While state legislators and officials wrangled in Sacramento over a mammoth budget deficit last week, health advocates a few blocks down the street were ironically upbeat at the Insure the Uninsured Project’s 13th annual conference.Â
The same economic crisis that grips the nation and has a stranglehold on California is seen by many health advocates as a rare window of opportunity to make significant progress toward providing health coverage for millions of uninsured and underinsured Americans.
“I’m not usually the optimist in the family,” state HHSA Secretary Kim BelshÃ© told conference attendees, “but I really think this is a rare situation. There’s something akin to a perfect storm brewing out there and I believe it brings opportunities that can truly make a difference.”
Health advocates’ optimism is based on the confluence of two events: the arrival of a reform-minded president and a new recession-driven will in Congress to spend federal money on health care and perhaps to pass health reform legislation.
“The chances are better than ever that we’ll have comprehensive reform by the end of 2009,” said Anne Gauthier, assistant vice president of the Commonwealth Fund and deputy director of the Fund’s Commission on a High Performance Health System.Â “This time of economic crisis is an opportunity for us. You’ve heard others say that here today,” she told the 450 conference attendees, “and you’ll hear it again. I think something’s really going to happen this year.”
Contrast in Mood From Last Year
Founded in 1996, Insure the Uninsured Project (ITUP) is a non-partisan organization funded by the California Wellness Foundation, the California Endowment, the Blue Shield of California Foundation and L.A. Care Health Plan. ITUP works with local and state officials to increase coverage for California’s 6.6 million residents without health coverage.
The organization’s annual conference is a chance for various stakeholders to trade ideas and share horror and success stories.
The mood at this year’s event, “Bridging the Gap During a Time of Crisis,” was a marked contrast to the mood at last year’s conference, which came days after California’s major health reform proposal went down in defeat.
“The conference a year ago was a time of disappointment for many of us,” BelshÃ© said. “Now, fast forward a year, tragically the problems are greater. More people are uninsured and underinsured, our state budget and national recession combined to create tremendous uncertainty. The size and scope of California’s budget challenges are really unprecedented.”
“But with those challenges I think there are tremendous opportunities as well,” BelshÃ© said.
In contrast to previous years, many of the two dozen speakers and panel members at this year’s conference looked mostly to Congress and President Obama for leadership in health reform.
“Is state-based comprehensive reform viable?” BelshÃ© asked. “The governor is optimistic, but he realizes we may not be able to move toward reform in the near term, but he is committed to moving in that direction in the long term,” she added.
Comparing National Reform Proposals
John Sheils — senior vice president with the Lewin Group, a national health care and consulting group — compared a dozen reform plans working their way through Congress, measuring each on their cost and expected impact on the number of uninsured.
“These plans basically fall into two categories,” Sheils said. “One group is plans that build on our current system and the other group is plans that take a new approach.”
President Obama’s plan, which falls into the first category, would cover about 26.6 million uninsured and would cost about $40.6 billion, according to Sheils.
By comparison, two plans in the second group — one by Rep. Pete Stark (D-Calif.) and another by Sen. Ron Wyden (D-Ore.) — would cover 48.9 million and 46 million uninsured, respectively, according to Sheils.
Stark’s “Medicare for all” would save the federal government more than $58 billion a year.
Wyden’s plan — the Healthy Americans Act, which Sheils helped write — would “basically break even, maybe save $1 billion,” Sheils said.
“We can’t afford to stick with this system,” Sheils said, calling America’s current system an expensive, disjointed patchwork of private and public insurance that leaves more than 50 million people without coverage.
“We need to start over,” Sheils concluded.
Sharon Levine from the Kaiser Permanente Medical Group and Steve Shortell from UC-Berkeley’s School of Public Health gave an update on the activities of FRESH-Thinking, a group of academics, policymakers and politicians working for the past three years on recommendations for reforming the country’s health care system. FRESH stands for Focused Research on Efficient Secure Healthcare.
Ezekiel Emanuel of NIH and Fresh Thinking’s project director, also was scheduled to speak at the ITUP conference but “his presence was required in Washington, D.C.,” Shortell said.
“You may have heard, there’s a job opening there right now,” Shortell said a day after former Senate Majority Leader Tom Daschle (D-S.D.) withdrew from consideration as President Obama’s appointee as secretary of HHS.
Shortell said FRESH Thinking identified eight specific areas that all reform proposals should address:
- Technology and outcomes assessment;
- Organization and delivery of care;
- Payment to providers;
- Structure of health plan competition;
- Funding of health care for all Americans;
- Legal and regulatory reform;
- Innovations in a cost-constrained environment; and
- Transition and implementation issues.
“So far we haven’t heard from special interest groups, but when some of these proposals start getting talked about seriously, you can expect a lot of push-back from special interests,” Shortell said.