Obama Kicks Off Efforts to Reform Health Care

President Obama tried to kick-start those efforts today with a health care summit at the White House. More than 150 leaders from Congress, business, medicine, and consumer groups were there. He told them the status quo was no longer acceptable.

Here is some of what he said:

U.S. PRESIDENT BARACK OBAMA: We're here today to discuss one of the greatest threats not just to the well-being of our families and the prosperity of our businesses, but to the very foundation of our economy, and that's the exploding costs of health care in America today.

In the last eight years, premiums have grown four times faster than wages. An additional 9 million Americans have joined the ranks of the uninsured. The cost of health care now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes.

Even for folks who are weathering this economic storm and have health care right now, all it takes is one stroke of bad luck, an accident or an illness, a divorce, a lost job, to become one of the nearly 46 million uninsured or the millions who have health care but really can't afford what they've got.

Let me be clear: The same soaring costs that are straining families' budgets are sinking our businesses and eating up our government's budget, too. The call for reform is coming from the bottom up and from all across the spectrum, from doctors, from nurses, from patients, from unions, from businesses, from hospitals, health-care providers, community groups.

This time, there is no debate about whether all Americans should have quality, affordable health care. The only question is, how? And the purpose of this forum is to start answering that question, to determine how we lower costs for everyone, improve quality for everyone, and expand coverage to all Americans.

And our goal will be to enact comprehensive health care reform by the end of this year. In this effort, every voice has to be heard, every idea must be considered, every option must be on the table. There should be no sacred cows.

A growing consensus on reform

JEFFREY BROWN: And for that, we have our own mini-summit with three people who took part in today's gathering, representing consumers, doctors and business.

Ron Pollack is the executive director of Families USA, a consumer advocacy group. Dr. Nancy Nielsen is the president of the American Medical Association. And Helen Darling is the president of the National Business Group on Health, which represents more than 300 large companies.

Well, Ron Pollack, first, help the rest of us understand where we're at today. How much actual consensus is there now on what can and cannot be accomplished?

RON POLLACK, Families USA: I think there is a growing consensus. What's totally different from what we experienced in 1993, 1994, and other past failed attempts is that the various stakeholder organizations, whether they're doctors or nurses or hospitals or the business community, we're all actually trying to sit together to find common ground.

And I think there's a better chance of passing health care reform this time than ever before. The president clearly wants it. All of the committee chairs have said this is their top priority. The stakeholder organizations are trying to cooperate with one another and are doing so, so far.

So I think we've got a real shot of getting health reform done this year.

JEFFREY BROWN: Helen Darling, I mean, we heard the president, and interestingly, several times he said, "This time," "this time," clearly contrasting to 1993 and other times. What do you think?

HELEN DARLING, National Business Group on Health: Well, I think, with his leadership and with the collaboration of the political leaders -- because it's all about leadership at this point, and which isn't to say there are not a lot of complicated problems that need to be solved, but there is consensus in some big areas, including that there has to be adequate, affordable coverage for all Americans, and there's agreement on that.

And I think there was probably less agreement before, even though people thought they believed that, but there is a commitment this time around that I don't remember seeing before.

There's also, just in one final point, is the emphasis on having to control costs was not there before, and that's completely different. And I think that's something that everybody understands. We don't really have a choice anymore.

JEFFREY BROWN: Do you agree with that, especially on the emphasis on cost, Dr. Nielsen?

NANCY NIELSEN, president, American Medical Association: Yes, I think so, because we do spend a great deal in this country compared to what is spent in other countries, and so there's no question that we need better value for the health care dollar.

I want to add just one thing, Jeff, to what is different this time, and that is, with people losing their jobs in droves and therefore losing their health insurance, the status quo is simply not acceptable. So it's both the cost issue and the number of people without insurance that is going to drive this to a conclusion.

Priced out of the health care system

NANCY NIELSEN: It makes much more tension for change, that's true, but it doesn't make it impossible. In fact, controlling the health care costs and getting better value for those dollars is going to actually be the key to improving our economy. And the president has said that, and there is great agreement about that.

JEFFREY BROWN: So if there -- I mean, if everyone agrees that the system doesn't work and that we're at a moment when something could happen, what are the tough choices that have to be made? When you look, Ron Pollack, at the situation, the things that you've wanted for many years, particularly access, greater access, what kind of tough choices are going to have to be made to provide that?

RON POLLACK: Just one point about that, access. We just issued a report that showed, in the last two years, there were 86.7 million people who didn't have health coverage for some portion of that two-year period.

