HIT Washington Writer

WASHINGTON – The process this year for fixing the U.S. healthcare system is very different from the failed attempt 15 years ago, President Barack Obama's new White House health czar said last week during a briefing with reporters.

There has been a much greater engagement on the part of congressional committee chairman this time around, and groups that previously opposed each other have become "strange bedfellows" working together in a "remarkably harmonious process," said Nancy-Ann DeParle, director of the White House Office of Health Reform.

"We are making a lot of progress in realizing the president's goal of getting health reform done this year," she said during a news conference sponsored by the Kaiser Family Foundation (Menlo Park, California).

While Sen. Max Baucus (D-Montana), chairman of the Senate Finance Committee, has already scheduled roundtable discussions on health reform, beginning this week, the committee's chairman in 1993 "didn't agree that health reform was a priority," and instead sought first to reform welfare and tackle other issues, DeParle said.

The Obama administration over the past three months has been "vigorously engaged" with Congress in working on a plan for overhauling the U.S. healthcare system, DeParle said, noting that while lawmakers have been on a spring recess over the past few weeks, congressional staffers have been in the office working on specifications and drafting bills.

"We are meeting with them every day and working on the weekends," she said. "This is very active work that is going on."

DeParle noted that she spends about 75% of her time with congressional staff, with the remainder being spent on traveling to communities to hear directly from Americans or meeting with stakeholder groups.

Since joining the Obama administration last month, DeParle said she has held one-on-one meetings with at least 40 members of Congress from both sides of the aisle and also has met with various stakeholders, including unions, hospital and provider groups and consumer organizations.

"No one wants the status quo," she declared.

Unlike the effort 15 years ago, DeParle said, "Congress has put its money where its mouth is and has already enacted a budget resolution with healthcare reform" included.

While lawmakers may not agree with "every single point" in the president's plan, DeParle said, "they are all saying that they want to work with us constructively."

She noted that by October of President Clinton's first year in office, there were at least a dozen bills before Congress on health reform, including a 1,400-page plan proposed by the Clinton administration, with no consensus.

However, DeParle said, "this time around it's only April," with expectations that there will be bills in both the Senate and the House ready for a vote by this summer.

One of the president's main goals has been to create a public health insurance plan, similar to the plans that cover government employees and members of Congress, which would be available to all Americans.

However, many Republicans and private insurers oppose the idea, arguing that the costs would be too great for taxpayers to bear and that it would put private insurers in an unfair position of competing against the government's ability to provide lower payment rates.

But DeParle argued that the resistance is more from a misunderstanding about how a public plan works.

A public plan, she said, would provide a mechanism to lower costs and would help keep the private sector honest by providing competition, which DeParle said are goals that nearly everyone has agreed must be achieved for healthcare reform to be successful.

"If there are other ways to do that," she said, the president "would be open to it."

A public health plan would have little to nonexistent administrative costs, because it would be sponsored by the government, DeParle maintained.

However, she said, such a plan would operate under the same types of rules as private health insurance plans.

DeParle noted that many state employee health plans are really just public plans. She insisted that a public plan would more than likely have payment rates similar to private insurers, which would ensure fair competition.

"There are policy ways of getting around some of the objections people raise," DeParle said.

But, she added, "if it is a philosophical debate, that may be another thing, and people may not be able to agree."

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