Today, the House Democratic Steering and Policy Committee held forum to highlight the urgent need for comprehensive health insurance reform. Democratic Steering and Policy Committee co-chairs Rep. George Miller (D-CA) and Rep. Rosa DeLauro (D-CT) chaired the forum, featuring a panel of experts on health insurance, the health insurance industry, and health insurance reform.
Speaker Pelosi opened the forum:
As President Obama has said: 'Health insurance reform is entitlement reform.' We must reverse the upward spiral of increasing cost, which again, adds an additional priority to our budget and to future generations. We have a moral responsibility to stop that and to reverse that.
We also have a moral responsibility to pass health insurance reform and we will do so this year. It is a moral imperative, a health issue, it is an economic issue. I believe that we can do so best by increasing competition, and by increasing competition we will again, improve quality, lower costs, expand coverage, and maintain choice. I believe that a public option is the best way to do that.
I look forward to hearing from the testimony of our expert witnesses. I thank them for their leadership in their fields, for their presence today, and I look forward to benefitting from their wisdom.
Karen Davis, President of The Commonwealth Fund:
“We must change course…spending is the US is twice per-capita of what it is in other countries. We're now spending 17% of the nation's economy on health care — it will grow to 21% by 2020 if current trends continue. Health insurance premiums are now 18% of family incomes and they will increase to 24% by 2020 if we continue on our current course. Nor are we getting value for what we're spending — the US ranks last on many indicators of health and quality of care.”
John Arensmeyer, Chief Executive Officer, Small Business Majority:
“Behind the statistics, though, there are millions of individuals struggling with medical bills and keeping their businesses afloat. We hear stories every day from small business owners who can't get coverage because they've been sick in the past or the health plans they are offered are outrageously priced. Louise Hardaway, a would-be entrepreneur in the pharmaceutical products industry in Nashville, had to give up on starting her own business after just a few months because she couldn't get decent coverage–one company quoted her a $13,000 monthly premium for herself and one employee.”
Jacob Hacker, Stanley B. Resor Professor of Political Science, Yale University:
“Without a public plan as a backup and benchmark, insurers will still have ways to maximize their profits at the expense of health security, driving up premiums and out-of-pocket costs. A competing public plan is a backstop…public insurance has much lower administrative expenses than private plans, it obtains larger volume discounts, it does not have to earn profit, and the experience of Medicare suggests that it has a superior ability to control spending while maintaining broad access over time.”
Thomas Priselac, American Hospital Association (AHA) President and CEO of Cedars-Sinai:
“The people of our hospitals are fully committed to reform because we see every day how good our health system can be but also how much room there is for improvement. We commend the House Committees for taking a major step in this decision by expanding health care to the uninsured…achieving this goal requires a shared responsibility among all stakeholders. This includes an individual mandate, employer responsibility, and government subsidies for those that need financial assistance.”
Mary A. Maryland, PhD, MSN, APN, BC American Nurses Association:
“Every day, nurses know firsthand and see the heartbreaking consequences of patients having outcomes that we don't like in relationship to our nation's flawed system. We hold a patients hand when they learn that their health insurance has been canceled or denied and on occasion, we even see subsequent death related to delayed treatment. This is why ANA remains committed to the principle that health care is a basic human right and that all persons are entitled to access readily available, affordable, quality health care services. ANA strongly supports the inclusion of a public health insurance option as a central part of reform.”
Wendell Potter, Former Communications VP/Spokesperson for CIGNA:
“The practices of the insurance industry over the past several years have contributed directly to the growing number of Americans who are uninsured and the even more rapidly growing number of people who are underinsured. H.R. 3200 would go a long way toward making many of the standard practices of the industry illegal while providing much-needed assistance to low and moderate income Americans who cannot afford the overpriced premiums being charged by the cartel of large for-profit insurance companies that now dominate the industry.”
