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Waxman: Public Program 'Critical' to Universal Coverage Plan

By John Reichard, CQ HealthBeat Editor

JANUARY 29, 2009 -- While other key Democrats are hinting that a health overhaul may not be accomplished this year, House Energy and Commerce Committee Chairman Henry A. Waxman isn't among them, declaring Thursday that overhaul legislation can be introduced and signed into law in 2009.

Addressing a conference sponsored by the left-leaning advocacy group Families USA, Waxman, a California Democrat, offered few details about how such complex legislation could become law so quickly. He offered no timetable for when his own committee will take up the issue, saying an announcement would come later. And he gave no ground on an overhaul element likely to stir strong opposition from many Republicans. "I believe that it's critically important that we have a public program alternative" to private insurance in a system of universal coverage he said, rejecting as a "false dichotomy" arguments that the system should be all private or all public.

Waxman described the chance to enact a health overhaul as an historic opportunity and the reason he waged his successful bid to take over the chairmanship of the committee. He called his panel the lead committee on the issue in the House and said that because of its size—59 members—and its mix of urban and rural, liberal and conservative, and veteran and new members, achieving consensus on the panel would mean "we'd be pretty close to what would be a consensus in the House and the Senate."

Waxman underscored the need to build a system of universal coverage on the existing system of employer-sponsored health insurance, as well as Medicare, Medicaid, and the State Children's Health Insurance Programs. He called the principles espoused by President Obama for a health overhaul exactly the right approach. Obama would build on the existing system, allowing those with employer coverage to keep what they have while also having the alternative of a public program of coverage.

"If we're going to succeed we've got to find common ground. We have to recognize that any successful approach has to reject the false dichotomy of everyone in a government plan, or everyone left to the mercies of a market-based approach. I believe that we must have a significant role for private insurance. But I believe that it's critically important that we have a public program alternative."

Referring to the insurance exchange proposed by Obama, Waxman said "it gives people a place to go to get good, accessible, affordable and regulated coverage through private plans or if they prefer, they can go into a public alternative. We leave the choice to them."

Some Republican aides have suggested a bipartisan deal won't be possible if Democrats insist on a public plan alternative, but Waxman said "in practical political terms, I think we have to offer those who support a single-payer plan a reasonable public plan option, even if it's not ... all that they want, just as we assure those that pay for a more private, market-based approach that there's a very large political role for them to play." Waxman added that "the better they perform it, the better they have a private system that works best, the less they need to be threatened by a public plan alternative."

"I believe that it's critically important that we have a public program alternative," Waxman said. "I think market forces will work better if there's some creative tension between the two different choices. Rather than have us pick one or the other alternative in legislation and likely continue with a gridlock of our efforts, we should put both in place letting individual families make the decisions about what coverage is best for them in their community."

Waxman said that while coverage expansion is a key element of an overhaul, so too is strengthening public health programs and building a "robust" workforce of public health professionals. "I know that if we stop kids from ever developing an addiction to cigarettes or any other tobacco products, we can improve our health and stop the needless cost of treating so many tobacco-related disabilities, diseases and early death," Waxman said. "We're going to move our FDA regulation of tobacco legislation very, very soon," Waxman said to whoops and applause from the audience.

Waxman spoke of the need for bipartisanship and of the necessity for people with different views to not scuttle the overhaul effort if they don't get their top priority in negotiations. "What we're determined to do is work to find the approach that will be broadly acceptable to the American people." Waxman said he is "sympathetic" to the idea of a mandate that individuals buy coverage, an approach that helped forge a compromise on a system of near universal coverage in Massachusetts.

"It may well be the critical component of making insurance work," he said, apparently referring to the mix of both good and bad risks that would come into the insurance pool as a result, allowing more affordable coverage for those with costly illnesses. But an effective regulatory structure is critical. "You don't want to mandate people to buy something they can't afford" and that won't serve their needs, he said.

Waxman rejected arguments that the current economic woes mean an overhaul must be postponed. "This isn't something to put off, this is something to do right now to help fix our economy" by easing the burdens of rising health costs on business and increasing the productivity of workers. He ended his remarks with a rousing call to action. "We don't intend to let delay sap the opportunity to finally enact the legislation we've waited decades for" he declared. "I must tell you, this is our time. We need to get this job accomplished this year. And get the bill to the president."

Informed after his speech of Steny H. Hoyer's, D-Md., commitment to floor action in this session of Congress rather than this year specifically, Waxman said, "I think he doesn't realize that we can move quickly."

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