Medical Device Daily Washington Editor
WASHINGTON — The healthcare reform movement has not lost steam here in the nation's capital, but is unlikely to budge this year, thanks to the elections. That fact, however, is insufficient to blunt the appetite of the Senate for a conference on the topic, replete with lofty rhetoric about bipartisanship.
The event's organizers tried to tamp down expectations by informing them that this event was designed to set the stage for 2009, but the most sober moment was provided courtesy of the chairman of the nation's central bank, who told attendees that virtually any sweeping changes are likely to boost, not trim, the cost of healthcare in the U.S., at least in the early going.
Sen. Max Baucus (D-Montana), chairman of the Senate Finance Committee, said going to the moon "sounds like a piece of cake compared to reforming healthcare." He attempted to sound a big-tent tone by stating that such efforts "will succeed only if we work together and think outside the box."
Baucus asserted that there is "solid agreement that too many Americans lack access" to coverage and that some believe that "solving the cost and coverage problems will fix the quality problem." Still, he claimed "we're not here to push an agenda," but to "lay the groundwork for next year."
Sen. Chuck Grassley (R-Iowa), the ranking member of the Finance Committee, said reform "will happen in the very near future" and described healthcare as the "number one economic issue facing our country" as well as "the No. 1 political issue." Grassley also asserted, "We also know that we can't fix our healthcare system just by finding ways to cover the uninsured."
Grassley said the U.S. cannot follow the road traveled by other Western nations. "We need a uniquely American solution," he said, pointing out that a big problem on Capitol Hill is that "it is so easy to kill legislation in Congress ... and difficult to pass legislation." He also decried the "protection of narrow interests."
"I challenge you to compromise as you will challenge me to compromise," Grassley said.
The next speaker was Ben Bernanke, PhD, chairman of the Federal Reserve Bank, who opened by reassuring the audience that he is keenly aware that "improving the performance of our healthcare system is one of the most important challenges our nation faces." He said new therapies promise further medical miracles, but said that "the decisions that we make about healthcare reform will" influence much of the larger economy.
"By any measure, healthcare represents a major portion of our economy," Bernanke said, and is "the largest single component" of household budgets, even larger than food and housing. He also reminded attendees that some projections call for healthcare to consume 30% of GDP by 2030.
He warned, however, that reform should not jettison the existing strengths of healthcare in the U.S, which he said "has many."
Access, Bernanke said, is "the first challenge healthcare [reform] must address." He said the uninsured incur roughly half the cost of those who have insurance, and are 37% more likely to die from car accidents and significantly more likely to die from cancers due to later-stage diagnoses.
The second issue is quality of care, which Bernanke said "is generally very high" despite the fact that "inconsistent use of best practices by doctors and hospitals" remains an issue. "More widespread application of evidence-based medicine" could change much of this dynamic, he said.
"At some point, healthcare spending [growth] as a percentage of GDP will stop," if only because of the threat of a bankrupted economy, Bernanke said, but he admitted that he could not forecast when such a state of affairs might prevail.
Device makers got a small message nested in the larger message. "The health benefits of new technologies ... have generally exceeded the cost," Bernanke said, but he also said that the inflation fed by new therapies is a significant factor in healthcare inflation.
"The effects of healthcare costs deserve special notice," he said, but in reference to the access problems connected with higher costs, "the government may have to absorb an increasing share of healthcare costs."
Bernanke did not recommend that policy makers put the pedal to the metal, however. "We may need to first address the problems that seem more easily managed," he said.
"People who are not insured are not all alike," he remarked, citing as examples those who are not insured due to affordability issues, those whose access is hindered by a pre-existing condition, and those who do not purchase insurance simply because they do not anticipate a problem.
As for mandatory insurance enrollment, Bernanke said that supporters argue that full enrollment is needed to provide the necessary risk pooling while opponents dislike mandates because they infringe on individual choice,
Is employer-provided insurance a good idea? Perhaps, but the preponderance of this model (158 million Americans get their coverage this way) "means that the market for individual plans is underdeveloped" and that labor mobility is impeded, he said.
Bernanke said that vertically integrated systems, such as Veterans Health, "are more adaptive and respond more quickly" to the need to change, but he also said there will be no free lunch.
"The solutions we choose for quality and access ... will almost certainly raise the [overall] cost as well," he said. Bernanke also pointed out that more exhaustive screening will catch diseases that had gone untreated and hence will boost spending, but also said "this is not a reason" not to expand access.
He cautioned against the prospect of losing babies with bathwater, stating that "as we focus on the problems of our health system, it is easy to forget what is good about it," naming the advances in care provided courtesy of medical technology and pharmaceuticals. "We must take care to maintain the vitality and the spirit of innovation that has been its hallmark."