Health Care Policy and Politics: Rx for Progress

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Health Care Policy and Politics Rx for Progress

• May 16, 2005
• Chris Jennings

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OUTLINE

• Why Health Care Matters
• Why Progress is So Slow
• What is the Current Health Agenda
• Why Re-engagement of Debate is Inevitable
• What Can Be Done To Increase The Chances of
  Progress

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Why Health Care Matters
Health Care Policy is a News Driver Shares of
G.M. Tumble On Issue of Health Care, New York
Times, 4/15/05 Schiavo Case Puts Face on Rising
Medical Costs, Washington Post,
3/23/05 Technique Shows Promise Against
Alzheimers, Washington Post, 4/25/05 Medicaid
Is Said to Be A Key to a Deal on Budget, New
York Times, 4/27/05 Medicare Heading For
Financial Crisis Health Program Deemed Worse Off
Than Social Security, WebMD Medical News,
3/23/05 Seniors Face Medicare Premiums Jump,
CNN.com, 3/31/05 Medicare Rx Plan Tough Pill
for Ohio, Cincinnati Enquirer, 2/13/05
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Why Progress Is So Slow

• General Political Polarization
• Redistricting has made for too many safe seats
• Parties particularly Republican Party have
  moved to the extreme and the center has moved to
  the right
• 80s and early 90s very different from today in
  terms of comity and bipartisanship
• No party has substantial majority
• 24-hour news cycle and multiple cable outlets
• Venomous talk radio

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Why Progress Is So Slow

• Conflicting Ideological Visions

• Republican Vision
• Ownership Society
• Individual insurance market
• Capping federal and employer contribution
• Skin in the game
• Less regulation, more choices

• Democratic Vision
• Shared responsibility
• Group insurance
• Limiting cost through pooling catastrophic
  expenditures and other cost containment policies
• Evidence-based benefit packages and consumer
  protections

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Why Progress Is So Slow
Competing Interests Of Outside Stakeholders

• Providers
• Hospitals, nursing homes, home health care
  agencies
• Physicians, psychiatrists
• Nurses, social workers, pharmacists, and other
  allied health professionals
• Pharmaceutical and device manufacturers

• Purchasers
• Consumers
• Federal, state, and local government
• Self-insured businesses and labor unions
• Traditional insurance, HMOs, PPOs

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What Is The Current Health Agenda
Presidential Priorities

• Top Tier
• Terrorism/Iraq stabilization
• Social Security reform
• Tax reform simplification and permanent tax cut
• Down-payment on deficit reduction
• Second Tier
• Tort reform
• Energy reform ANWR
• Welfare and Immigration reform
• Health reform initiatives

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What Is The Current Health Agenda

• Bush/Republican Health Agenda
• Implementing Medicare Modernization Act
• Medical malpractice reform
• Association Health Plans
• Health Savings Accounts
• Medicaid-CHIP reform / deficit reduction
• Individual tax credits

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What Is The Current Health Agenda

• Democratic Health Agenda
• Bifurcated response because there is no clear
  leader
• Oriented to define Republican vision as capping
  and shifting costs and/or wasting limited
  resources on policies that ignore real problems
• Policies with greatest consensus include
• Public/Private partnerships building on CHIP
  success and allowing access into Federal
  Employees Health Benefit Plan
• Targeted coverage expansions for children,
  55-65 year olds, workers in between jobs, etc
• Pooling, subsidizing, and managing catastrophic
  cost
• Modernizing health care system and making it
  more accountable through new technology, quality
  standards, and comparative effectiveness research
• Difficult to breakthrough to public because
  press gives little attention to Democratic agenda
  (because they are out of power)

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Why Re-engagement Of DebateIs Inevitable

• Health Costs are the Number 1 Concern of
  Americans (49). More Than
• Their income not keeping pace with inflation
  (46)
• Missing their rent or mortgage payments (29)
• Losing their job (23)
• Being a victim of a terrorist attack (19)
• Source Kaiser Family Foundation Health Poll
  Report survey (March 31-April 3, 2005)

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Uninsured Problem Is Growing

• Uninsured rose by 5.2 million between 2000-03
• Problem expanding
• Affecting workers in large firms, people with
  higher income, education
• States are cutting back on public coverage
• Medicaid enrollment increased by 6 million
• Yet, 1 to 2 million low-income people may lose
  Medicaid due to continued state budget stress

Sources Census Bureau. Projection for 2013 from
Gilmer Kronick,Its the Premiums, Stupid
Projections of the Uninsured Through 2013,
Health Affairs April 2005.
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Satisfaction Declining
Sources McInturf and Greenberg January 2004 for
the AHA
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Health Care Premiums Taking A Larger Bite Out Of
Income
Percent of income dedicated to average
family health care premiums (9,950)
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93
Median Household Income (58,000)
Minimum Wage Income (10,080)
Source Kaiser/HRET Health Benefits Survey, 2004,
Census Bureau, 2004
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Growing Recognition By Purchasers That Unrivaled
Investment Yields Poor Return
2001 cost per capita
Average ranking on 16 key health indicators
12th
3rd
13th
1st
Average Life Expectancy (yrs)
77
79
78
81
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Why Re-engagement Of DebateIs Inevitable

• General Motors Can No Longer Be Competitive
• Largest private purchaser of health care in US
• 1.1 million employees, retirees, and dependents
• Over 5.2 billion spent on health care over
  1.7 billion on Rx drugs
• GMs health care expenses cost over 1,500 per
  vehicle more than twice as much as their
  foreign competitors

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What Can Be Done To Increase The Chances Of
Progress

• Develop and Implement a Strategy that puts Health
  Care Reform at Forefront of National Debate
• Develop a message that defines the challenge as a
  crisis that can and must be solved
• Underscore that policy prescription can be
  achieved without substantial disruption
• Ensure the message plays to the insured as well
  as the uninsured
• Message must have a messenger who is a credible,
  trustworthy leader (preferably a president)

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What Can Be Done To Increase The Chances Of
Progress

• Develop and Implement a Strategy that puts Health
  Care Reform at Forefront of National Debate
  (cont)
• Religious and moral underpinning of this issue
  must be underscored
• Make it an economic necessity not just a moral
  imperative
• Design policy to be more oriented to principles
  and practical marketing than explicit details
• Nonetheless, ensure that policy back-up is
  viable, defensible, and can withstand scrutiny

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What Can Be Done To Increase The Chances Of
Progress

• Develop and Implement a Strategy that puts Health
  Care Reform at Forefront of National Debate
  (cont)
• Conduct outreach to validators who are likely
  to be consulted by media
• Engage and invest broadly based group of
  stakeholders to support, with particular focus on
  strange bedfellows (like the business and
  religious communities)
• Recognize that window of opportunity is short and
  that process and political support for policy
  cannot be sustained over extended period

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What Can Be Done To Increase The Chances Of
Progress

• Develop and Implement a Strategy that puts Health
  Care Reform at Forefront of National Debate
  (cont)
• Clearly demonstrate how policy can help real
  and sympathetic Americans in need
• Be honest about financial/administrative
  trade-offs to sufficient degree to not be
  vulnerable to inevitable attacks from opponents
• Recognize that timing and good luck are necessary
  pre-conditions for success

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Conclusion

• Why I Remain Motivated and Optimistic
• Advice from John Glenn about seizing the
  opportunity
• Admonition from Winston Churchill about Americans