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James Floyd, M.D.

James Floyd, M.D.

Posted February 27, 2009 | 10:39 AM (EST)

Behind Closed Doors, Repeating Mistakes from the Past on Health Care Reform


Last week, The New York Times reported that Senator Ted Kennedy has been holding secret meetings with lobbyists to reach "consensus" on a proposal for national health care reform. Included in the list of participants were America's Health Insurance Plans, the National Federation of Independent Business, and the Pharmaceutical Research and Manufacturers of America -- some of the same players who defeated the Clinton health care reform effort 15 years ago. Notably absent was Physicians for a National Health Program, the California Nurses Association, Healthcare-Now, and other advocacy groups that oppose the private insurance industry and support the creation of a national single-payer program.

According to the Times, lobbyists have discussed increasing health care coverage by subsidizing the purchase of private insurance and expanding public programs. This was the approach taken in Massachusetts following the passage of the Massachusetts Health Reform Law in 2006. Touted as providing universal health care, it expanded and modified Medicaid, subsidized skimpy coverage for those not poor enough to qualify for Medicaid, and imposed financial penalties against those who didn't purchase insurance. This reform has been hailed as a bipartisan success and appears to be favored by both President Obama and Senator Kennedy.

But what has been the result of the Massachusetts reform? A report released last week by Physicians for a National Health Program and Public Citizen documents that as much as 5 percent of the state remains uninsured -- a decrease of only half from the baseline rate of 10 percent and a far cry from universality. New financial barriers, such as co-payments for medications and office visits, have led some of the poorest patients to interrupt care for life-threatening illnesses. The additional cost of the reform has topped $1 billion annually, forcing the state to cut funding to the public hospitals and community clinics that provide a crucial safety net for those who cannot afford health care.

Over the past 20 years, similar reform efforts have been attempted in other states -- Oregon, Minnesota, Tennessee, Vermont, Washington, and Maine. Because these incremental reforms did not address the problems and waste created by private insurers, they all failed to significantly reduce the number of uninsured while costs continued to outpace inflation.

The Times reported that a key feature of the Massachusetts reform that has been embraced in the Kennedy meetings is the requirement that every American have insurance, with financial penalties for those who don't. This mandate is a backwards formula for universality, one that can be arrived at only by starting with the premise that the financial interests of the insurance and pharmaceutical corporations are to be protected. According to James Gelfand of the United States Chamber of Commerce, "Forcing individuals to purchase insurance in the current market would be a disaster. Before we even have that discussion, we need to make health care more affordable and improve its quality."

In other words, we shouldn't force people to buy a flawed and unaffordable product. The only fair way to mandate universal coverage is to automatically enroll everyone in a program that provides a single, high standard of care and allows them to pay based on what they can afford, through progressive taxation. Even Nobel laureate and former Clinton economic advisor Joseph Stiglitz "has reluctantly come to the view that it's the only alternative."

There are troubling parallels between Kennedy's secret meetings and the meetings of the Task Force on National Health Care Reform chaired by Hillary Clinton in 1993. Although special interests were officially excluded from the Clinton task force, documents obtained through a lawsuit filed by the National Legal and Policy Center revealed that more than 300 individuals who participated in task force working groups came from the private sector, and included representatives of the insurance industry and small business groups. In addition, a report from the Center for Public Integrity revealed that around the time of the task force, 80 former government officials -- including 12 former members of Congress -- had gone through the "revolving door" to work for health care interests, many of whom actively lobbied on health care reform.

Fast-forward to 2009 and former-Senator Tom Daschle's failed appointment as Secretary of Health and Human Services. The official story focused on his failure to pay his taxes, but what angered most health care reform activists most was his previously undisclosed work as a health insurance lobbyist.

In post-mortems on the Clinton health care reform effort, pundits concluded that it was overly ambitious and too complicated to garner the necessary public support. They also recognized the impact of the highly successful lobbying effort by the health insurance industry -- the "Harry and Louise" television ads -- and the anemic response from the White House. Perhaps what doomed the Clinton effort to failure at an early stage was the inclusion of the very interests that must be fought to guarantee comprehensive and universal coverage to every American.

Yesterday, President Obama released a budget proposal that includes $634 billion to fund health care reform, days before a White House summit on health care reform begins. Like the Kennedy meetings, this summit currently does not include advocates for single-payer but is well-represented by lobbyists for the insurance industry and other groups who oppose fundamental reform.

President Obama, we urge you not to make the same mistake that the Clintons made. Please don't exclude from the discussion the people who are your grassroots support for real change. Although people in your meetings may be telling you otherwise, there is tremendous support throughout the country for a single-payer system. Give us a seat at the table if you truly want to build consensus around health care reform.