President Obama has made health-care reform one of his top domestic priorities. The reasons are clear. The US spends 17% of its gross domestic product on health care, far more than any other country. In spite of this, we rank low on health measures such as infant mortality. About 47 million US citizens don't have any health insurance. They can't access low-cost preventive care, and instead end up receiving expensive care through overcrowded emergency rooms. Physicians and hospitals face confusing, intricate payment rules from insurers, while US manufacturers, burdened by substantial health-care costs, compete against manufacturers in other countries who don't pay for health care.
Because of this, there seems to be a general consensus that significant change is needed. Major players who opposed reform in the past are now signaling that they are ready for change.
The stakes are high for every one of us, says Jessie Gruman, PhD, president of the Center for the Advancement of Health, Washington, DC. "Essentially this debate is about whether having a bad diagnosis like cancer bankrupts your family, whether people have to choose between feeding their kids and getting health care, whether being sick and losing your job means you also lose your health care. This is what's on the table. That's why it's vital."
The US Legislative Process
Unlike Clinton in his failed health-care reform efforts of 1993, Obama hasn't taken a major role in drafting specific proposals. Instead, he has set forth general principles, and called on Congress to draft appropriate legislation. His guiding principles state that comprehensive health reform should:
- reduce long-term growth of health-care costs for businesses and government;
- protect families from bankruptcy or debt because of health-care costs;
- guarantee choice of doctors and health plans;
- invest in prevention and wellness;
- improve patient safety and quality of care;
- assure affordable, quality health coverage for all Americans;
- maintain coverage when people change or lose their jobs;
- end barriers to coverage for people with pre-existing medical conditions.
Over the past several months, we've seen various efforts to spark a national conversation about health-care reform. During the presidential transition period, more than 3,200 community-based meetings were held to discuss health-care needs and options. In March, Obama called a White House summit meeting of major players to discuss health-care reform. (For reports on these initiatives, see http://www.healthreform.gov. Editor's note: Link no longer working.)
Now the Senate Finance Committee, led by Max Baucus (D-MT), is playing a leading role in drafting health-care legislation. At the end of April, it released a 52-page report on reform policy options. The Senate Committee on Health, Education, Labor and Pensions (HELP), chaired by Senator Ted Kennedy (D-MA), will also play a significant role. Kennedy has asked Senator Tom Harkin (D-IA) to lead a working group on prevention and public health, while Senator Barbara Mikulski (D-MD) leads a working group on quality improvements.
Access to Health Care … What Kind of Care?
Observers agree that current reform efforts focus on increasing access to care and cutting costs. However, Obama's list of guiding principles also emphasizes investments in prevention, wellness, patient safety, and quality of care.
"Access is really important, and we need to address it," says Janet Kahn, PhD, executive director of the Integrated Healthcare Policy Consortium (IHPC). "The question is, with what are we going to address it? We're giving them access to what? It is far too soon to give up on a more comprehensive approach to health-care reform." IHPC is a broad coalition working for safe, high-quality, integrated health care, including access to a full range of conventional, complementary, and alternative health-care professionals, collaborating with one another on behalf of patient health.
As legislation emerges, IHPC will post information on its website and ask readers to support specific aspects of the bill. "There is a movement under way requesting an office within either the White House or HHS [Health & Human Services] devoted to wellness, health promotion, and integrated health care," Kahn says. "In addition, we want support for efforts to have federal health care programs deal even-handedly with qualified, regulated health professions such as chiropractors, naturopathic physicians, and Traditional Chinese Medicine practitioners."
 Another key issue for Townsend Letter readers will be the definition of "qualified coverage," says Kathleen Stoll, deputy executive director of Families USA, Washington DC. "This legislation is likely to include a mechanism to decide what sort of care qualifies for coverage. This would be particularly important for people who want to access chiropractors and other practitioners." Families USA has set up a comprehensive website called Stand Up For Healthcare, where it will post information about legislative proposals as it becomes available. "People can get e-mail alerts there to give them a window into what's really happening in Washington, and let them know the best time to contact their representatives," Stoll says.
Can We Repeal Altman's Law?
Stuart H. Altman, PhD, professor of national health policy at Brandeis University, has observed and participated in US health-care reform efforts over many years. "I have reluctantly developed what I now call Altman's Law," he told Congress. "Almost every American advocacy group supports some form of universal health insurance. But if it's not their preferred version, their second best alternative is to maintain the status quo." That's the reason, he says, that even though the vast majority of Americans believe we should have universal insurance, "we can't seem to make it happen."