So the key issue, I think, that's going to confront the Congress is whether there's going to be an up-front, early investment to try to make sure that the subsidies that are needed to make health coverage affordable will be provided.

We've got so many people who today are just priced out of the health care system. And so the president has made a significant investment. He's put up $634 billion over 10 years, fully paid for, but he's also made clear it was a down payment.

And I think that's going to be the toughest thing, because if you don't get that upfront investment, then you won't have the subsidies and people still will not be able to afford health care coverage.

JEFFREY BROWN: Right, but he put up the $600 billion in this blueprint. And then right away experts, many experts said, well, that's only about half of what it would cost to do what he wants to do. So where do you see the tough choices to get there?

HELEN DARLING: Well, I think one thing is someone will have to decide, and it's not clear who that will be, is whether or not the package of coverage that is going to be offered and paid -- and have to be paid for is going to be very rich or it's going to be adequate and good, but not totally comprehensive.

And the hardest decision, particularly for the people who want universal coverage, is to say, "We may not immediately be able to afford everything for everybody, you know, the first year out."

Because the packages right now in the United States, unless somebody is going to give us some income -- and there's not a lot of evidence that anybody wants to do that -- is it costs a family about $15,000, is a comprehensive package of coverage in this country right now.

But coming up with that for families and to finance that, particularly all the ones who will need subsidies, especially now, is going to be very hard.

Helping doctors save costs

NANCY NIELSEN: Well, we certainly feel the pain of our patients. We know what happens when patients don't have health insurance. So it is really a moral imperative, as the president said, that we get to covering everyone.

But the issue is, is about value. What is it that we're getting for those dollars that we're spending? And this is, frankly, a shared responsibility. And that was actually addressed a little bit in the final session, but not enough yet.

Every one of the stakeholders in all of this enterprise is going to have to be able to come to grips with, "Let's look at how we can do things more efficiently."

JEFFREY BROWN: Can I ask you, though, to be specific in the case of doctors?

NANCY NIELSEN: Sure. Sure.

JEFFREY BROWN: I mean, is there a specific savings that you could offer to us?

NANCY NIELSEN: Absolutely. Absolutely. First of all, we've seen a jump-start on that in the stimulus package, with the promise of helping doctors have health information technology that will allow us to be more efficient. It's not efficient to not have a laboratory value or a chest x-ray and have to do it again.

It costs money. It's not good for patients. It's not good for anyone. So health information technology will enable us to do things better.

But what I want to also throw in here is it is a shared responsibility. And when you look at the costs, 75 percent of the costs are due to a few chronic conditions. If we can really invest in prevention and wellness as a society, then we're going to prevent those very costly conditions that emanate from obesity and diabetes and cancers due to smoking and that sort of thing.

Balancing several key priorities

RON POLLACK: I don't think you really can trade those things off. We clearly would like to make sure, as the president said, that everyone has access to high-quality, affordable health care.

But as you expand access, if you don't deal with cost, that's going to be a pyrrhic victory, because over time individuals, families will not be able to afford the coverage, businesses will no longer feel that they can provide coverage to their workers, and so you've got to do both things at the same time.

That's different from what happened in 1993, 1994. I think the public perceived the debate in 1993, 1994 to only be about coverage, as important as that is. But we have to combine coverage with cost. And when we deal with costs, we have to make sure that we improve quality. And I think those are not incompatible.

JEFFREY BROWN: Do you think all three are possible, and particularly, again, at a time of economic crisis, when there's not a lot of money out there?

HELEN DARLING: Well, I would say, again, we have to do all three simultaneously. And in some important ways, there are opportunities on the quality and safety side, as Dr. Nielsen talked about, in health information technology.

We can get much better care for people with health information technology. We can also improve, reduce errors and safety problems in hospitals, health-care-acquired infections, those are things that cost a lot of money. They drive up costs of health care right now. And if we can improve the record in those areas, we can have safety, quality, reduced costs, and better access.

JEFFREY BROWN: OK, I note that Orrin Hatch today, he said that bringing you all together -- for the president to bring you all together was probably the easy part. And he said, "There will be some broken pottery soon enough in this process." Do we all agree on that?

RON POLLACK: There are going to be some issues. I mean, you even saw when the president put on the table the $634 billion, one group raised an issue there, another group -- but I think we're together to try and make this happen at the end of the day.

JEFFREY BROWN: OK, thanks very much, Ron Pollack, Nancy Nielsen, and Helen Darling. Thank you, all three.