'Yes We Can'... Because We Must

Wednesday morning, June 24th I left Boston on my way to Washington DC and after that Bethesda Maryland for a few days. In DC in the morning I was one of eight people from Massachusetts, who believe “Massachusetts is not the model”, to meet with some of the people that were going to be in the White House that evening for President Obama’s town hall meeting on national health reform which aired on ABC to talk about health reform in Massachusetts. I gave them my morning copy of the Globe I picked up at Logan and read on the way down. The front page story (above the fold) was about the projected cuts of $115 million from the state’s health care budget. The front page of the Metro section (again above the fold) was a story on the State Treasurer saying that the Massachusetts experiment in “health reform was too pricey.” In the afternoon I took the Metro to Bethesda to attend a conference of the Agency for Healthcare Research and Quality (AHRQ) to discuss the role of primary care practice based research networks in helping move the AHRQ agenda promoting and funding in the area of comparative effectiveness research, a necessary strategy in national health reform aimed at getting a better return on investment of the health care dollar in regard to efficacy and quality. That night I watched the President on ABC.

The next day, Thursday, I attended a rally organized by Health Care for America Now (HCAN) at the Capitol and was hyped by the overwhelming display of support for health reform from communities, organizations, and workers from across the country. I spent the day talking with legislators, staff and policymakers, including our own John McDonough who came out of a Senate committee mark up session to meet with us.

Friday morning I attended the closing of the AHRQ conference in Bethesda and had an afternoon meeting with some officials in the Health Resources and Services Administration in Rockville. It was an exciting and validating few days with the positive buzz around health reform. There was but one degree of separation between me and the Senator, me and the President, and reform seemed all but assured.

A month later on Wednesday morning, July 22nd I’m in Boston on my way to work hearing on the morning news shows about the President’s press conference scheduled for that evening and how national health reform is in jeopardy of failing due to Republican opposition and some renegade Democrats. Republicans see it as the President’s Waterloo and the so called Democrats see it as too expensive. That evening President Obama made a powerful and compelling case for why we must succeed at national health reform. He articulated all the reasons. He outlined the consequences of inaction. The cost of health care is making the country less competitive in a global economy. As a nation we spend more on health care than any industrialized nation in the world that manifests in less health. Health reform is an essential strategy in the turnaround and revitalization of the economy. More and more Americans are losing their health insurance everyday, the result of job loss or unaffordable premiums. We cannot afford to wait … the time is now.

Massachusetts health reform has been at the center of the national discussion and debate and seemingly the preferred model for a national program and while it is not the model the Massachusetts experience provides valuable lessons worth learning.

Universal coverage is a valued principle and what we want in an equitable, quality health care system. However, without addressing escalating costs it is unaffordable in the short term and unsustainable over the long term. Health care costs in Massachusetts continue to rise faster than the national average and in the face of the current fiscal crisis the state cuts $115 million from Commonwealth Care, threatens the removal of 30,000 working, taxpaying, legal immigrants, and the largest safety net hospital is threatened with bankruptcy.

Cost containment and control has to be a priority in any model of reform as escalating health care costs threaten the bottom lines of businesses, the household budgets of families, and the viability of the US economy. High premiums from insurance companies result in enormous profits (surpluses in non-profit vernacular) as they pass on more to the consumer in co-pays, deductibles, and other out-of-pocket expenses. Several strategies may lead to cost containment such as price controls, strict hospital budgets, pay for performance, investments in prevention, even tort reform, and all should be tried.

A public option, yes a Government run heath plan, is essential as one other strategy for cost containment is “free market competition” and a public plan to compete with the private insurance industry is just what the people need. Despite the assertions of those that use the scare tactics about government run health care, we already have a government run plan and it must be unknown to them that Medicare consumers express the highest satisfaction rates of all consumers of health care in America.

Budget neutrality is a Washington term that requires health reform to pay for itself. The Massachusetts health reform principle of shared responsibility provides an important lesson. So a proposed tax increase on income of those more wealthy Americans after the dramatic cuts they enjoyed under the last administration seems fair. The offer of $80 billion from the pharmaceutical industry should be looked at, to see if we can get more. Increase “sin” taxes on alcohol and tobacco and impose “health risk” taxes on sugar sweetened beverages such as soda and energy drinks. Repeal deductions for medical expenses, and eliminate Medicare Advantage plans administered by insurance companies.

The American health care system is in crisis. All of the warning signs indicate its eminent collapse. They time to act is now before we find ourselves reacting like we did with the financial crisis. The time is here … Health Care for America NOW!

Elmer Freeman is Executive Director of the Center for Community Health Education Research and Service and Director of the Office of Urban Health Programs and Policy, Bouvé College of Health Sciences at Northeastern University

This program aired on July 24, 2009. The audio for this program is not available.


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