State of the Nation’s Health Care 2008
Robert B. Doherty
Senior Vice President
Governmental Affairs and Public Policy
American College of Physicians
Thank you, Dr. Dale, for offering a compelling vision of a health care system that is second to none.
One in which the words “uninsured Americans” disappear from our national vocabulary.
It may seem that ACP’s vision is so far removed from the inefficiencies, inequities, and inconsistencies of U.S. health care as to be an impossible reach. I believe otherwise, and will spend the next few minutes describing how ACP plans to use the political process to translate our ideas into a mandate for reform.
I approach this from having spent almost 30 years of my life trying to introduce well-meaning policy recommendations into the rough and tumble world of politics. I have the battle scars from the last time we tried and failed to get health care reform enacted in the United States. It would be easy for me to be cynical.
But I have reason to hope, even believe, that this time around, things will be different.
Reason to hope that a new President and a new Congress in 2009 will achieve something that none of their predecessors accomplished, which is lasting reform of a dysfunctional health care system. Let me give you three reasons why this is so.
First, the new President and Congress may have no choice but to institute reforms to make health care more accessible and affordable. Why? Because health care will become so expensive that the country will no longer be able to support it. As costs rise, many people who now have coverage will lose benefits or pay more. Consider this:
- Just two years into the next administration, the 78 million baby boomer generation will start to turn 65 and become Medicare-eligible.
The Congressional Budget Office recently reported that federal spending on Medicare (net of beneficiaries’ premiums) and Medicaid would rise from 4 percent of GDP in 2007 to 7 percent in 2025—well in excess of anticipated economic growth to support the higher spending. The CBO stated, and I quote, "The main message of this study is that, without changes in federal law, federal spending on Medicare and Medicaid is on a path that cannot be sustained."
- And if the new President is fortunate enough to be re-elected to a second term, he or she will see total health spending reach $4.0 Trillion (20 percent of GDP) by 2015, up from $2.0 trillion in 2005.
This isn’t an arcane budget problem that only people in Washington care about.
It will affect every person, in every community, in the United States.
Out-of-control spending will mean less money in the federal budget for everything else.
It will mean higher Medicare payroll taxes and premiums for beneficiaries.
It will mean deep benefit cuts in federal health programs.
It will cause U.S. businesses to be less competitive in the global economy.
As businesses drop or curtail coverage, it will mean more people without health insurance and higher out-of-pocket costs for those who have it.
And if that isn’t enough for Washington to act, can you imagine what it will be like for our elected politicians if the entire system melts down on their watch?
That is why I am hopeful that the new President and the new Congress will want to enact health care reform. Why they will want to act to put health care on a sustainable path before the system falls apart.
Second, this time around, we have the evidence to refute the biggest argument made against health care reform, which is that U.S. health care is the best in world—so why change it?
We now know otherwise. As reported by Dr. Dale, we have the hard evidence to support what many of us already know from personal experience: Americans get poorer care, at higher cost and with less access, than people in other nations.
We also have the evidence to develop a road map of what needs to be done, learning from other nations’ experiences.
It goes without saying that the United States is not Denmark, or Canada, or France, or Australia, or Japan or Germany. We can’t simply replicate what other countries have done. But we can learn from them and develop a uniquely American solution that respects American values and traditions.
The countries studied by ACP have certain common features that explain why their health care systems consistently out-perform the United States.
- They guarantee coverage for all.
- They have found that every dollar spent on primary care pays for itself with better outcomes and lower overall costs.
- They have physician payment systems that reward quality, prevention and care coordination rather than just the volume of services.
- They create incentives for individuals to use health care resources wisely.
- They invest in health information technology and research.
- They have uniform billing and lower administrative costs.
Surely, the United States, with all of its energy and creativity, can arrive at a consensus on how to incorporate each of these elements of a high performance health care system into the American health care system. We likely won’t do it in the same way as our neighbors to the north or across the Atlantic or Pacific. But we have the evidence to point us in the right direction.
Third, this time around, physicians are leading the fight for a better health care system.
The American College of Physicians represents 125,000 physicians and medical students. We are the largest specialty society in the United States and the second largest physician membership organization. We are saying, on behalf of those who have devoted their professional lives to caring for patients, that the U.S. health care system is not working as it should, the status quo is unacceptable, and that we need fundamental reform.
By this fact alone, ACP brings a great deal of credibility to the debate. I believe that our members’ patients—the public—will listen when it is their doctors who are saying that change is needed.
In the past, physician membership organizations were often accused, perhaps with some justice, of being on the sidelines or even opposing health care reform. Today, ACP is showing the political world that this is no longer the case.
We are demonstrating our commitment by challenging our members to be advocates. In fact, the ACP views advocacy for equitable health care as being an essential part of what it means to be a doctor.
In your packet is a copy of a document called “Medical Professionalism in the New Millennium: A Physician Charter.” This paper , which has been endorsed by ACP, the American Board of Internal Medicine, and the European Federation of Internal Medicine, states that:
"Physicians must individually and collectively strive to reduce barriers to equitable health care. A commitment to equity entails the promotion of public health and preventive medicine, as well as public advocacy on the part of each physician, without concern for the self-interest of the physician or the profession."
