Diagnostics & Imaging Week Washington Editor

WASHINGTON — The healthcare debate usually pits Democrats against Republicans due to legitimate philosophical differences about the respective roles of the private and public sectors. So forging a bill that pulls in enough members of both parties and getting it to the White House has been nearly impossible.

However, at least one member of the U.S. Senate, Ron Wyden (D-Oregon), is convinced that the stars are sufficiently aligned to give such a bill a chance.

At the beginning of the Senate Budget Committee hearing last week, committee chairman Kent Conrad (D-North Dakota), said that where healthcare cost projections are concerned, demographics “are a significant factor.” But he added that “the 800 pound gorilla is healthcare expenditures. It can swamp the whole [economic] boat.”

Saying that projected Medicare and Medicaid expenditures in 2050 will be larger than the entire current federal budget. He described these two programs as the vehicles for a “demographic tsunami.”

“We incentivize treatments, and if you incentivize treatments, you’re going to get a lot of them,” he said. However, he added the optimistic proviso that with appropriate reforms, “we can get dramatic savings” and not compromise care.

Sen. Judd Gregg, (R-New Hampshire), the ranking GOP member, said “there’s no magic wand that will solve the problem,” and that among the necessary ingredients for the current effort are healthcare information technology (HIT), transparency in terms of provider quality and market approaches to payment and care delivery.

Wyden, a member of the budget committee, quipped that “we have only been on the cause of fixing healthcare for about 60 years,” but that three elements in the current environment now make a fix possible.

First, much of corporate America “has done an about-face,” he said, from the positions they took in 1993, when then-First Lady Hillary Clinton offered a comprehensive reform proposal.

The second hopeful augur, Wyden said, is that “new alliances have formed that we didn’t see in 1993,” including substantial overlap in the positions of labor unions and many corporations.

The third hopeful sign he cited is “an ideological truce” between Democrats and Republicans, with the latter “acknowledging the need to cover everyone” and the former having “come a long way as well” in recognizing that government alone cannot fix the problem.

Thus Wyden feels that the time is right for the Healthy Americans Act, or S. 334, which he and Senator Bob Bennett (R-Utah) are co-sponsoring.

Wyden dismissed what he said is “the popular wisdom is that [healthcare reform] is too big, too complicated. People say there are too many lobbyists” and those with coverage prefer “the devil they know to the devil they don’t know.”

Wyden said, “We’ve got mostly sick care. We don’t have healthy care and we don’t have prevention.”

He said that in his town hall meetings on healthcare, attendees say, “we want coverage like you have in Congress,” and that the Lewin Group (Falls Church, Virginia) claims that everyone in the U.S. could have the same kind of coverage Congress has, given the national figures.

Wyden said that Medicare and military care “ought to be left intact,” but that the 160 million covered by employment-based insurance present an opportunity.

“The employer ought to cash them out” so that both employer and employee win “with the very first paycheck,” he said.

Under the Wyden/Bennett proposal, employers would pay employees the amount that the employer would ordinarily send to an insurer on that employee’s behalf, said to be a sum of $10,000 in many instances. However, the Wyden plan would disallow taxation of this money.

Employees would be able to sign up for any of the plans available in their area, and insurers “would no longer be able to cherry-pick” enrollees, Wyden said.

Bennett said, “I believe Congress needs to address healthcare reform this session” and that sufficient common ground exists to get it done. He said that the current political scene constitutes the perfect conditions for change.

These perfect conditions include the fact that no incumbent will run for the presidency in 2008 and Democrats are itching for change.

“Now is an ideal time for Congress to pass comprehensive healthcare reform,” Bennet said.

Wyden then fielded a variety of questions about the proposal.

Gregg asked if the plan isn’t “basically a voucher program?”

Wyden replied: “let’s not characterize it as a voucher program. That’d be the kiss of death.”

Gregg then asked how he could be sure that consumers will use the healthcare checks wisely.

Wyden responded: “once that person has the money in their pocket and has choices in healthcare ... they look for a variety of choices” that will give them the best value for the money, suggesting that most consumers will avoid waste because they can pocket any savings.

Conrad said he liked the plan, but “the devil’s in the details.” And he asked Wyden who would decide on the required minimum healthcare package.

Wyden said “we had a big debate about how to set the minimum package,” and the bill’s sponsors chose “the middle range of packages available to members of Congress.”

One of the witnesses, Arnold Milstein, MD, medical director of the Pacific Business Group on Health (San Francisco), did not refuse to endorse the bill, but said that “healthcare reform should initially focus on the 30%-40% of waste” in healthcare.

“This is a critical focus” and would allow “greater investment in quality of care,” he said.

Milstein, a member of the Medicare Payment Advisory Commission, said payers must motivate physicians to conserve resources to the levels seen by their more efficient peers and that several entities that had invoked such consumption benchmarks experience much lower rates of growth in healthcare costs than the national average.

As to why payers should focus on doctors, Milstein said physicians are “the highest leverage point, because state law” gives them independence in terms of treatment, but they influence healthcare behaviors more effectively than anyone else in the chain of events.

Milstein said few employers have sufficient data to make such comparisons, using the Medicare database, which he called “the only such database of sufficient size” to generate the needed data.