Bill aims for public to drive health reform

Legislation sponsored by Sens. Ron Wyden and Orrin Hatch would mandate forums to assess public opinion on how the U.S. health care system should work.

By Joel B. Finkelstein, AMNews staff. Dec. 9, 2002. Additional information

Washington -- The latest news about the condition of the nation's health system has been anything but good.

The number of uninsured Americans grew to 41.2 million last year. Health insurance premium increases are again in the double digits. And several former Dept. of Health and Human Services secretaries, who gathered recently to tape a television show for PBS, reportedly described the American health care system as "a mess."

Yet Congress has been shy of big ideas for reform since the failure of President Clinton's plan in 1994.

Now, two senators have come up with a concept they say would introduce fresh ideas and opinions from outside of Washington.

The Health Care That Works for All Americans Act promises to let the public "jump-start health reform by stating their priorities from the outset, rather than being treated as an afterthought," Sen. Ron Wyden (D, Ore.) told the Senate when he introduced the bill in October.

Co-sponsor Sen. Orrin Hatch (R, Utah) said "the legislation ... will stimulate fruitful discussion and debate on how we can really effect improvements to our nation's health care system -- improvements that can be accepted at all levels, from communities on up to the federal government."

AMNews last month asked Wyden some questions about the proposed bill.

Q: What is the goal of the legislation?

A: It's to create a health care system that works for all Americans. The fact is that essentially the same thing has been tried for 57 years, going back to Harry Truman's efforts in 1945. What happens is a politician writes a bill in Washington, D.C.; interest groups attack it; the public is understandably confused; and then nothing happens.

I have gone back and tried to assess what needs to be done differently. Our initiative has four touchstones.

The first is get the public involved from the outset, in terms of getting their sense of what needs to be done. The second is to ask three questions: What services are essential, what are they going to cost, and who is going to pay? The third is to guarantee a vote in the Congress on what comes from the citizens. And the fourth is that it be bipartisan.

Q. Is the objective to have universal health care?

A. When Republicans hear the words universal coverage, many of them get uncomfortable. It implies big government, lots of taxes, a command-and-control bureaucracy.

When Democrats hear the phrase "access to care," they feel uncomfortable because they think people might get access but they'll never be able to afford it.

So what Sen. Hatch and I have done is to go back and forth between the various groups on the political spectrum to find a concept that would be acceptable to both sides. The one we have in the title of our bill, a health care system that works for everybody, is something that bridges the philosophical gap.

Q. Who do you envision participating in the forums called for in the bill?

A. The membership of the Citizens' Health Care Working Group is spelled out in the bill. It's business people, consumers, labor. In terms of public participation, people would be involved in the community meetings but also online. Doctors are specifically named as participants in the working group. Physicians could also participate in the public part just like everyone else.

Q. What do you think are the chances of passing this bill next year?

A. We have had a lot of interest on the House side. With Orrin Hatch, who is the second ranking Republican on the Senate Finance Committee and the Chair of the Judiciary Committee, I think that opens some eyes. And I am going to do everything I can to push it early next year. I think we are going to be able to build a very good business-labor coalition, as well. I spoke yesterday with Secretary of Health and Human Services Tommy Thompson, who was very supportive. I feel good about our ability to pick up support.

Q. What would you hope to see in legislation spawned by this public discussion?

A. What I really want us to zero in on is health care that is essential, effective and affordable. We need to lay out for people the alternatives and proceed from there.

Q. So you see this more as a public debate or education, and not just a way to generate new legislation?

A. Yes. For example, someone attending a community meeting stands up and says that they think there should be long-term-care coverage funded by the government. At that point, the person running the meeting might refer the speaker to a page in the health care report that shows it will cost him or her X amount of dollars per year starting at the age of 48. That's the way I see this unfolding.

Q. How much would you expect implementation of the bill to cost?

A. We would authorize $9 million over three years, funded by Congress, for the purposes of carrying on the meetings and bringing the public into the debate.

ADDITIONAL INFORMATION:

Power to the public

The Wyden-Hatch bill would set into motion a sequence of federal agency and congressional actions that promises a novel approach to health care reform within three years of enactment. The legislation mandates creation of a 26-member Citizens' Health Care Working Group with the following tasks:

Hold public hearings to discuss issues related to the health care system in America.
Produce a simple and accessible report on the current state of the health care system.
Hold community meetings to gather information on what the public wants from health care reform.
Produce a report from which legislation can be drafted and voted on.

GOVERNMENT & MEDICINE