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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