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Can Tommy Thompson Do for Health Care What He Did for Welfare?

APRIL 17, 2006 -- Tommy Thompson for president? The former Department of Health and Human Services (HHS) secretary doesn't figure in the early speculation about which Republicans will run for president in 2008. But ask Thompson directly and he says he is "absolutely" considering the possibility.

Thompson said after an appearance Monday with former HHS Secretary Donna Shalala that he wants to get his ideas on health care out in front of the country and indicated that a run for the presidency is a way to do it.

Most of the speculation about Thompson's political future centers on whether he will run again for governor of Wisconsin, a post he held for 14 years before becoming HHS secretary in 2001. He's expected to make his mind up by May 15 on whether he'll run for that position; after that decision is made, Thompson said he'll decide whether to make a run for the White House.

A run by the 63-year-old Thompson at this stage of his 38-year political career might sound far-fetched given the organizational and fundraising demands. But signaling that he has wider ambitions than running for governor yet again might help him reach a wider audience on health care issues, a former aide said.

Regardless of whether Thompson ultimately decides to run for higher office, "I think he wants to try to influence policy and this is the best way to do it," the aide said.

Thompson's appearance Monday illustrated the attributes that could build the case for a White House bid—an independent streak, a pragmatic bent, an ability to form working relationships with Democrats, and an itch to tackle big social problems.

Having worked with Democrats to adopt welfare revisions in Wisconsin that helped pave the way for a national overhaul of the welfare system, Thompson displayed similar passion Monday about tackling health care. He appeared at an event in Washington, D.C., that was part of an ongoing series of forums moderated by former Louisiana Democratic Sen. John Breaux on finding common political ground on health care.

Despite skepticism on the part of Shalala that health care would decide the 2008 presidential election, Thompson insisted that health care would dominate that campaign, saying it has been a paramount concern of audiences he's talked to over the past year in delivering some 100 speeches.

Rattling off statistics about various problems with the health care system, Thompson chided Congress for failing to take on health care and took a swipe at the White House as well.

The growing uninsured population is "a real emergency" Congress isn't addressing, Thompson said, noting predictions that the size of that population will climb to 54 million in the next five or six years. According to the Census Bureau, 45.8 million U.S. residents currently do not have health insurance.

Thompson said he sought to make health care a leading priority of President Bush's second term but was rebuffed; the White House "palace guard," Thompson said sarcastically, told him Social Security would be the leading domestic priority instead.

Breaux offered the possibility that the public–private approach taken by Congress to offering Medicare prescription drug benefits might be a model for covering the uninsured and Thompson agreed.

Last week marked a "tipping point" on the Medicare drug issue, Thompson said, noting new poll findings showing that the public is warming up to the benefit and that favorable press coverage is starting to emerge as well.

Thompson said the architects of the Medicare drug law (PL 108-173) thought its provisions would work effectively if they attracted at least three private plans to deliver the benefit nationally. Instead they got 10, Thompson said, helping to bring down the costs of the benefit.

That shows a strong interest on the part of insurers in bidding for government health care business, he suggested. To cover the uninsured, each state should pool together residents without coverage and invite insurers to make bids on coverage, he said.

"The private sector really wants to bid on this," Thompson said. As a result, there would be low bids and affordable coverage, he added. Pools would have to be tied to reinsurance mechanisms limiting the losses of insurers on providing coverage, he added. A reinsurance mechanism also would help reverse the decline in the percentage of employers offering coverage, he added.

The private sector would have to be given the freedom to develop types of coverage suited to the particular groups the government is trying to cover, he said.

Thompson praised the new law in Massachusetts requiring the uninsured to obtain coverage. "I think Massachusetts is sort of the tipping point," he said. "I think other states are going to follow" the lead of Massachusetts.

Thompson called for tax credits to help the uninsured purchase insurance policies, saying the Bush administration has proposed such credits.

Shalala agreed with Thompson that an individual mandate with a statewide pool of the uninsured and subsidies to buy coverage could work. But having the statewide pool would be essential for keeping coverage affordable, she emphasized.

Neither Thompson nor Shalala thought the nation would be ready to adopt an individual mandate within the next few years. Shalala suggested that experience developed through widespread state experimentation with widening coverage could help develop a consensus leading to an eventual national solution. The federal government should encourage those state experiments, she said.

Shalala agreed with Thompson that having private plans deliver benefits is what is politically feasible, but said the jury is out on whether that approach saves money. Right now private plans cost Medicare more, not less, she said.

She warned that plans might begin dropping coverage of certain drugs over time to save money. "The test is not today—the test is two years from now," she said.

Breaux concluded the event by asking what Thompson and Shalala would do first if they could dictate how Congress addresses the health care issue. Thompson said adopting electronic medical records would be his first move. If the nation decided it wanted to have electronic health records for everyone in two years, "we could have it," Thompson said. Shalala said she would start with experiments of the kind occurring in Massachusetts but voiced concern that subsidies would harm care given to the poorest residents, including through charity care hospitals. State experiments should not come at the expense of care given to the poor, she said.

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