Health Policy Blog

The goal of the Mayo Clinic National Symposium on Health Care Reform is to develop concrete action steps the private sector and the next president and Congress can take to fundamentally reform health care in America. During the breakout sessions this afternoon, the 400 participants divided into separate groups representing Users of Care, Purchasers of Care and Providers of Care. Tomorrow morning we will hear reports from those sessions, as each group identified five top action priorities for the private sector.

In tonight’s plenary session, we heard from representatives of the three remaining major-party candidates for President, in a discussion moderated by ABC’s Cokie Roberts. Those representatives were:

• Katherine Hayes, J.D., from Sen. Hillary Clinton’s campaign
• Douglas Holtz-Eakin, Ph.D., from Sen. John McCain’s campaign
• Kavita Patel, M.D., from Sen. Barack Obama’s campaign

Other panelists involved in the discussion were:

• Steven Pearlstein of the Washington Post
• Elizabeth McGlynn, Ph.D., RAND Health
• Karen Davis, Ph.D., The Commonwealth Fund

Here’s an introductory video offering some patient perspectives on government’s role:

Pearlstein said the first thing we need to do is get the candidates to agree that “we’re gonna do this” in the next four years. He gave the example of the base-closing commission; we need to commit that we will start a process and live by it. He said the current situation is like a WWI battlefield, in which everyone is dug in and protecting turf. We need to identify a reform coalition and identify who is in it and who isn’t. Big Pharma, Trial Lawyers, AFL-CIO and big insurers won’t be in it because they do too well in the current system.

Among those he says may be in the “coalition of the willing” are: small business, disease advocates, most hospitals.

Who does he see as likely in the coalition? Big business, governors, AARP, unions like the SEIU, advocates for the uninsured, teaching hospitals and prestigious clinics, nurses.

Among physicians, some specialties may have a hard time joining: cardiologists, cardiac surgeons, radiologists and others who do well under the current system.

Dr. McGlynn said she wants the candidate representatives to address why the situation is different now, and why reform can happen when it hasn’t in the past. She said her one “non-negotiable” is that Quality needs to be part of the consideration; most of the debate has been about access so far. Most adults don’t get the care that is recommended for their age group. That gives her hope, because everyone has something to gain if quality improves.

Dr. Davis focused on the broad agreement among the candidates on some basic principles, and that we need a high-performance health system. She said the four pillars of the Mayo Clinic platform are essential: covering the uninsured, payment reform, coordination of care and a focus on improving value. She said the most important need is national leadership, which is why she’s optimistic, because all of the candidates are talking about it.

Ms. Hayes said she believes Sen. Clinton’s proposal is consistent with the Mayo Clinic principles, and that her goal is quality, affordable coverage for everyone. She feels we need to have a goal up front of covering everyone, and that the next president will need to move quickly in the first 100-120 days to build a case and enact reform. Because all of the remaining candidates are U.S. Senators, one benefit is that they all have the understanding of the legislative process.

Dr. Holz-Eakin says what is different this time is that health care is the number one issue among voters. Every candidate has had health reform as part of the platform. Sen. McCain says payment systems should be reformed to only reward quality, that we should energize an innovative insurance market and that we need to re-introduce personal responsibility for behaviorally influenced disease. He says any reform that doesn’t primarily address cost will miss the mark, as the Massachusetts experience indicates. Insurance is just a way of shifting around who pays the bill; the problem is that the costs are too high. Sen. McCain believes the route to improvement is more vigorous competition in the insurance markets, and that it will need to be a continuous effort, not a one-shot deal.

Dr. Patel said the first principle of the Obama plan is what health care should be, not just what happens when you’re in the doctor’s office. His plan requires transparency of results. He has not been opposed to a mandate for individual insurance if that is the judgment of Congress. Sen. Obama doesn’t want to have a “my way or the highway” attitude about a specific plan, but to have some core principles underlying the discussion, and then work together to develop a solution.

In tomorrow morning’s breakout sessions we will have three groups identifying the action steps the federal government should take.

In the follow-up, Pearlstein said the problem with mandates is that in America it’s difficult to force people to do things; the real goal of mandates is to get money from young, healthy people who can afford to be part of the system, so you can afford to pay for them when they do need care. McGlynn said that highlights the heterogeneous nature of the uninsured: a third have the money but choose not to have coverage; a third qualify for government programs but haven’t enrolled, and the other third are the ones truly squeezed.

Hayes said you can’t eliminate the pre-existing condition issue unless you have an individual mandate; you can’t let people just buy in when they get sick. Pearlstein said the problem with the mandate is that most candidates won’t let the young and healthy opt for a truly catastrophic plan. That’s why the prices get so high that young people won’t want to comply with the mandate.

Dr. Davis says the one “third rail” of the health reform debate is employer-funded coverage; it’s something 160 million people have, and people will be fearful of losing it. Pearlstein says the move away from reliance on employers to something more portable should be gradual and natural, not an abrupt, anxiety-inducing change.
Go to the video archive to see this full session.