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Leading Health Analysts Implore Congress: Don't Walk Away This Time

By John Reichard, CQ HealthBeat Editor

September 17, 2009 -- You could almost hear them groaning, "No, not again!"

A group of leading analysts and health policy advisers, many of them veterans of the failed congressional overhaul debates of yore, implored lawmakers at a press briefing Thursday not to give up on revamping the system now that the going has gotten tough politically.

And from both the left and the right, their warning to the middle class was: While you may worry about the uncertainties about changing the system, the risks of taking refuge in the status quo are much greater now than they were at critical junctures of past overhaul debates when Congress simply walked away after controversy flared.

They also sent an "open letter" to Congress saying that the "current health care system is in crisis and is not sustainable in the future." Despite the controversy over existing proposals in Congress, "the bills under consideration contain provisions that will seriously address problems in health care and must be reconciled," they declared.

Some 400 people signed the letter. "We have taken care of patients, managed large and small health care organizations, taught young students medicine and public health and conducted research on the quality of health care and ways to improve the health care system for all Americans," they said.

The group expressed alarm that a "fringe element" has hijacked the debate, in the words of Clifton Gaus, a leading health services researcher who led the predecessor agency to the Agency for Healthcare Research and Quality in the Clinton administration.

"We are extremely concerned that a small but vocal minority of people in the current debate have misstated and distorted numerous facts in an effort to scare our citizens," the letter said. "This is unconscionable and you must not be distracted from the critical task at hand."

As examples of such distortions, they said current bills do not allow the government to ration health care, will not promote or allow euthanasia, will not allow the government to deny benefits to the disabled, will not break the budget, will not take away existing insurance coverage, will not cover illegal immigrants and may slow the rate of increase in some provider payments but will not diminish benefits or access to physicians.

From the left, Princeton economist Uwe Reinhardt said in a statement released at the briefing that there's a lot at stake for the middle class in the overhaul given rising costs and rates of uninsurance.

"Total spending on health care for a typical privately insured American family is now $16,700 . . . .it will double again by 2019. Wages and salaries on the other hand are rising at less than 3 percent a year."

While President Obama in his recent speech to Congress made a strong moral case for covering the uninsured, "the middle class also must ask itself whether it can weather the brewing financial storm on its own, without the benefit of health reform," Reinhardt said.

William L. Roper, who served in the Reagan and Bush administrations in key health posts including presidential adviser, head of the Centers for Disease Control and Prevention, and head of the Medicare and Medicaid programs, agreed with Reinhardt.

It is "so important" to listen to Reinhardt, he told reporters. "The way things are going is a recipe for disaster," said Roper, who is now the CEO of the UNC Health Care System at the University of North Carolina. Roper said that while leading health overhaul proposals will mean lower Medicare reimbursement at his system, the financial burden of caring for uninsured patients is so crushing that Congress must act "this year."

Brandeis University economist Stuart Altman recalled his three year stint advising President Nixon on health policy. The media at the time predicted a health overhaul was inevitable. "Everybody was for it"—but in the end Congress walked away. Then in the early 1990s, Congress "just punted" again.

The number of uninsured has risen from 14 million in the Nixon years to 50 million now and health spending has jumped from $70 billion then to over $2 trillion now. What scares him as he looks at the latest debate is that it would be so easy for lawmakers to walk away again, Altman said but the big loser would be the middle class.

"They think they're fine" if Congress bails, but "they're not fine," he warned.

Chip Kahn, a key health adviser to congressional Republicans in the 1980s and 1990s who helped defeat the Clinton plan as an insurance lobbyist, said he has a simple message. "Good intentions just won't do it." Congress has to be willing to come up with the money needed to move to universal coverage, he said. "It's just got to get done.

"Unless we make the effort to get there, I just don't think we're going to make progress on all these issues" including bending the cost curve, Kahn said. Coverage is needed to bring Americans into a system of coordinated care, he said. Kahn now heads the Federation of American Hospitals and has been a consistent advocate of wider insurance coverage throughout the current debate.

"We are pushing back to say that it is the status quo that we can't afford," said Judy Feder, a former adviser to President Clinton who is now a Georgetown University professor who has run unsuccessfully twice for the House as a Democrat.

Members of Congress may think the safe thing to do politically is to walk away again from an overhaul but Feder said, "I'm here to say it will cost them." She predicted they will lose their seat if they block an overhaul. "They won't be coming back," she said.

The analysts found fault with existing Democratic proposals but said they could be refined. Altman for example voiced concern about subsidy levels in the overhaul plan proposed by Senate Finance Committee Chairman Max Baucus, D-Mont. But he expressed cautious optimism that the plan would serve as the basis of successful overhaul legislation. Kahn said that the leadership of Baucus will become evident as he begins a markup next week of his legislation.

Khan predicted that Baucus will "pull off the miraculous and get a bill."

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