published Sunday, February 21st, 2010

A delicate balancing act


by Emily Bregel
Audio clip

Craig Becker

Days before the Obama administration's planned bipartisan summit aimed at kick-starting stalled health reform efforts, some proponents see dwindling prospects for passage of a comprehensive plan.

"There were such high hopes at the beginning and by gosh, it's just all gotten kind of worn away," said Dr. Jeannette Martin, a retired pediatrician in Chattanooga.

Republicans in Congress want to start over with a plan simpler than the voluminous bills adopted by the Democratic-controlled Congress. The legislation stalled over different provisions between the House of Representatives and the Senate.

  • photo
    Staff Photo Illustration by Tracey Trumbull/Chattanooga Times Free Press Health care reform photo illustration

"There are ways to find common ground, and I think we ought to do it step by step," said U.S. Sen. Johnny Isakson, R-Ga. "You get it better by building blocks than you do by one pervasive piece of legislation."

But some stakeholders and policy experts say a piecemeal approach to reform won't be that easy. Many proposals that have bipartisan support are predicated upon the inclusion of other reforms.

"Some of the pieces in the reform are systematically linked so that you can't just take a piece here, a piece here and pass those," said Dr. Larry Churchill, medical ethicist at the Vanderbilt University Medical Center, in an interview.

Two years after President Barack Obama campaigned on a pledge to overhaul the nation's health care system -- and after a year of wrangling in the U.S. Congress -- the House and Senate bills that remain in limbo.

The president has pitched Thursday's half-day, televised meeting as an effort to advance the debate and involve Republican lawmakers. The White House announced last week that the president will reveal his own health care proposal in advance of the summit.

URGENT PROBLEM

With health care spending hitting $2.5 trillion in 2009, the industry now makes up 17 percent of the GDP, according to a recent report from the U.S. Centers for Medicare and Medicaid Services. Rising insurance premium rates are hitting employers and those shopping on the individual market, and 45 million people don't have any health insurance.

U.S. Rep. Lincoln Davis, D-Tenn., insists the rising cost of health care and the declining share of Americans with coverage requires changes in the current system.

"As health care costs consume a greater share of our families' expenses, and coverage can be dropped without reason, the need for reform is more apparent than ever," he said.

Supporters of health care reform insist some type of measure may still be salvaged. Some Republicans say they are willing to support some parts of the bills, including support for wellness and prevention efforts, electronic health records, interstate insurance exchanges and tax incentives for individuals and businesses to buy health insurance.

U.S. Rep. Phil Roe, R-Tenn., wants Obama to "sit down with Republican leaders, Democratic leaders and a blank piece of paper" and reach a new bipartisan agreement on fewer items.

AREAS OF AGREEMENT

Within both political parties, there is support for guaranteeing health coverage for people with pre-existing conditions. Insurance companies even signed on to the idea, so long as it is accompanied by a mandate that individuals purchase insurance. Otherwise, insurers complain, Americans would wait until they got sick to get insured.

John Sorrow, president of the Mid-South Region for Cigna Healthcare, which has more than 2,000 employees in Chattanooga, said the company is concerned that "requiring guaranteed coverage without an individual mandate would be counterproductive."

But a mandate is still a highly contested idea, even for proponents of comprehensive health reform. For working poor and middle-class Americans to be able to afford to comply with the mandate, they'd need generous government subsidies, which might not be politically feasible right now, said Dr. Ken Ellinger, a Democrat and professor of political science at Dalton State University.

"There is not support to pass a bill that is going to subsidize Americans in the middle class," he said. "I don't see how piecemeal reform can even work. ... The piecemeal approach is really saying, 'We're not serious about health care reform at all.'"

The Tennessee state Senate last week passed a bill that would compel the state's attorney general to legally challenge any federal mandate that residents purchase health insurance. More than 30 other states have passed or are considering similar bills, the Times Free Press reported.

Other agreements worked out early in the reform process are now in question. Last summer the hospital industry made a deal with the White House to give up $155 billion in funding over 10 years to help pay for reform, based on the premise that a broad expansion of insurance coverage would drastically reduce hospitals' losses for treating patients who can't pay.

If far less than 95 percent of the public is covered under piecemeal reform efforts, those committed funds from hospitals -- which would have offset the cost of reform -- can't be counted upon, said Craig Becker, president and CEO of the Tennessee Hospital Association, the state's major advocacy and lobbying group for hospitals.

"That was the deal -- we would get coverage and we would take the cut," he said.

While Democrats' proposals have aimed to cover 30 million uninsured people, a Republican plan would cover only 3 million, the Associated Press reported.

Dr. J. Mack Worthington, a local physician, likens the way the health reform plans evolved in Congress last year to designing a house that becomes too expensive to build.

"Soon the idea of a basic shelter has evaporated into an expensive project that far exceeds your needs and likely, your budget," he said. "Health care reform should go back to the drawing board and, maintain a narrow focus of providing affordable health care for the millions that have no coverage."

REFORM IDEAS

Stakeholders are still holding out some hope that minimal reforms could get passed. Mr. Becker said at the very least, universal coverage for children should be guaranteed. He hopes for a pilot program that would pay doctors and hospitals in "bundled payments," instead of paying providers individually for each service rendered. That would encourage better efficiency and coordination in care, he said.

Bill Taylor, head of Physician Practice Resources in Chattanooga, thinks health insurance should be sold long term, similar to life insurance.

"When a baby is born its parents would choose its health care plan," he said. "That plan would be responsible for financing its care for life. Then there would be financial incentives for health promotion and disease prevention not available in most policies today."

Ron Harr, senior vice president of human resources and public affairs at BlueCross BlueShield of Tennessee, wants reforms that promote more wellness initiatives, electronic health records and payments to providers based upon their performance.

"Because they do not address the underlying cost drivers in the system, the bills raise health care costs for everyone and obscure the true, long-term financial impact," he said.

Still, Dr. Ellinger doesn't expect much out of the summit this week.

"I'm not even close to being hopeful enough that this is going to be anything other than political posturing," he said. "We're going to be visiting this again and something else will have to be done. The status quo is not an option."

Continue reading as area lawmakers respond to the health care reform

about Emily Bregel...

Health care reporter Emily Bregel has worked at the Chattanooga Times Free Press since July 2006. She previously covered banking and wrote for the Life section. Emily, a native of Baltimore, Md., earned a bachelor’s degree in American Studies from Columbia University. She received a first-place award for feature writing from the East Tennessee Society of Professional Journalists’ Golden Press Card Contest for a 2009 article about a boy with a congenital heart defect. She ...

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