Over the next few months, can we overcome the enormous inertia of the status quo? Everyone agrees that the current system isn't working … but can we generate majority support for an alternative?
A substantial proportion of Obama supporters are deeply committed to a single-payer health-care option (similar to Canada's system). Online discussion groups and websites buzz with support for various versions of single-payer.
During the campaign, Obama said he'd support single-payer health care if we were creating a brand-new health-care system from scratch. However, given the legacy systems already in place, he said, "we may need a system that's not so disruptive that people feel like suddenly what they've known for most of their lives is thrown by the wayside."
Passing health-care reform will require support from conservative Democrats, notes Stoll. "As long as we have the current makeup of Congress, that makes single-payer impossible. If we want health-care reform to happen this year, we have to deal with the Congress we have before us."
Nevertheless, Stoll observes that single-payer advocates play a valuable role in the ongoing discussion. "There's a significant benefit from people saying they support single-payer. It's important not to let a centrist position become defined as the left, because then the center moves to the right," she says. "However, it's also important not to draw firm lines in the sand. There is room for very positive, significant health-care reform even with the current Congress."
How You Can Make Your Voice Heard
At about the time this issue of the Townsend Letter reaches newsstands, some version of reform legislation will come out of committee, and the national debate will move into high gear.
The US legislative process is time-consuming and intricate – a marathon, not a sprint. If both House and Senate pass reform legislation, there will be differences between the two bills. Then a conference committee, with members from both House and Senate, will come up with a final version that combines aspects of both bills. This version must be passed again by both House and Senate to become law.
If you want your voice to be heard during this critical period of discussion, debate, and decision:
- Follow the current debate through web sites and newspaper articles.
- Write letters to local papers.
- Call local talk radio shows.
- Write letters and call your congressional representatives.
- If your representatives are on the key committees dealing with health-care reform, then make a special effort to stay in touch with their thinking and let them know what matters most to you.
The most important thing is to contact your own representatives, says Gruman. "Our elective representatives respond to us, and they don't respond to people who don't live in their district or their state. That's what electoral politics means."
However, Stoll has a more expansive viewpoint. "It is always powerful to be a constituent and let your member know what you think. Eventually there will be a floor debate, and every Senator and member of the House is going to count," she says. "I think it's also important to keep an eye out for key committee members such as the Senate Finance Committee, and make your voice heard with those major players."
In addition to letters, e-mails and phone calls to your representatives in Congress, consider making the extra effort to talk with them face to face. They all set up meetings back in the district to talk with their constituents. It may be a breakfast at the local diner, or an afternoon meeting at the library or the county building. When you take the time to go to those meetings, you can have a significant impact on their thinking about health-care reform, because you live in their district, and you vote. Go up to them, shake their hands, and tell them what matters most to you.
Is it possible to repeal Altman's law? "We cannot let our second choice in health-care reform remain the status quo," Stoll says. "We must not lose this window of opportunity. Next year election politics will kick in, and budget deficit politics will become even more strident. Here's the key: if we don't do it this year, it will be another ten or twenty years before we have another opportunity like this one."
Elaine Zablocki is the former editor of CHRF News Files.
Resources
http://www.healthreform.gov (Editor's note: Link no longer working.)
This site, maintained by US Department of Health & Human Services, has a wealth of materials, including links to reports from community meetings during the transition, and the White House Forum on Health Reform. It is updated weekly.
Center for Advancing Health: www.cfah.org
Integrated Healthcare Policy Consortium: http://ihpc.info
Families USA
http://standupforhealthcare.org
http://www.familiesusa.org
To Write or Call Your Congressional Representatives
For the House, go to: https://writerep.house.gov/writerep/welcome.shtml.
For the Senate, go to: http://www.senate.gov/general/contact_information/senators_cfm.cfm.
These sites offer mailing addresses and phone numbers. In addition, if you follow the links to your representative's website, there will be a link to send an email message; look for the "Contact Me" button.
The Senate Finance Committee is taking a leading role in drafting reform legislation. Go to: http://finance.senate.gov/healthreform2009/home.html.
For the Senate Committee on Health, Education, Labor, and Pensions (HELP) go to: http://help.senate.gov.
Complete videos of HELP committee hearings are available online. For the February 23 committee hearing on "Principles of Integrative Health: A Path to Health Care Reform," go to: http://help.senate.gov/Hearings/2009_02_23/2009_02_23.html.
For the February 26 committee hearing on "Integrative Care: A Pathway to a Healthier Nation," go to: http://help.senate.gov/Hearings/2009_02_26/2009_02_26.html.
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