Make Medicine Better

As I write this note, I am en route to Washington, D.C. I, along with eight colleagues from the Association of American Medical Colleges (AAMC) and the Catholic Healthcare Association (CHA) are meeting with President Obama at the White House this afternoon.

A Year Ago

It has been one full year since the United States Congress began its work on health care reform. At that time, in poll after poll, Americans cited the need for all citizens to have guaranteed access to affordable health insurance coverage, while maintaining individual choices of doctors, hospitals and insurance plans. A year ago, almost 50 million people living in the United States were without health insurance; a year later that number has increased in the wake of a deep economic recession. Absent reform, the number of uninsured will continue to grow and the financial burden will fall mostly on teaching and disproportionate share hospitals. Within BJC, Barnes-Jewish and Christian Hospitals, as well as our rural hospitals will feel the strain most acutely.

Much of the proposed health reform legislation is about expanding coverage to the uninsured, using two major vehicles: expansion of Medicaid – up to 133% of the federal poverty limit for all categories of eligibility; and subsidies for individuals and small group employers to purchase coverage via a private exchange that would emulate characteristics of large group risk pools (such as that which is available to BJC employees).

A Year Later

Two different versions of health reform legislation have emerged, one passed by the House of Representatives and one passed by the Senate. Neither version has bipartisan support. Republicans are unanimous in their opposition. Health reform has become very political and bitterly divisive.

President Obama is now calling for an “up” or “down” vote. In legislative terms, he is asking for House Democrats to vote “up” on the Senate version of health reform legislation, and then subsequently, to have both House and Senate Democrats vote “up” on sidecar “budget reconciliation” legislation to bridge the differences between the Senate and House versions. The reconciliation legislation need only secure a majority vote in both chambers of Congress.

Importantly, there is no other reform proposal, offered up by either Democrats or Republicans that will expand insurance coverage to 30 million people. Leaders of both political parties know full well the math of the uninsured and they understand that the $900 billion cost over ten years is generally speaking, “in the ballpark”.

The Republicans have asked the President and the Democrats to “start over”, and to move more slowly with incremental reforms that don’t carry such a large price tag. The President has declined, stating that health insurance reform and coverage of the uninsured are moral imperatives for the nation.

Republicans have legitimate concerns with health care reform as proposed by the Democrats. They cite the growing federal budget deficit, the financial strain of existing entitlement programs, government involvement in individual health care decisions, government interference with free market dynamics, not enough emphasis on cost control, special “deals” for members of Congress and interest groups, higher taxes, and inappropriate use of the reconciliation process as reasons for their opposition.

Democrats, with equal legitimacy, will respond that the growing federal debt is a not of their making, that comprehensive reform is needed now to reign in the costs of entitlement programs, that the government must intercede to pay for, and in many cases provide insurance coverage for seniors (Medicare), the poor (Medicaid), and those who are not attractive “risks” in the private insurance markets, and that Bush-era tax cuts and Medicare prescription drug coverage are contributory to the deficit crisis and were passed into law by Republicans using the very same reconciliation process that Democrats plan to use for health care reform.

Indeed, there are two sides to every story. Among those who live in the bi-state region, we have both Republicans and Democrats, and political party positions resonate more with some than with others.

Meeting With The President

We met with President Obama for about one hour. He was joined in the session by Nancy-Ann DeParle, White House Director of Health Care Reform, and Tina Tchen, White House Director of Public Engagement.

He spoke to us briefly about why health care reform is so important for our country. He acknowledges that the proposed legislation is imperfect, and that we will need to make it better over time. He then gave each of us an opportunity to share with him our various perspectives on what we think is important and what we believe will need more attention as we go forward.

It is worth noting that the President recalled for the group, his visit to Barnes-Jewish Hospital, and the time he spent shadowing a nurse on the BJH cardiac step-down unit. When it was my turn to speak, I shared with President Obama the key role that BJC plays in securing our regional safety net, and because we are the largest provider of medical care for the poor and uninsured in our region, we support his proposals to expand insurance coverage to 30 million presently uninsured Americans. We talked about the unique medical care needs of the poor, the disabled, the drug-addicted and those suffering from mental illness. The President shares our concerns for the most vulnerable in our society.

The Catholic community here in the bi-state region (Missouri & Illinois) may be reassured to learn that the Catholic Healthcare Association (represented at the meeting by their president, Sr. Carol Keehan, and the CEOs of Catholic Healthcare West, Catholic Healthcare East and Ascension Health) supports the President’s proposal for health care reform, and believes the legislative language has the necessary protections to ensure that no federal taxpayer money will be used to pay for abortions. Tony Tersigni, CEO of Ascension Health, the nation’s largest faith-based health care system and headquartered here in St. Louis, expressed his full support for the President’s Plan.

Final Thoughts

The opportunity to meet with the President of the United States was very special, a day I will not soon forget. I find President Obama to be an inspirational leader, very smart, and that rare person who can combine humility and humor to make all of us feel very much at ease, even in a place as intimidating as the White House. He is fully engaged in working to pass health reform legislation, and he understands both the policies and the politics that are driving the process.

For each of us, health care is a personal decision, and I expect there is a diversity of opinion among you as to whether health care reform, as presently proposed, is good or bad for our country. The House of Representatives could vote on the Senate version of Reform as early as this coming weekend. For those of us with health insurance provided through our employers such as BJC, we may think the outcome will not affect us one way or another. And so long as we continue to be employed, that is likely the case. But, as I make my own judgments regarding health care reform, I think about those who are not presently employed, and those who are employed by small employers who cannot afford to provide health insurance for their employees, and those who have a medical condition that will preclude them from being insured should they lose access to employer-sponsored coverage.

There are many scenarios under which any one of us could find ourselves without health insurance. For me, health care reform comes down to this: if Congress votes “up”, 30 million more people will have guaranteed access to affordable health insurance, and we all will continue to have individual choices of doctors, hospitals and health insurers; if Congress votes “down”, the number of uninsured will not change, and it is unlikely that Congress will take up the problems of the uninsured for some time to come. I vote in favor of the 30 million.