Senator Says Health Reform to Come in Baby Steps

Although Baucus was critical of the health care reform plan offered by Republican presidential candidate Sen. John McCain, which would depend in large part on encouraging competition that McCain believes could lead to lower prices among major insurers, he said major reform and long-term solutions will require both parties to unite behind a compromise approach.

“Everyone needs to step back and not put forward solutions that are anathema to the other side,” he said.

An eventual health care overhaul is likely to blend aspects of the Democratic-backed plan to boost government involvement in health care policy and Republican-supported market-based approaches, said Keckley.

“The economic reality will force us to address these [challenges] in a centrist way,” Keckley said.

Mary Grealy, president of the Healthcare Leadership Council, which represents major health care businesses, agreed that a wide variety of approaches needs to be considered. Among the approaches she urged is for Congress to consider use of Medicaid funds to encourage more small businesses to cover low-income workers and their families (see Medicaid Back in Spotlight as Remedy for Insurance Crisis).

The AMA, which has urged coverage of all of the nation's uninsured, favors a reform approach that would expand access to private insurance through the use of tax credits (see Single Payer or Individual Tax Credit: Which Reform Proposal Is Best?). But fights over the best approach to reform need to give way to real changes that will increase health care access in the short term, according to AMA President Nancy Nielsen, M.D., Ph.D.

“These are not simple problems, but we must get beyond talking about them and get to some real solutions,” Nielsen said.

The challenges facing supporters of a major health care overhaul have grown more daunting in recent months as the economy has deteriorated, and the government has committed huge sums to rescuing it. For many congressional leaders, the issue has taken a back seat to the need to address the economy and climate change, said Baucus. However, major changes in the health care system will be his committee's leading priority in 2009, he noted.

“Health care has become so complicated that it's hard to even see the crisis,” he emphasized.

Baucus has begun talks with the chairs of the other congressional committees with jurisdiction over aspects of health care policy regarding ways in which they can move incremental reform legislation quickly. Although Baucus has not yet written the “incremental” health care overhaul bill he plans to push, his criticism of others' bills to expand health care access may indicate directions in which he will not move. One such bill introduced by Sen. Ron Wyden (D-Ore.), the Healthy Americans Act, would, for example, replace the tax incentives for employer-provided health insurance with a mandate that workers buy their own insurance.

“People are comfortable getting their health care from their employer,” Baucus said about his opposition to Wyden's approach.

Baucus's legislation will aim to cover all Americans; encourage prevention efforts; better spread the costs of health care among individuals, employers and the government; and reduce the rapidly rising costs of such care, he said. Possible “solutions” to health system problems include creation of risk pools for small employers to join, thus lowering their costs, as well as reform of the individual and small-group insurance markets to eliminate practices such as rejections based on preexisting conditions.

The scope of any measure that could pass next year is unknown, but for now Baucus is not setting his sights too high.

“It took many years to get here, and we can't solve it immediately,” he said. “But at least we can take incremental steps.”

The text of the Healthy Americans Act can be accessed at<http://thomas.loc.gov> by searching on the bill number, S 334. ▪