The New Health Dialogue

(We are updating this with a few comments made at the summit, and a little more explanation of how the Senate Democratic bill's approach to "across state lines" would work.)

We expected a few issues to be stressed at today's health reform summit -- among them, buying insurance across state lines and malpractice reform. We were right. We've been tweeting all morning, but here are a few thoughts and a guide to some work we've done in the past on these topics.

Across State Lines. Republicans are still pushing the idea of letting people buy insurance across state lines -- an idea we've pointed out doesn't work, at least not how they have historically constructed it. Here’s our report (and also the executive summary) published back in 2008. Our study indicates that allowing insurers to sell across state lines, in the way the Republicans have and continue to propose, would make it harder and more expensivefor many Americans to access quality health coverage. It may benefit some of the young and healthy, but it would have a devastating impact on the insurance market for everyone else (and none of us will be young and healthy forever). It would gut many of the patient protections and state rules now in place, and as President Obama put it, risk creating a '"race to the bottom."

However, the Senate bill does allow states to pool enrollees and form insurance "compacts" (check out the Kaiser side-by-side for more details) permitting the sale of insurance across state lines -- but with oversight, regulations and a mandate. As Senate Finance Committee chairman Max Baucus commented at the Blair House earlier today, "We do allow for that [across state lines]. But not exactly the way some would." Once the exchanges are up, Baucus added, people could buy insurance across state lines and benefit from competition. But there would be rules -- that strengthen patient protections. When the Senate Finance committee first developed its "states' compact" approach, Len Nichols wrote on our blog that it would ensure that insurance market rules would be uniform across state lines, "ensuring that every insurance package provides access to necessary services and protects consumers' health and financial needs."

Malpractice Reform. We believe that it's worth trying some new approaches to malpractice reform as we seek a more efficient health care system and encourage doctors to move away from the current fee for service system and adapt to new delivery system models. Properly done, addressing malpractice can also improve what is often called "the culture of safety" in medicine. Even the American Medical Association, while certainly not backing off from its support of caps on awards, has explicitly endorsed alternative models, including the "disclose and apologize" approach favored by President Obama.  Health CEOs for Health Reform addressed malpractice reform in a white paper, Realigning U.S. Health Care Incentives to Better Serve Patients and Taxpayers (p. 8), released at our event on Capitol Hill this past June:

Reform medical malpractice laws to protect providers that adhere to high-quality care standards. Patients should have the right to address medical grievances through the legal process. However, providers who follow best practice and quality standards should be protected from unwarranted legal action. We must shield providers who wholeheartedly embrace the best-identified quality and efficiency standards from legal consequences like having to participate in proceedings without merit. A high-level, federal task force on malpractice reform, appointed and staffed by the Office of the Secretary, should be given one year to propose how to: create and oversee safe harbors for clinicians following best practices and recommend changes in federal or state statutes. 

Joanne Kenen, our blog editor, published an article on the topic earlier this year in The American Prospect Online. You can find more of our observations about  malpractice reform here and here and here and here. Bottom line: my colleagues at New America -- like President Obama himself -- have argued in the past that it's time to think about creative ways of breaking the long political impasse on malpractice. Not because it's a magic bullet for health costs -- it's not, although we are in the every-billion-counts stage. Not because we favor arbitrary caps on patients that have been truly injured -- we don't. But we do think there are bipartisan alternatives that can go hand in hand with efforts to make health care more efficient, to improve (rather than impede) patient safety, care, quality -- and also, to encourage physicians to be a partner as we innovate and experiment with ways to change our health care system for the better.

Some additional information and resources to get you ready for today’s big event:

Who. Here’s the formal invitation, and there’s the guest list. And then the most up-to-date attendance list. 

When. Thursday, February 25, 2010, 10am ET

Where. The Blair House. You can watch it live here, on C-SPAN 3, or follow us on Twitter. (Also if you can't watch in real time as much as you'd like, we just heard that NPR will have a one-hour special recap at 9 pm Eastern time.)

What. Where do we even start? The President hopes to demonstrate that despite all the shouting, opponents of reform do actually share some of his goals. He would like to “create a climate that helps revive their [Democratic] legislation in Congress.” Here’s the preliminary White House Summit agenda. And here’s the President’s proposal, released Monday. The Senate bill, the House bill. A good comparison of the three. A collection of Republican health care proposals and an article about their strategy.

Bipartisanship. You’ll hear charges of secrecy and partisanship. Actually, as we've pointed out repeatedly, this bill incorporates many bipartisan ideas that have circulated in Washington for years. Read our post on the insurance mandate’s Republican roots and the original NPR story. Then, look at this graph that compares provisions in the Senate Bill, Sen. Chafee’s (R) bipartisan moderate bill (1993) and House Minority Leader John Boehner’s (R) bill.