In a post titled ‘Why big reform won’t happen in 2009,’ Joe Paduda of Managed Care Matters responds to our argument that the economic crisis demands health care reform. While recognizing, to some degree, that Congress cannot help American families or address the economic woes “in a lasting, meaningful way without health care reform,” Paduda argues that a lack of cost containment measures render comprehensive health care reform unaffordable:

While I applaud their motives, perspective and logic, I would also note that their piece completely misses the big point, a point they themselves explicitly acknowledge. None of the health care reform initiatives presently before Congress (except for the Wyden-Bennett bill), nor President-elect Obama’s health reform platform address costs.

A recent analysis of Barack Obama’s proposal by PricewaterhouseCoopers’ Health Research Institute priced Obama’s plan at $75 billion a year, with over one-third of the costs coming from existing funding for the uninsured. The group did agree with Paduda, noting “unless successful cost containment strategies were put into place, growing health care costs will increase the costs of Obama’s plan.”

Fortunately, Obama did not leave cost contain containment out of his proposal. In fact, just this summer CAPAF released an analysis of Obama’s cost-containment strategies. The report recognized that while universal health care reform would require an upfront investment in coverage and health care infrastructure, Obama’s containment measures would also help bring down health care costs and make covering all Americans more affordable.

Here are the specifics:

- Expanding Access Contains Costs: By extending coverage to all, Obama can achieve efficiencies, end cost shifting and rationalize
financing mechanisms. As Bookings Institute economist Henry Aaron points out, broadly expanding coverage is “a precondition for effective measures to limit overall health care spending.”

- Harness Market Power of Group Purchasing: Through Obama’s proposed insurance exchanges, small purchasers and individuals achieve greater clout vis a vis insurance companies. Small purchasers would enjoy greater choice of health plans, greater choice of provider networks, and lower premiums than they experience today.

- Emphasize Prevention: While the United States spent $132 billion in 2002 treating Americans with diabetes, just $70 billion went to the prevention of all diseases. It can be difficult to quantify the possible savings from expanded prevention efforts, but experts estimate that just ensuring that every child receives every routine vaccination could reduce direct and indirect health care costs by up to $40 billion over time.

- Improve Information On Effective Treatments: Today, Americans are likely to receive the appropriate care just half of the time, and approximately one-third of individuals seeking care are likely to experience a medical error such as a medication mistake or the wrong lab results. Improving quality could help save lives and contain costs. Estimates of savings go as high as 150,000 lives and $100 billion every year.

- Greater Use Of Information Technology: Less than 25 percent of hospitals, and less than 20 percent of doctor’s offices, employ health information technology systems. Estimates vary, and real-life experience is limited, but one group of researchers finds that implementing health IT would result in mean annual savings of $40 billion over a 15-year period.

- Better Management Of Chronic Disease: Treating the 90 million Americans with chronic conditions costs about $1.2 trillion a year, or approximately two-thirds of national health care spending. Better care for individuals with these conditions can translate into substantial savings. If every diabetes patient received the appropriate primary care for their condition, for instance, then national health care spending would fall by $2.5 billion.

The Washington Times fired off two separate editorials today criticizing incoming Health and Human Services secretary Tom Daschle’s Federal Health Board initiative and progressive health care reform. Universal health care “would also reduce consumer choice and drive many private insurers out of the market,” the Times claimed:

Although his board would technically have no say on the 68 percent of health care that is provided through the private sector, Mr. Daschle modestly adds: “Congress could opt to go further with the Board’s recommendations. It could, for example, link the tax exclusion for health insurance to insurance that complies with the Board’s recommendation.” Those last 19 words would spell the end of independent private-sector health care in America. [Tony Blankley]

It would result in massive increases in federal spending, higher federal taxes and taxpayer debt being passed on to our children and grandchildren. It would also reduce consumer choice and drive many private insurers out of the market, leaving all but the wealthiest Americans with little choice but to receive care from the resulting government monopoly. [Washington Times]

The attacks are certainly reminiscent of the conservative effort to mischaractarize President Clinton’s health care reforms. In 1993, the Heritage Foundation labeled Clinton’s plan “a massive top-down, bureaucratic command-and-control system that would meticulously govern virtually every aspect of the delivery and the financing of health care services for the American people.” An influential editorial published in the Wall Street Journal by the Manhattan Institute similarly described the Clinton plan as a “coercive” proposal that “takes personal health choices away from patients and families.” [Health Plan's Devilish Details, WSJ, 9/30/1993]

Fifteen years later, conservative talking points — however consistent — still don’t match reality. In truth, Tom Daschle supports the breadth of progressive health care initiatives: 1) an insurance exchange that allows private plans to compete with a new public plan 2) expansion of Medicaid and SCHIP 3) subsidies for Americans who can’t afford to buy insurance.

Rather than relying on the government to provide care, progressive prescriptions are rooted in the philosophy of shared responsibility in which every player in the health-care arena — the government, employers, doctors and hospitals, insurers, and individuals — help support a rational, sustainable system.

Daschle’s Federal Health Board that would resemble the current Federal Reserve Board for the banking industry. The Board would ensure harmonization across public programs of “health-care protocols, benefits, and transparency” and would set “evidence-based standards for benefits and quality for federal programs” in the hopes of lowering the complexity of different insurance regulations and ultimately lowering costs. “These standards would apply to federal health programs and contractors and serve as a model for private insurers,” Daschle writes in his book.

Reigning in unsustainable health care spending and providing a model for private insurers is far from a doomsday conspiracy. Consider Massachusetts’ landmark health reform law. The legislation built “upon the existing health care system, with expansions to Medicaid, subsidized coverage for people with low incomes, and reform of private insurance markets.” Far from forcing bureaucrats into consult rooms or spelling “the end of independent private-sector health care,” the legislation increased access to meaningful coverage. In fact, since the program’s launch in June 2006, 439,000 more people have enrolled in health insurance, and nearly half of them signed up for private insurance not funded by taxpayers.

Without offering any alternatives, ideological conservatives are now gearing up for another health care fight. Unfortunately for them, things have changed since the 1990s. This time around, “what’s really exciting about the stakeholders is no longer are they saying that the second-best choice is to do nothing.”