In a lively 45-minute session near the end of a long day, representatives from eight leading presidential candidates (Clinton, Dodd, Edwards, Giuliani, McCain, Obama, Richardson, and Romney), along with Len Nichols of the New America Foundation, gathered on stage in front of more than 500 participants at Health Affairs’ 25th anniversary health policy summit, to discuss the candidates’ views on health system reform. The panel, moderated by Drew Altman, president and CEO of the Kaiser Family Foundation, kept the stump speeches to a minimum and displayed the breadth of their knowledge and experience in the health reform trenches already — well before the first primary vote is cast.
Take, for example, Douglas Holtz-Eakin, who for several years was the head of the nonpartisan Congressional Budget Office (CBO) and served as chief economist on George W. Bush’s Council of Economic Advisers and senior staff economist on George H.W. Bush’s council. He now advises the campaign of Sen. John McCain (R-AZ). Or Gregg Bloche, a Georgetown University law professor and longtime Health Affairs contributor, who now advises the campaign of Sen, Barack Obama (D-IL).
Or Don Moran, another Health Affairs contributor and former Office of Management and Budget (OMB) staffer who worked for ICF before founding the Moran Company; he now advises the campaign of former New York mayor Rudy Giuliani. [Note: The Guiliani campaign does not have a dedicated page on its Web site discussing health reform] Or Jeanne Lambrew, yet another Health Affairs author, an associate professor at the Lyndon B. Johnson School of Public Affairs at the University of Texas at Austin, and a onetime health adviser to the Clinton White House; she now is an “informal adviser” to the campaign of Sen. Hillary Clinton (D-NY). Far from being mere political operatives, they and the other panel members have impressive credentials in health reform at the state and national levels.
Altman, whose foundation is known for its health polling, started the discussion with the results of the Kaiser Family Foundation’s latest tracking poll, which show health to be the second most salient issue for Democrat, Republican, and Independent voters alike. He then conducted a straw poll of the nine staffers on stage, asking them, first, how many think that there will be a “truly big discussion” of health reform during the 2008 campaign. All nine staffers said yes. He then asked whether there would be “significant legislation” on health reform in the next Congress. Again, all nine said yes. Finally, he asked what the biggest issue was: cost (two staffers), expanding coverage (one staffer), or a combination (six staffers).
Under Altman’s fast-paced questioning, the adviser panel had the opportunity to sum up first the differences between the parties’ stances on health reform and then, to dig a little deeper, the differences among Republicans and among Democrats. For the most part, the panel stayed away from direct criticism and confrontation. Bloche, in his opening remarks, came the closest to campaign rhetoric by declaring that if a Republican is elected president, “the number of uninsured will pass 50 million on his watch.” He said that nobody but McCain is seriously addressing access and that Guiliani’s answer to the question is, “9/11.” That comment drew a few groans from the largely bipartisan audience and a defense from Moran, representing Guiliani.
Altman’s request for opinions about what has been happening at the state level (especially in Massachusetts and California) sparked a lively discussion on the extent to which states should be asked to lead the way. A recurring theme was international competitiveness in a global economy; Lambrew commented that in such a context, a national solution is needed, not fifty state solutions. Sally Canfield, representing Mitt Romney (the former governor of Massachusetts during whose administration the Massachusetts reforms were passed), commented that to solve the problem of the uninsured, you first need to determine who your uninsured people are and what problem you are trying to solve. That state’s reforms were designed to target young, fairly affluent males, who are among the largest uninsured group in that state. A solution that works for that population, Canfield said, would not necessarily work for states whose uninsured residents have different characteristics.
Each adviser spoke clearly and passionately about his or her candidate’s priorities in answer to Altman’s probing questions. However, nobody who has been paying attention to the candidates’ positions on health reform — especially in an audience representing the elite among health policy and industry experts — learned anything new. What was impressive was the degree of expertise on display. No matter which candidate is ultimately chosen as president, the debate around health reform, both during and after the campaign, will benefit from the experiences of those whom they have chosen to advise them.