Most of these elements are controversial. Former single-payer advocates, for instance, are banking on a public plan to open the door to a single-payer system. Insurers know that and are working overtime to make sure that doesn't happen. Aside from saying he supports a public plan, the president hasn't gotten his hands dirty in the political muck. Is he pursuing a conscious strategy to be above the fray or waiting to see what Congress does before jumping in? Is the president being strategically vague or abdicating to Congress because he, too, is feeling the heat from the special interests that contributed millions to his campaign?
Campaign rhetoric led the electorate to believe that a new president was ready to overhaul the healthcare system and bring health coverage to everyone. A poll released by the Kaiser Family Foundation indicates that there is strong support for health reform but that the public can be swayed on the details. "There is still a tremendous opportunity for leadership," says Kaiser CEO Drew Altman. But the special interests can still move the debate in one direction or another.
Money directed at health information technology in the stimulus package is not likely to bring down the cost of medical care; nor will preventive care, the much-touted disease-management programs or research into what medical interventions work. Earlier this year an article in the Annals of Internal Medicine by three respected healthcare experts, Theodore Marmor, Jonathan Oberlander and Joseph White, concluded that such reforms "sound like benign devices to moderate medical spending" and may be desirable for other reasons. But they are "ineffective as cost control measures." Serious cost containment--global budgeting, for instance, which sets a cap on what can be spent on healthcare by various sectors--is as far off of the table as single-payer.
"We do not know how to control health spending significantly," Princeton health economist Uwe Reinhardt told health journalists at their annual conference a few weeks ago. "The Obama administration must have the guts to force physicians to defend their high cost of spending. We could save 30 percent without hurting patients if they practiced medicine right." But the administration seems to be moving more in the direction of stopping the Medicare fee cuts already scheduled for doctors. The AMA was gleeful when the administration released its budget. President Nancy Nielsen said that the budget proposal "takes a huge step forward to ensure that physicians can care for seniors by rejecting planned Medicare physician payment cuts of 40 percent over the next decade."
If Obama wants to give more than lip service to a public plan, he should offer guidance on how it will work. Right now the term is loosely tossed around and means different things to different interest groups. But most ordinary people, if they understand it at all, believe it will enable them to chuck the coverage they have and choose cheaper and better coverage. If Massachusetts healthcare is a model, though, that's not likely. There, if residents have employer coverage and decline it because it's too expensive, they are barred from subsidized insurance. In other words, they don't have much of a choice. The reason: to keep people from "crowding out" private insurance; that is, taking away business from the private carriers. On May 4, New York Senator Charles Schumer stepped into the void and proposed " principles" that seem to answer some objections from insurers.
Right now it looks like the insurance industry has the upper hand in negotiations over a public plan. It will take a lot more voices and political muscle to nudge health reform to a point where it serves the needs of millions of Americans who are either shut out of the current system or have become its victims.
The inclusion of as much as $36.5 billion in spending to create a nationwide network of electronic health records fulfilled one of Obama's key campaign promises -- to launch the reform of America's costly health-care system.
But it was more than a political victory for the new administration. It also represented a triumph for an influential trade group whose members now stand to gain billions in taxpayer dollars.
A Washington Post review found that the trade group, the Healthcare Information and Management Systems Society, had worked closely with technology vendors, researchers and other allies in a sophisticated, decade-long campaign to shape public opinion and win over Washington's political machinery.
Such an approach would rely on unprecedented data-mining into medical records and the practices of doctors, a kind of surveillance that also would enable insurers to cut costs by controlling more precisely the care that patients receive.
"Finally, we're going to have access to millions and millions of patient records online," said Blackford Middleton, a physician, Harvard professor and chairman of the Center for Information Technology Leadership, whose studies have concluded the health-care system could save $77.8 billion each year through the universal use of information technology networks. "This is the biggest step for health-care information technology in this country's history."
But others said the case was far from being so clear. Some observers said the projected savings are overly optimistic and that launching such vast computer networks under tight deadlines is risky, a lesson learned by the Bush administration when it botched a variety of homeland security systems rushed into place after the Sept. 11 terrorist attacks.
The CBO, then led by Orszag, examined the industry-funded study behind the $77.8 billion assertion, among other things, and concluded that it relied on "overly optimistic" assumptions and said much is unknown about the potential impact of health information technology.
A CBO analysis of the stimulus bill this year projected that spending on electronic health records could yield perhaps $17 billion in savings over a decade.
GE Launches $6 Billion Plan to Develop Health Care Innovations
With the pace of health care reform quickening in Congress, General Electric came to Washington on Thursday, May 7, to launch a multibillion-dollar initiative it says will provide better health care at lower costs to more people—goals shared by many lawmakers.
The company also hopes the $6 billion program, dubbed “healthymagination,” will substantially boost its bottom line by fostering the growth of GE Healthcare.
During the next six years, GE plans to invest $3 billion in research and development to create at least 100 technologies and innovations it says will reduce the cost of medical procedures by 15 percent, increase access to health services by 15 percent and improve quality and efficiency by 15 percent. Another $3 billion will be allocated to improving coverage in rural and poor communities around the world.