Health Reform Dialogue – Does and Doesn’t Achieve…..

The self-named Health Reform Dialogue of executives from 18 leading health and business organizations met for 6 months and released its report on Friday.  Consensus within this group is better than no consensus, but I’d hoped for a bit more substance in their report – which is what usually comes out of projects facilitated by the Keystone Center.

The group apparently did agree on an individual mandate to have insurance – but their inability to agree on a public plan option for all individuals reportedly led to 2 unions leaving the project before its completion. However, the report also includes some items that are so general they don’t pass the head scratching, “that’s so obvious but where are the specifics?” test.  For example, who isn’t in favor of:

  • Reduce administrative costs
  • Eliminate disparities in health
  • Help individuals improve their health

While other organizations have issued detailed studies on each of these topics, it would have been useful if the HRD’s report referenced some of these documents, or included more specific recommendations for actions under each of these generalities.

Timing of Health Reform Actions
In addition, the group apparently reached consensus that immediate action is needed.  Or as they put it, “right now, this year.”  However, as I discussed with a class at Northeastern University last week, the implementation of any new Federal program takes time.  For example, the Medicare Prescription Drug benefit took 2 years from the passage of the legislation in December 2003, to the new benefit starting in January 2006 – with some of the steps required to implement the program including:

  • Regulations Drafted and Published
  • Comment Period for Regulations
  • Regulations Revised, Finalized and Published
  • Plans Submit Applications, Proposals and Bids
    • PDPs & MA-PDPs
    • Actuarial Equivalent Benefit Structures
  • Plans Approved
  • Marketing of Individual Plans
  • Enrollment into Plans, Members Get Membership Cards, etc…

There is no reason to think that a new Federal health insurance program or mandates could be started any faster than Medicare Part D because one of the valuable “prices” we pay for our Democratic society and form of government is that public programs require public input and oversight –  which takes time.

Obama Administration’s Early Investments in Health Reform
Consistent with the reality that it takes time for new government programs to start and for health research to yield useful information, the Obama administration has wisely chosen to quickly start funding some parts of health reform that will take a long time to produce value, such as Comparative Effectiveness Research and Health IT.

These investments are like preparing architectural drawings and conducting geological analyses of the land before building a new building.  We can only hope that while these activities move forward, the Health Reform Dialogue participants can form the nucleus around which others can aggregate to achieve more detailed agreements to work with Congress and the Administration on health system improving legislation – even if what is achieved doesn’t meet everyone’s definition of “health reform.” Having worked with most of the organizations – and several of their individual representatives – I believe this is possible.

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