Medical Device Daily Washington Editor
WASHINGTON – Veteran television reporter Cokie Roberts gave attendees at this year's American Association for Clinical Chemistry meeting an overview of the healthcare debate on Capitol Hill and in the presidential election. With three decades of experience in covering the Hill, Roberts is perhaps uniquely positioned to take the pulse of Congress on such matters, especially since both her parents served in Congress, representing the district of New Orleans.
Roberts' presentation was premised in the query, "How healthy is the healthcare debate?" She said, "The answer to that question is 'where you stand depends on where you sit.'"
Giving a bit of history, Roberts said the healthcare debate is "a different debate from what it used to be." In the 1970s and 1980s, a healthcare crisis "meant that people wanted to go to their own doctor for free and wanted their parents to be able to keep their house.
"Congress kept trying to find ways to expand coverage," she said, noting that one plan that arose during the Reagan administration had the endorsement of the White House as well as Dan Rostenkowski, who at the time held a lot of sway over such policy matters in the House of Representatives. "It turned out everybody liked [the plan] but the recipients.
"At that point, Congress repealed the law, and that was the last thing – other than the Children's Health Insurance Program – that happened in terms of federal expansion of healthcare coverage."
The topic is back, Roberts said, "because there is a sense that the voters want something to change," but "it is not clear what they want. The people who are covered complain about the size of the co-payments" and the revolving door of plans contracted by their employers, while those with no coverage complain about the lack of affordable coverage.
Healthcare dominated opinion surveys as the most important issue for much of the past couple of years, but Roberts said recent surveys indicate that the economy is now the most important issue, with Iraq second and healthcare third.
"We now have two candidates with two very different plans," Roberts said, but "the interesting point is that the radical one comes from the Republican candidate," which would reduce employer-based coverage by eliminating the tax-exempt status of healthcare premiums.
"McCain has no proposal for expansion of public-sector coverage" other than more doctor choices for those covered under Veterans Health, Roberts said. She said that a plan offered by Sen. Ron Wyden (D-Oregon) and a similar proposal by the Service Employees Union International also would eliminate employer-based coverage "because the tax benefits that employers get ... go disproportionately, in their view, to higher-income employees."
This would "free up $200 billion in tax breaks," which "liberals say could go to cover the uninsured" and conservatives would put toward market-based reforms, Roberts said.
"I wouldn't hold my breath for any of this to happen, even if John McCain is elected," she said. The opposition comes not only from Democrats. The 111th Congress "is likely to be significantly more heavily Democratic," she pointed out, but McCain's approach "would also have a tremendous problem with public opinion."
This is because a recent tracking poll indicated that "even though people hate what they have to go through to sign up for their coverage, they don't want to get rid of it." Many respondents, 63%, think it would be harder to select and sign up for coverage under an alternative scenario, and 80% say it would be harder to retain coverage when ill.
"And that's pretty much the general response to anything like a radical notion," which Roberts said also applies to single-payer coverage. "I think you're much more likely to see something like what Barack Obama is proposing," which she described as a patch-together plan covering all children and requiring employers to offer benefits or kick in for a new public program that would help finance access to those with no other avenues of access.
Obama's plan "would also expand Medicaid and SCHIP," Roberts reminded the audience, adding that Obama's campaign says the plan would cost up to $65 billion a year, financed by anticipated savings to healthcare and higher taxes on high income individuals and families.
"I wouldn't hold my breath on that too hard, either," Roberts commented, adding that any comprehensive reform "is more likely to look like this patchwork than like radical change." Part of the reason for this view on her part was that one of the lessons of the Clinton healthcare proposal in 1993 included the lesson that any occupant of the Oval Office "not to come at [Congress] with an etched-in-stone plan and ask them to react."
Roberts said the question now is whether Congress can "do the hard work" and "is willing to come up with a plan." She said "if voters demand it, Congress will absolutely respond," and polling numbers suggest voters will demand reform, largely because healthcare inflation has gobbled up all the increases in income over the past decade.
"What happens if they don't? This could be the case," Roberts said, adding that Congress "will have one further incentive, which is Medicare." A failure to act "makes them look irresponsible ... but they've looked that way before" and might again, she said.
Roberts told Medical Device Daily that it is not a forgone conclusion that meaningful reform of Medicare spending does not have to wait until Generation X has claimed the majority in Congress. However, the necessary ingredients are not easily obtained. "People have to trust each other that the numbers are real," she remarked, adding that "everyone has to hold hands and jump in together."
"People will do something" in a crisis, Roberts said, "and it will have to be Baby Boomers who take responsibility" to see that Medicare spending does not swamp the economy. However, she also said that neither party is going to vote for a plan that eliminates employer-based coverage altogether.