OBSERVATIONS - November 13, 2007
Surprising Level of Consensus Among CEOs at Health Affairs
Summit
On November 1, Health Affairs held its 2007 Health Policy Summit
in celebration of the journal’s 25th anniversary and the retirement
of its founding editor, John Iglehart. The goal of the summit was
to bring together many of the nation's most prominent health care
leaders to share their vision for the future of health care. A full
agenda is available on the Health
Affairs website.
While the entire roster of speakers – a “who’s
who” of health policy and health services research luminaries
– was outstanding, I found one panel particularly striking.
The CEO Roundtable Discussion featured leaders representing the
following:
• Labor – Andy Stern of SEIU;
• Consumers – Linda Golodner of the National Consumers
League and Bill Novelli of AARP;
• Hospitals – Jack Bovender of HCA;
• Insurance – Angela Braly of Wellpoint;
• Health Care Technology – Joseph Hogan of GE Healthcare;
and,
• Policymaking – Gail Wilensky of Project HOPE and MedPAC.
What was striking about this panel was the high level of agreement
among participants from very different political camps regarding
the necessary elements of health care reform. And, unlike so many
discussions of health care reform over the past 15 years, there
was agreement on specifics, not just on general (but vague) principles,
such as the need for equity and improved access. Specially, I heard
the following points of consensus among these strange bedfellows:
• HSAs and tax credits may help some, but they are not the
answer to reforming American health care.
• Universal “coverage” is not coverage if it doesn’t
provide meaningful support for preventive care.
• Real health care reform will require an enforceable individual
mandate along with nongroup market reform (of some type –
no agreement on the specifics). These two things have to happen
together.
• One of the largest threats to access to care is the dwindling
primary care physician pipeline. This problem must be addressed
as part of health reform.
• Payment reform is needed to improve the level of organization
and integration of the health care delivery system and to support
greater investment in clinical information technology (again –
no agreement on the specifics of payment reform).
• To rein in the ever-increasing rate of health care spending
growth, we must focus to a much greater degree on the wide variation
in spending on end-of-life care.
I was particularly intrigued to hear so much support for an individual
mandate (albeit with the usual caveats that it be done “correctly”)
coming from both the right and the left. Consensus on this issue
is no small thing. In fact, lack of agreement on requiring people
to have health insurance has derailed many previous attempts at
reform. But Angela Braly of Wellpoint said it best when she pointed
out that without everyone participating in the market, “actuarial
gravity” – or adverse risk selection – is an unavoidable
reality. And it seems that no one on the panel disagreed with her.
If these leaders’ opinions represent those of others in their
respective sectors, maybe we’ve finally reached a point where
there is political will to get something done. Maybe this time,
we’ll take the bold leaps necessary to fix American health
care, instead of just tinkering around the edges.
-- Laura Tollen, MPH, Senior Policy Consultant,
KP IHP
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