As a deputy science advisor and associate director of the Office of Management and Budget under President Jimmy Carter, Gilbert Omenn saw firsthand how difficult it can be to try and reform the nation's health care system.
Yet Omenn, the former University of Michigan Health System CEO who now serves on a national panel examining health and other government spending, believes the chances are as good as they've been in years to reshape the $2 trillion system later this year.
Omenn spoke with Business Review following an appearance at a health care leaders summit Tuesday in Detroit.
Business Review: What does the history of attempts that various administrations have made to reform health care suggest for the current effort?
Omenn: The history, going back to 1932, is that it's very difficult to take on what is now one-sixth of the economy... when there are so many very entrenched interests with very important jobs and roles to protect, and businesses. In general, the public is more anxious about the unknown than the known, even if the known is not fully satisfactory. So it's very complicated, very challenging, and there is no guarantee that something major will come out of this year's effort. But I think the chances are better than previously.
What factors do you consider to be most in favor of achieving reform this year?
The biggest factor is the strong, popular president who's made it among the highlights of his program. At the same time we have key members of Congress who seem to be well-aligned with the president's intentions. The most important is the overall sense that we could do better for most parties, and the seniors in the system, and certainly for the value for our money, if we could make some significant changes.
What are the biggest roadblocks?
The biggest roadblock is that the status quo is acceptable to quite a lot of people. People who have employment-based insurance, people who have Medicare, really aren't desperate about their situation unless they're worried about losing their jobs or they're worried about losing their health insurance at their day jobs or worried they can't switch jobs because they can't carry forward their insurance because they have some pre-existing conditions. And to the extent that people are worried about what comes next, that of course leads to some anxiety in favor of the status quo.
Where do you think businesses are aligning themselves in terms of the reform movement?
Businesses are all over the terrain. Sixty-one percent of people have their health insurance on an employment basis. There are quite a lot of people who are dependents or retirees who have lost insurance, but that means that the majority of business jobs are providing health insurance - some of it is really good, some of it is less good coverage. Smaller businesses on the average tend to have less people and less expensive coverage. Some do very well, and some provide financial assistance for their workers to buy group insurance from the outside.
I think that those businesses that do a lot of international business and find themselves up against the wall trying to keep their costs under control when health care costs keep rocketing upwards have a huge incentive, but many of those business leaders are ideologically opposed to higher taxes or government role, and they're stuck opposing the whole intervention but complaining that health care costs are a huge burden.
You said we should sacrifice public health options, meaning I gather Medicare and Medicaid, for the non-elderly. Can you explain?
I said that that's what the Congress might do. There's a whole range of views across the political spectrum. Many on the left would really like to have Medicare for all - single payer, extremely low administrative costs, well-established benefit, etcetera. There are a lot of advantages, frankly. And on the far right, the voucher system is a tax credit maybe or maybe not adjusted for our health risks, and go and see how you can do negotiating for your own health insurance. And for some people that's fine.
In the middle, there's this notion that we want to continue with employment based health insurance, and to some extent health insurance bought outside the job, either in group or through individual insurance policies, which are usually notoriously expensive.
The question is, will the Democrats hold out for a public plan option for non-elderly working people? And the answer is, I don't know. I think most Democrats would like to see that option, maybe even some moderate Republicans. It's considered a really big compromise for people who prefer Medicare for all as a single payer. But if Medicare for all is off the table, then the next compromise is a public plan option, which it'll all be about counting noses. If they need a few more votes, especially from centrist Republicans in order to push the big package through, I think that big ticket item would be particularly vulnerable.
From the Oakland Business Review
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