WASHINGTON – Witnesses at separate hearings held Wednesday by the Senate Health, Education, Labor and Pensions Committee and the Senate Finance Committee said healthcare reform is necessary and can't be achieved without spending money up front. The experts also recommended providing broader risk pools and establishing comparative effectiveness.
The new stimulus package provides incentives for doctors and hospitals to adopt healthcare IT and provides funding for comparative effectiveness research.
The Congressional Budget Office's new Director, Doug Elmendorf, said increasing health insurance pools – a concept contained in President Barack Obama's plan to expand healthcare coverage – will not work without mandating coverage. Without mandating, only the sick will purchase insurance, jacking the price for those who aren't sick and driving away those who only marginally wanted to purchase it in the first place.
It will take time to make a change and investment up front, Elmendorf said.
"It's a big ship that's not moving that fast, but it's very big and very hard to turn," he said. "No doubt, if you started shifting incentives, the faster the ship will turn."
Many believe, along with President Obama, that healthcare IT will lay a foundation for change in the U.S. healthcare system and a venue for improving quality of care, cutting costs and saving lives. Healthcare IT will also allow the government to pay providers based on performance.
Cathy Schoen, senior vice president of The Commonwealth Fund, told the Senate HELP Committee that changes will require new leadership and collaboration across public and private sectors.
"Effective payment reforms will require time to develop and implement and flexibility to innovate as the nation learns," she said – a notion backed by the CBO. "Information systems require investment and time to yield maximum returns through adoption and use."
"Yet, wide public concern and stress on businesses and public sectors make it increasingly clear that we cannot afford to maintain the status quo. Each year we wait, the problems grow worse," Schoen said.
Sen. Sherrod Brown (D-Ohio), on the Senate HELP Committee, said, "It’s not enough to fight for affordable coverage, we must fight for real coverage. Health insurance shouldn’t be a vehicle for punishing the sick and rewarding the healthy. It shouldn’t be a hammer that beats healthcare costs down by arbitrarily denying care to those who need it."
Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, said healthcare is the next big objective. "We need fundamental reform in cost, quality and coverage. We need to address all three objectives at the same time. They are interconnected," he said.
Republicans agree that reform is urgent and necessary, but differ on the means needed to get there. Sen. Charles Grassley (R-Iowa), disturbed by the lack of debate over the stimulus package, urged caution. "I have heard some folks say it is our moral responsibility to provide healthcare coverage for all. We have an equal if not greater moral responsibility to do so in a fiscally sustainable manner," he said.
Grassley said he is wary of spending money up front to reap savings in the future. "The President has an opportunity as he walks this razor’s edge between a broken healthcare system and fiscal catastrophe," he said.
Obama has called a gathering of stakeholders and a bipartisan mix of lawmakers to meet next week and begin the difficult work of smoothing out differences. The Obama administration had plans for healthcare reform prepared prior to the election, and the Senate Finance Committee has held hearings on the issue since last summer. Last fall, key Democratic congressional leaders said they were "ready to roll" on healthcare reform, and they will take the cue from Obama's guidelines.
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