Greetings from San Diego. The sessions today carried-over from my comments yesterday. If I had to summarize the key messages they would be that some type of health care reform is coming- and we've got to get our country healthier than it is today in order for us to make anything work. The two key issues that will be the focus of the entire debate is access and cost and you'll be hearing about these two issues throughout the debate that is about to begin.
The primary discussion around health care reform centered on whether we need to have a "public option" included in the system we have today. This idea was at the center of the "health insurance exchange" concept Obama used during his campaign. Naturally, the health care industry today would rather keep the public option out. But, those in favor of it argue that this option will fill the gaps for those that don't have coverage today, and inject more competition in geographic areas that have little or no competition in the current market. (Rumor has it that Max Baucus sent a letter to President Obama today telling him the "public option" would be included in his proposal).
Former governors Jeb Bush, Howard Dean, and John Kitzhaber started the day specifically talking about the need for a public option in the health care reform agenda. Bush was against it, Dean was for it, and Kitzhaber made the most sense to me with his recommendation of scrapping the system we have today in total- and starting over. I just don't think that his option is politically feasible. But, he made some interesting and fascinating points to support his case that I hope people listen to as this process evolves.
Jacob Hacker (Professor of Political Science at the University of California at Berkley), Gail Wilensky (Economist and Senior Fellow at Project HOPE- and on the Board of United HealthGroup), and Len Nichols (Director for the New America Foundation) continued the debate later on in the day. Hacker was a strong supporter of the public option (and wrote the White Paper the Obama Administration is using to support the idea), Wilensky was against, and Nichols was uncommitted- he just wants to make sure reform happens this time around.
By the end of the day, I was concerned that most of the political debate is being centered around the need for a public option as opposed to the other key issues we need to address (some of which were presented by Deloitte yesterday). The focus on value, consumer engagement, payment reform, and IT infrastructure seemed like side-bars as opposed to key components of a reform strategy.
The other key message today is another topic we've talked about for many years- our culture is unhealthy and something needs to be done to begin to change it. We all know the statistics- 70% of all of our costs are related to chronic conditions- and with the aging of the Baby Boomers it's only going to increase. And, of these costs; 40% are related to lifestyle, 15% are related to socio-economic factors, 5% are related to the environment, 30% are related to biological factors, and only 10% are related to actual medical costs.
So, when you put it all together what we're talking about is a need to begin to create a healthier population- and then reforming the payment and delivery structure that surrounds it. It's certainly easier said than done.
Regardless of what side you are on, each and every discussion today supported the fact that the system we have today is morally and economically unsustainable. The real possibility exists of our country defaulting on our debt obligations because of the costs of our health care system. A substantial (not incremental) reform strategy is required this time- we don't have a choice. The debate is about to heat-up and (as I said yesterday) providers, health plans, consumers, and legislatures had better be ready. We're in for a whole new ball game.
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