Stanford Medicine Newsletter Updates For the Local Community

Uncertain prognosis for health care changes



There is growing public pressure for healthcare reform, which was a focal point of Barack Obama’s presidential campaign. But the reality of economic recession, as well as a fractious po-litical system in Washington, makes major change difficult to achieve, even in the best of times.

So is there a chance that Obama and congressional leaders will be able to push through health-care reform? Experts say it’s almost certain that modest efforts to fix the system, similar in scope to the recent expansion of an insurance program for children, will meet success. But any sort of real revolution in health care is probably a long shot.

Planning reform

It shouldn’t be a surprise that health care has emerged as a critical issue. The country’s health-care problems (including 45 million uninsured and spiraling health-care costs) are simply too big for leaders to ignore, and everyone seems to have an opinion on the best solution.

On the campaign trail, Obama composed a plan that would build on our current system of employer-based health insurance and existing public programs, and use tax dollars to ensure health-care access for all. But one of the biggest concerns with the proposal is its hefty price tag: The nonpartisan Urban Institute estimated that it would cost $1.6 trillion over 10 years.

“When you run the numbers and estimate what universal coverage would cost, it’s going to be too hard to push through unless there are substantial offsetting savings,” said Alan Garber, MD, PhD, a Stanford professor of medicine and of economics.

Since the election, other leaders have offered their own reform plans. Sen. Max Baucus (D-Mont.), who chairs the powerful Finance Committee, recently unveiled a plan that would create a “health insurance exchange,” in which insurers could sell plans to the uninsured, and would mandate that all Americans be covered. Sen. Bob Bennett (R-Utah) and Rep. Ron Wyden (D-Ore.) plan to reintroduce their Healthy American Act legislation, which would require all U.S. residents to enroll in employer-sponsored health coverage or purchase private insurance plans approved by states. And Sen. Edward Kennedy (D-Mass.), who has long been a leader in health-care policy, is planning to move forward soon on his own universal health care bill.

Bumpy road

No Washington insider expects the president or any legislator to see his or her plan sail through Congress. For one thing, the country’s bleak finances, including a deficit close to $1 trillion, could stall a universal coverage proposal or other pricey initiative. Democrats and Republicans also have major differences in their views on the goal of health-care reform, the structure of the health-care system and the role that government should play—which could make even a compromise bill difficult to come by.

Add to this the complexities of the U.S. political system. No bill can become law without the approval of the majority of members, and no bill can be voted on in the first place without the blessing of congressional committee chairs. In the Senate, the filibuster rule allows just one senator to block a vote on a piece of legislation, and it takes a super-majority of 60 votes to resume action.

“With the way Congress is structured, and with the filibuster in the Senate, it’s a major hurdle to get anything through—let alone a major health-care reform bill,” said Leon Panetta, a former congressman and Obama’s pick for director of the CIA.

Changes ahead

Obama has repeatedly said that reform remains a priority for him and that it’s not something that can be put off because of the bad economy. During a press conference this winter, he called health care “part of the economic emergency.” He also showed his commitment to the issue by creating a new White House Office of Health Reform.

Many experts accurately predicted that the first initiative to be passed by the new Congress would be an expansion of the State Children’s Health Insurance Program (SCHIP), the federal program that provides insurance to children in low-income households not eligible for Medicaid. The program had previously covered 6 million children, and Obama recently signed a bill to continue the program and provide coverage to an additional 4 million.

With SCHIP now addressed, experts like Panetta say we should expect to see the approval of other, smaller health-care measures. And while there may be disappointment if Obama and con-gressional leaders don’t deliver on their pledge of major health-care reform, there’s still the political reality of the little-bit-at-a-time approach.

“It’s impossible to revamp the entire system, so incremental health-care reform shouldn’t be [considered] a bad thing,” said Linda Tarplin, a veteran Republican health-care lobbyist. “Anything you do to improve the health-care delivery system and people’s ability to get affordable, quality insurance is a plus.”

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