Governor Patrick’s budget for FY 2010 continues full funding for all health reform programs. No cuts are being made to eligibility or benefits. No waiting lists are proposed for any program. The budget does assume no increases in Medicaid provider rates, which is hitting hard at safety net providers. The Cambridge Health Alliance, the second largest safety net provider, came to a restructuring agreement with the state that will result in the closing of some capacity. But none of this is striking at the core health reform program.
    Enrollment has stabilized in Commonwealth Care, with no significant increases in enrollment since last fall. Charity care spending continues to decline. The federal funding was secured in a deal signed in late December.
    We keep waiting for the backlash against the individual mandate, and nothing has materialized. When we talk to company benefits managers, they all say that people are aware and accepting of the mandate and are signing up for coverage to avoid the penalties.
    The Connector is reviewing bids for next year’s Commonwealth Care managed care providers. They are anticipating no more than a 2% increase in average price. They’ve restructured the risk sharing and the auto assignment protocols that will result in a tighter clustering of the bids from the MCOs. The Connector also announced that average Commonwealth Choice premiums will increase by only 5% next year. Yesterday they debated whether the affordability schedule should increase by 2% or 5% – hardly financial disaster territory.
    So what evidence of looming financial disaster do you see?

  6. Reform efforts have simply been too fragmented (like the system itself). The concept of bringing the stakeholder groups together makes perfect sense, but there needs to be a pooling of resources among all of the reform groups out there. We need to take advantage of any possible synergies if we want to make an impact.

  7. Brian
    You keep referring to NBCH in your comments. NBCH is the National Business Coalition on Health, a coalition of coalitions headed by Andy Webber. It is a doer organization.
    Having been involved in the National Coalition on Health Care in the mid-1990’s, I agree with your assessment that it couldn’t get its members to agree on anything except for the most general. It might have had very big names on the letterhead, but that was the extent of their participation. I also think that a lot of the companies that participated were there because of their own internal politics, not because they were believers.

  8. Sad but true. When I was working on national health care reform between 2000-2007 through the Center for Practical Health Reform (CPHR) – an effort that was based (gasp!) outside the Beltway – I approached the prominent VP Benefits for a Fortune 10 firm and asked for his participation. He was indignant. “Not if its anything like Simmon’s group at NBCH!” Even among its presumed supporters, NBCH managed to convey that they were uninspired and glacial in their progress.
    NBCH’s sins are worse, though, than simply squandering terrific resources that could have let them meaningfully inform and helped lead the reform process. Dr. Simmons also sometimes behaved as though he was the designated director the nation’s health care reform process, so was unreceptive to collaboration and exchange that might have moved the process along.
    In fairness, health care reform is based on seizing political opportunities that only come by every few years. That said, a mature effort recognizes that, sticks with and refines the message and the recommended solutions, and continues to build support. Unfortunately, NBCH appears to have lacked to leadership to accomplish any of these things.
    Fortunately, the nation has a wealth of expert advisors on health care reform, many of them inhabiting this site. We have an embarrassment of riches in that department. Whether they can get sphere of influence and a hearing is another matter.
    What is less certain is the wisdom of trying to have a multi-constituency, action-oriented platform like NBCH, where many member organizations vehemently oppose the promoted reforms. (As we’ve seen recently, medical and health plan groups aren’t exactly thrilled about the prospects of transparency.) I should note that we began with a similar model in CPHR, though we eventually realized that it was impossible to make this approach work.
    I’ve come to believe that a coalition of non-health care business interests, unsullied by the self-interested motives of the health care industry, probably has the best shot at overwhelming the opposition mounted by the health care lobby and getting through changes that can actually drive down cost while improving quality.
    Non-health care business will try to do that because its in their interests, but given the power of the health care lobby, it won’t be easy or pretty. And it certainly isn’t a sure thing.
    But this process will almost certainly pass by NBCH, which started out with great promise and vision, and which will probably become just another forgotten effort.