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appointment cards

By Arnold Birenbaum
As we approach the midterm elections and there is a strong possibility that the House and Senate will be reseated in 2007, with the Democrats in the majority in both chambers, we can attribute the change in party preference in some battleground states and Congressional districts to the voting public’s recognition that a sectarian war in Iraq has been the unintended consequence of the American-led invasion and occupation of that sad country. Americans are also learning via government studies that this foreign adventure helped attract alienated and marginalized young men from Muslim countries or Muslims from western nationals ready for jihad. A war without end is unacceptable today and it eclipses all other issues. Even concern for terrorism has dropped well down on the list of priorities. Still around as a perennial second-place issue, going back to 1993, is health care. We need to do the right thing in Iraq and we need to do the right thing at home.

For those of us who have been calling for universal health care insurance coverage for all Americans under a single-payer system similar to Medicare, the recent survey data from multiple organizational sources, show that health care is an important but secondary issue when proposed government actions are prioritized by respondents. For the past twenty years, it has been designated the problem that won’t go away. In fact, when we drill down to see what the thousands of Americans surveyed are really worried about, it is the cost of health care and concern for those without insurance.

How can health care coverage be advanced in this climate? A sharper image of what is happening to families is required. We need to demonstrate that there are people today burdened by medical debt to the point that they cannot maintain their homes, make car payments, or save for their children’s undergraduate education. We have a model for how to proceed. Prior to Medicare being signed into law (1965), Congressional hearings were held to graphically show that for poor senior citizens, the choice was often between food or a visit to the doctor. More expensive procedures, usually involving elective surgery, were often postponed indefinitely by the elderly on fixed incomes. The power to hold these hearings resides with the major party in both houses. A Democratic majority will help to start this process.
Medicare was not just a proposal by the Democrats. There was bipartisan support for it.

Today’s Federal legislatures are deeply divided along party lines but the cost of care impacts on citizens in all parts of the country. The states with the highest rates of uninsurance are red states where the Republican party is in the majority. The culture of caring for the elderly via the social insurance model (found in Social Security and Part A of Medicare) also relieved directly the younger generations of burdensome expenses, even though payroll taxes were increased.
The culture of caring is not just for the elderly. The American family is being squeezed out of our current prosperity. Those in the workforce with moderate incomes need a victory in the struggle with increasingly limited coverage in employer-sponsored policies, greater premiums and co-pays, or the elimination of coverage altogether. Lower-paid workers often cannot afford the premiums and co-pays when insurance is available and so they do not take up these opportunities for coverage.

Finally, we also need to show that the Congress in 1965 was able to take on the American Medical Association at the zenith of its power and prestige to create a universal health insurance program for Social Security recipients. The powerful players today are the managed care plans/insurers and the pharmaceutical industry. They need to learn how to do the right thing when it comes to creating quality care for everyone at a reasonable cost.

Moving health care to the forefront of the national policy agenda in the 2008 Presidential elections and for the next Administration is a key initiative of the non-partisan Center for the Study of the Presidency (CSP). As Dr. Drew Altman and Professor Blendon point out in their article, health care concerns must be central to the 2008 election cycle to ensure that needed reforms occur in the future. In this regard, the Center for the Study of the Presidency has been organizing working sessions on critical national challenges for the 2008 Presidential candidates and, as part of this effort, convened several meetings with Kaiser Family Foundation leadership on the Center’s 2008 Health Agenda. This agenda is a critical component of CSP’s overarching mission to apply lessons learned from an historical examination of the Presidency to promote innovative solutions that address current vulnerabilities facing the nation and to anticipate opportunities ahead to promote progress and prosperity.

A suite of health care concerns – soaring medical costs, uninsured citizens, the need to protect against and respond to natural disasters, pandemics, and possible bioterrorist threats, to emphasize prevention and preparedness, to strengthen health-related research, and to improve the delivery of quality medical and public health services – are issues that must be at the top of Presidential candidates’ lists. Indeed, these concerns, which cross over forty Federal agencies, underscore that strong leadership in the White House and in the Executive Branch of government on science, health, and technology is more important than ever.

The Center believes it can help find a path forward to improve health. Utilizing a model that the Center for the Study of the Presidency first developed to help Secretary Ridge and his senior staff launch the Department of Homeland Security, CSP will convene a wide range of experts from the health community, Nobel Laureates, public policy organizations, academia and current or former government officials for frank, off-the-record discussions of each of the health care issues identified above. These sessions and conferences will produce one or more briefing papers that describe the nature of the challenge, set forth various policy options and the resources required to pursue each, and explain why Presidential action is critical to overcoming the national health vulnerability. A national conference will then be convened to examine lessons learned from previous Administrations and to gather broad input across expertise and geographic regions of the country. A national poll will be conducted of public and health care providers’ attitudes, hopes and expectations for health care in the next Administration.

Findings from the national poll and recommendations from the working sessions and the national conference, summarized in an Executive Report, will build common ground among the participants, frame the Presidential debates on science, health and technology issues, and enable the next Administration in 2008 to begin its policy deliberations with a set of issues, strategies, and solutions with the support of committed Members of Congress, their staff, the private sector, public policy organizations, health groups, the media, and the American public to accelerate progress on health, science and medicine in the United States and globally. The Center for the Study of the Presidency looks forward to working with the Kaiser Family Foundation and other committed and concerned organizations and individuals to achieve these goals.

Rear Admiral Susan J. Blumenthal, M.D., M.P.A.
Senior Advisor for Health, Science and Medicine
The Center for the Study of the Presidency
Former U.S. Assistant Surgeon General
U.S. Department of Health and Human Services

Please comment on Newt Gingerich’s effort in the area of health care, “Center for Health Transformation” and the effects that this is having (or might have) on the national health care debate. Thank you.

For example, in two other popular healthcare blogs — The Medical Blog Network and The Health Care Blog — we’ve been discussing why fixing American healthcare is so difficult. The conversation threads covered many topics ranging from how to educate the public and get them motivated to demand change, to what role our government could take and whether it can be trusted. At the same time, on the Insurance Blog we’ve been hotly debating whether there even is a healthcare crisis and whether the insurance industry is part of the problem and whether healthcare should be considered a commodity subject to market forces.

Not surprisingly, there’s a wide range of opinions as to what the problems are and how to deal with them. As we continue to discuss and debate the issue of reform in HealthAffairs and other open forums, I believe a clear vision of the “big picture” will emerge and a rational path to solving the complex problems we face will surface.