The California Senate Health
Committee’s rejection last week
of Gov. Arnold Schwarzenegger’s $14 billion health reform plan does not mean the issue is dead in the water.
The spotlight is expected to move to what Democratic and Republican presidential candidates plan to do about the issue in an election year.
Many leading Democrats, including Sens. Barack Obama and Hillary Clinton, are seeking to achieve universal coverage through building on the existing employer-sponsored healthcare system.
Republicans such as Sen. John McCain, Govs. Mitt Romney and Mike Huckabee, are more likely to offer tax-based incentives to encourage Americans to buy healthcare coverage on their own.
Finding a way to bridge such differences would be important to win independent swing voters in the November general election and to fashioning a legislative compromise when a new Congress is seated in 2009, according to a recent study in the New England Journal of Medicine.
A recent Kaiser Family Foundation poll found that voters ranked healthcare as their second-most important issue, trailing only the war in Iraq and ahead of immigration.
With that in mind, the Business Journal’s Vita Reed asked several Orange County healthcare executives, “What would you like to see in national healthcare policy?”
Following are their edited
comments.
Richard Afable
Chief executive,
Hoag Hospital,
Newport Beach
Healthcare is at or near the top of the list of public interest and candidate rhetoric as we approach the presidential elections. This is no surprise, given that any attempts at meaningful healthcare reform during the past 20 years have generally gone for naught.
Once again, we have begun the debate of healthcare reform: why, who, what, when and most importantly for voters, how and how much.
While all the presidential candidates agree that reform is necessary, what is noteworthy is the clear divergence of views between the two major political parties as to the means by which reform would occur.
The Democratic view is universal coverage through new taxes and closing of tax “loopholes” for the wealthy. The Republican approach envisions expanded but not universal coverage, focused primarily on existing private systems and funded through personal tax breaks designed to allow people to buy health insurance.
All would provide healthcare “coverage” either through private or governmental insurance programs.
What is missing, of course, is true healthcare reform that addresses not only access and payment, but the quality, consistency and outcomes of care. The political debate in this presidential season is focused on “who has access to care?”
This should really be a two-part question: “who has access, and to what kind of healthcare?” I feel we will be back at the table (or voting booth) very soon, regardless of who wins the election, if the fundamental issue of the need for effective, safe, efficient and equitable healthcare for all citizens (and others) is not addressed directly and well.
Orange County presents itself as a microcosm of what befalls and challenges the rest of the country in how healthcare should be provided and to whom. As the fifth largest county in the U.S. by population, we have every element of what does and does not work in our healthcare system.
Great hospitals, great doctors and great care are available for those who are fortunate enough to afford it or have it offered through employment. On the other hand, access is exceptionally poor for those outside the system. California overall and OC specifically is at or near the top of the list of communities in the U.S. with large numbers of uninsured and underinsured.
Until the problem of the underinsured and the uninsured is addressed directly and well, healthcare will remain a tiered system with costs and inefficiencies that cannot be remedied within the social rationing that exists today.
Julie Miller-Phipps
Vice president,
area service manager,
Kaiser Permanente Orange County
The conventional wisdom is that in election years it is very difficult to make progress on significant budget or health legislation. Most legislators want to avoid making the difficult moves required,either reducing services or raising taxes,in the months leading up to an election.
This year is a little unique because of two factors. First, health policy is central on the political agenda. Not only are the major presidential candidates talking about health reform, policymakers across the country have their eyes on the reform efforts in California.
So while it’s not likely that major federal reform legislation will move during this year’s session of Congress, the public may move closer to a consensus about what should be done, and that, in turn, could affect policymakers’ views of what is possible. It’s very possible that leaders in Congress will hold hearings and place some legislative “markers” in anticipation of the election and positioning toward next year.
We do expect a continued debate over Medicare this year. Congress will have to act again by mid-year if it wants to avoid a pending 10% cut in the rates physicians can charge Medicare for services provided to Medicare beneficiaries.
Revising the physician payment rate,and the extraordinary expense of doing so,has driven Congress to make only short-term changes, requiring it to revisit Medicare payment rates each year for the past several years. This year will be no exception. Eliminating the 10% cut for the rest of this year and next year will cost the government $10 billion to $15 billion.
To avoid raising taxes to pay for this, Congress will look to cut Medicare in other areas. It will look to lower payments to other providers, such as dialysis providers. The tug of war between Congress and the Bush administration about payments to Medicare Advantage plans (including Kaiser Permanente) will continue.