Bonnie Cramer, Chair of the AARP Board:
“At AARP, we believe that health care is not a Democratic issue. It’s not a Republican issue and it’s not about political gamesmanship. It’s about people’s lives. That’s why we believe that health care reform must fix what is wrong and preserve what is right. We have been working hard to cut through the noise and find the facts about what health care reform means for our members and their families. Unfortunately, some groups have been using scare tactics such as the notion that health care reform would ration care, would hurt Medicare or result in a government takeover. These statements are just a few of the many falsehoods that are being spread and is a block to the enactment of true health care reform.”
Rep. John Dingell (D-MI) asks J. James Rohack, MD, President of the American Medical Association (AMA), about the AMA’s support and thoughts on America’s Affordable Health Choices Act and the end-of-life counseling provisions in the legislation:
“Under the current law, when a Medicare beneficiary enters the hospital they’re asked do they have an advanced directive, and if they do not, they’re given their advanced directive materials by many times, the hospital clerk. We believe that’s the wrong time to have that conversation. We believe the conversation between the patient and the physician on what the patient wants to happen if they have a catastrophic illness should occur when the patient’s healthy. But because we’re talking about the Medicare program, it takes an act of Congress to be passed to have Medicare pay for anything…we just think that there’s a better way for it to occur and that’s as an outpatient at a time when the patient isn’t in a critically ill situation where it’s very difficult to have a good conversation.”
Chairman David Obey (D-WI) asks Professor Jacob Hacker to “unconfuse” him on the role of government in current health programs:
“Rep. Obey:Is Medicare a public program?
Rep. Obey: Is Medicaid a public program?
Rep. Obey: Is our Veterans health care system a government system?
Rep. Obey: Is the NIH which does the research on health care in this country, are they a government or a private operation?
Hacker: Yes. They are governmental.
Rep. Obey: What about SCHIP? Is that a government program?
Hacker: It is. I mean, it is administered at times by private carriers and there are private plans, but yes, it is a government program.
Rep. Obey: Well, thank you for unconfusing me.
Rep. Rob Andrews (D-NJ) asks Dr. Hacker about his testimony on co-ops saying, “you’re skeptical that co-ops would succeed because they would face the same problems in breaking into markets that smaller private competitors face today. What are the major problems that private competitors face into breaking into markets that are not their home markets?”:
“HackerWell, the primary problem can be summed up as the chicken and an egg problem. If you do not have a substantial network of participating providers, it’s almost impossible for you to gain subscribers, much less to get good rates, but it’s very difficult to build a substantial network of providers when there are several that dominate the market already. In 9 states, the largest insurer enrolls more than 70% of the privately-insured population. Some states, like Alabama, that number is above 80%. 17 more states bringing to 26 in total have more than 50% of the market dominated bit largest private insurer…
Rep. Andrews: So how does the public option get around this problem of building a viable provider network and therefore inducing real competition?
Hacker: It does it quite simply by building on the basic infrastructure of Medicare. This is why I'm emphasizing that it’s quite important to have a presumption of participation, of providers, who deliver services to Medicare beneficiaries.
Rep. Mazie Hirono (D-HI) asks the panelists about health co-ops saying, “I'd like to hear the views of Mr. Potter and Dr. Rohack regarding co-ops and their ability to provide competition and accountability and for Dr. Rohack, especially, in light of a recent poll of doctors indicating over 60% of them support a public option and some 10% of them support a single payer system:
“Potter:I don’t think co-ops have a chance to succeed or compete. It’s very hard to overcome the barriers in any given market to be able to sell insurance and the big insurance companies have very big economies of scale. The co-op just could not ramp up or have at any point… you have to buy your way into them unless you’re already there and the co-op wouldn’t have the resources to able to do that. They just would not have a prayer to be able to compete with the big, dominant companies.
Dr. Rohack: I think if we were in this room back in 1973 and ’74, that was the last time Congress did something to try and control health care costs, and that was creating federal grants to create health maintenance organizations, and if you take a look at the HMOs where they created the federal grants that are community based, the dollars stay in the community…you have other community-based models that seem to work. It was only when the consolidation became a problem that we have developed the current situation we’re in right now. So that would be the only concern about co-ops — is that what would prevent them from consolidating in ten or 15 years from now? We'll be back right where we are now dealing with large, national companies that don’t provide choice at a local level.”
Read prepared remarks from the panelists: