The New Health Dialogue

The GOP Doctors Caucus held a "hearing" this week to review health reform, which as you know has become far more complicated than Democrats anticipated just a few short days ago. The Doc Caucus is headed by Tim Murphy (R-PA). My dad, who just happens to be a physician in Murphy's district, took part to outline the case for comprehensive reform. I tagged along.

Murphy and his fellow conservative doctors listed six policy principles for reform. The devil, as always, is in the details:

1. Give every American the choice to buy a good plan from anywhere in the country. (Unfortunately, selling health insurance across state lines will likely have some unintended negative consequences in raising costs and reducing benefits -- check out our policy paper on the subject here.)

2. Allow small businesses and individuals to purchase insurance together. Forming a large group will give them more purchasing power. (This general idea has had bipartisan support for years. How to create such a pool  -- whether in a context of consumer-friendly regulation or industry-friendly deregulation -- has to date been a huge stumbling block).

3. Give people a choice to purchase a basic plan. (We'd caution a "basic" plan must be affordable, and it has to have enough benefits to be meaningful.)

4. Fix the waste, fraud, and abuse in the health care system that drives up costs, particularly in Medicare and Medicaid. (We think pretty much everyone can agree that fraud is bad. Recently, the HHS has cracked down on fraud and abuse in Medicare and Medicaid, with HEAT, the Health Care Fraud Prevention and Enforcement Action Team.)

5. Provide low-income families who do not qualify for Medicaid with some sliding-scale assistance to buy their own insurance. (Subsidies to purchase insurance are included in health care legislation in both the House and the Senate health reform bills -- whether both parties can come to terms on how to make this happen and in what context remains to be seen.)

6. Make insurance portable, personal, and permanent. People should be allowed to take insurance with them when they change jobs, and not lose their insurance when they are ill or have a pre-existing condition. (The basic message, again, consensus. How to do it in a bipartisan way? Not so clear.)

My dad spoke in favor of comprehensive national reform -- the kind of reform we write about every day. He argued that physicians see the human side of the suffering brought on by a lack of quality health care every day. For that reason, 10 of the largest physician groups in the US are generally supportive of reform efforts.

Another panelist, American Osteopathic Association President-Elect Dr. Karen Nichols (not the Dr. Nichols we usually write about) stressed the importance of changing the way we pay for care to reward value over volume. Many medical students come to her asking advice, she said, they want to go into primary care, but can’t afford to do so and still pay back their college and med school loans. Our current system doesn’t financially reward the high quality, preventative, coordinated care that primary care physicians are in a good place to provide, and young medical professionals are financially discouraged from pursing the vital field of primary care.

The members of the House GOP Caucus, and panelist Jim Martin, President of the conservative organization 60 Plus, wanted to see a more piecemeal, market-based approach to health care reform, rather than one big bill. (We recommend you check out the excellent post by our colleague Elizabeth Carpenter on why scaling back reform isn’t as simple -- or as viable a solution -- as it seems.) Rep. Paul Broun (R-GA) mentioned his own health care bill, HR 3889, several times during the discussion. Like the Republican bill released in November last year, Broun’s bill takes a very incremental approach. The original Republican bill failed to gain traction when its CBO score indicated it would cover only three million more Americans and would reduce the deficit by about $68 billion. (Compared to the Democratic House bill, which would cover 36 million more Americans and reduce the deficit by $104 billion.)

All of the members of the Caucus were at one point practicing doctors. They’ve all been on the front lines of the health care system. In listening to them express their views, it was surprising to hear how many policy ideas both sides of the political aisle had in common -- or potentially in common if the political environment allowed it, and if the details could be negotiated in a way that would actually achieve the goals of reform. Broun asked each panelist whether or not market-based solutions could solve the health care crisis. All agreed that the market had a role --  but not necessarily all the answers.

Rep. John Fleming (R-LA) probably put it best. In health care reform, he said, we all agree on increased access to care and lower costs, we just disagree on the role of government in the health care system. Oh yeah, that itsy-bitsy problem about the role of government in our society.

Still, listening to them, I did hear some consensus on what the problems are that need our attention. Maybe, just maybe, it's the germ of at least some bipartisan solutions.