We are helping ACP members be such public advocates by providing them with tools to participate effectively in the political process.
In your packet, and displayed before you, is a Candidate’s Pledge.
We are making the pledge available to each and every ACP member.
We will ask each and every member to use the pledge to obtain commitments from each and every candidate for Congress to create a U.S. health care system that is second to none.
ACP will also be sending the pledge directly to the presidential campaigns and to all members of Congress who are running for re-election.
The pledge asks the candidates to commit to the following agenda:
1. Health coverage for all.
2. Support for primary care.
3. Reductions in administrative costs.
4. Investment in health information technology.
5. Incentives for patients to use health care resources wisely.
6. And support for research—including research on the comparative effectiveness of different clinical treatments.
We realize that some candidates will not sign any pledges created by outside organizations—even when they agree with the content of the pledge. Even so, the pledge will help ACP members ask the tough questions of the candidates. The number of candidates who actually sign the pledge will be less important than how many of them end up advocating for the policies described.
We have also developed a web tool that allows our members to evaluate the announced positions of the Presidential candidates against the ACP’s policy benchmarks for achieving a high performing health care system. This tool, which is updated regularly as positions change or evolve or candidates drop out of the race (we’ve had to do a lot of that lately!), is designed to help our members become informed voters.
Finally, today’s report on the State of the Nation’s Health Care 2008 provides a general assessment of how the announced Republican and Democratic presidential candidates’ positions stack up against ACP’s policy benchmarks.
To be clear, we are approaching our involvement in the 2008 elections from a purely non-partisan basis. The views of ACP’s members cross the political spectrum from right to center to left and everything in between. As a matter of policy and law, ACP does not and will not endorse a candidate or express a preference for one candidate or party over another.
We believe though that we have a responsibility to provide unbiased information to our members on how the Presidential candidates’ health care proposals compare to ACP’s benchmarks.
We do not see health care reform as a particularly Democratic or Republican issue, but as national imperative that transcends political affiliations. Americans in red states and blue states alike are paying the price of a U.S. health care system that spends too much and gives them too little in return. Republican and Democrats alike have a shared national interest in creating a U.S. health care system that is second to none.
We know that this can be done. There are many examples of bipartisan efforts to develop proposals for guaranteed coverage. Even in the 110th Congress, not exactly a place of bipartisan harmony, a bipartisan bill—called the Health Coverage, Access, Responsibility and Affordability Act of 2008- has been introduced by Representatives Marcy Kaptur (D-OH) and Steve LaTourette (R-OH). This bill would implement many of ACP’s proposals to achieve health coverage while maintaining a pluralistic system of public and private insurance options.
We also have examples of governors from both political parties who are working on a bipartisan basis to achieve health care reform within their states.
Let the debate begin. For those candidates who prefer market-based solutions and less government, ACP challenges them to go the next step to describe how health coverage for all can be guaranteed by law within a market-system that relies on private insurance. For those candidates that prefer a larger role for government, ACP challenges them to explain how ideas like individual mandates would really work, how their plans would be paid for, and how individual choice would be protected from excessive government regulation.
ACP challenges all of the candidates to explain what they plan to do to avert the collapse of primary care in the United States. Regrettably, none of the proposals from the announced presidential candidates, Democrats and Republicans alike, propose the kinds of changes in reimbursement and workforce policies needed to assure a sufficient supply of primary care physicians.
For the past two State of the Nation’s Health Care briefings, 2007 and 2006, ACP has documented the fact that very few young physicians are going into primary care, and many of those in primary practice are leaving medicine. Yet the silence of the Presidential candidates on this impending crisis is deafening. We need to get their attention, and we hope to do it now.
ACP is not letting President Bush and the 110th Congress off the hook. There is much they can do to help the transition to a better performing health care system.
First, they should start by replacing pending Medicare physician payment cuts with positive updates, since those cuts would cause even more primary care doctors to leave practice.
Second, they should enact legislation to help people obtain or keep health insurance coverage—especially those who will lose their jobs if the economy goes into recession.
President Bush proposed several ideas for expanding coverage in Monday’s State of the Union address—making individual health insurance tax deductible, allowing businesses to form association health plans, and expanding Health Savings Accounts. These ideas, though, do not have much support among congressional Democrats, and by themselves, they are unlikely to make a big enough dent in the number of uninsured. It is important that President Bush and Congressional leaders reach out to each other to develop a bipartisan plan to expand health insurance coverage.
The federal government must also provide sufficient funding to the states, many of which are facing huge budget deficits because of the economic downturn, to preserve and strengthen the Medicaid and SCHIP safety-net programs.
The 2008 elections will decide if voters are going to accept a health care system that spends more, and achieves less in return, than any other industrialized country.
ACP’s fervent hope is that this time around, the voters will not settle for anything less than a commitment by the candidates to make the U.S. health care the best in the world. ACP is committed to doing everything in our power to make this so.
Dr. Dale and I will be pleased to answer your questions.
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