Maureen Zehntner
Interim chief executive,
UCI Medical Center,
Orange
There is no doubt our current healthcare delivery system is in need of meaningful reform. On this point, there is wide consensus. Nationally, healthcare continues to poll as one of the top three issues of concern to voters. All of the presidential candidates have a health reform proposal.
This is a clear indication that healthcare reform is becoming a mainstream imperative for 2008. Insight into the issues can be gained by looking deeper at the health reform effort currently under way in California.
There are an estimated 4.5 million people throughout California without any health coverage and many of the issues that plague our healthcare system are clearly present right here in OC. There are more than 300,000 persons dependent on Medi-Cal, approximately 25,000 people dependent on Orange County’s Medical Services Initiative program, and an estimated 455,000 OC residents have no healthcare whatsoever. Local employers in OC are challenged also by the costs of providing healthcare coverage for their employees.
The recent efforts of state policymakers, especially Gov. Schwarzenegger and the Legislature, are resulting in significant proposals to improve California’s healthcare delivery systems by significantly decreasing the numbers of uninsured, placing an increased focus on preventive care and disease management, and improving affordability.
The December 2007 Field Poll indicates more than 60% of Californians support the general principles underlying the current proposal advanced by Schwarzenegger and Assembly Speaker Fabian Nu & #324;ez. If major healthcare reform is enacted and the necessary initiative qualifies for the November 2008 ballot, the path taken by California should figure prominently in the national health reform debate.
Liz Bear
Administrator,
Saddleback Memorial Medical Center,
San Clemente campus
2008 is not beginning as a typical election year.
Many polls are showing that voters have turned their attention to domestic issues, particularly the recent economic downturn and its implication on access to healthcare.
Each of the major candidates has addressed healthcare in their campaigns. Public policy and fiscal challenges do not disappear in an election year.
Good health policy will include several critical incentives,incentives for providers and consumers alike to focus on prevention and wellness; incentives for innovation in caring for people with chronic diseases; and incentives that reward providers who can demonstrate the best clinical outcomes through compliance with evidence-based medicine and who provide the best service to patients, families and communities.
Physicians are facing cuts in Medicare payments beginning July 1, despite inflationary pressures.
If these cuts were to be enacted, more and more physicians will leave the Medicare program, resulting in the elderly population having fewer choices for their specialized care.
Hospitals face similar cuts this year. Hospitals and physicians must work to ensure full funding for the services we provided to our communities and patients.
Looking at the other end of the spectrum, insurance for children in low-income families is also threatened.
Congress has tried, with bi-partisan support, to increase the State Children’s Health Insurance Program, known as Healthy Families, in California. The president has vetoed these attempts on several occasions.
We must work together with children’s advocates to ensure (that) our most vulnerable populations have full access to the specialized care they need.
Jim Lott
Executive vice president,
Hospital Association
of Southern California,
Los Angeles
“Expect” may be too strong of a word. But we can certainly hope for,and demand,a number of things from our national leaders, even in the highly charged atmosphere of an election year.
These three are at the top of the list:
n Baby boomers may make their largest impact on our society in retirement: Our healthcare system is getting stretched to the limit as they make their way to hospitals and clinics in increasing numbers.
Our leaders in Washington need to support job training programs to inspire the next generation of healthcare professionals to rise to this challenge and to teach them the skills they will need to provide world-class care.
n Our emergency medical services safety net is crumbling.
Our 911 system is fragile and overtaxed, emergency rooms are often forced to close due to overcrowding and physicians are increasingly unavailable to be on-call as needed due to disincentives built into the system.
Let us hope that our leaders in Washington, D.C., see the urgency of this situation and include safety net solutions in any healthcare reform package.
n In addition to providing emergency care for all, hospital emergency rooms have, unfortunately, become “the” healthcare choice for America’s uninsured.
Those with no health insurance know they can receive care at a hospital ER, so this is where they go.
The obligation to provide care to the indigent will not change. Our national leaders need to recognize that the cost of providing this care is increasing.
Our leaders must adjust Medicare and Medicaid reimbursement rates to compensate hospitals and balance out the cost hospitals must absorb when they care for those who need help yet have no means of paying for it.
Hospitals are vital community assets, not just for our health, but for the health of
our economy. Strong hospitals provide easy access to world-class care at a reasonable cost.
But to maintain strong hospitals, we must address the threats outlined above to ensure that they remain viable contributors to our economy.
Regardless of what happens (or doesn’t happen) in Washington this year, we must take an aggressive approach to devising and implementing solutions,at the local level,to Southern California’s healthcare challenges.
