The National Consensus for Healthcare Reform (Part I)

The healthcare proposals in congress are tremendously detailed and many of the items are inter-related or are parts of a solution that requires work at many levels. Unfortunately, an ordinary citizen, like me, is challenged to understand all the details and their implications. So as a way of leveraging the “experts” – and by this I mean reasonably interested, credible parties who have long histories of being involved in health issues – I decided to investigate their positions. The assumption is that these non-extremist points of view reflect a more sensible and less hysterical analysis. I also investigated current polling of doctors and citizens on their views of healthcare reform.

To my surprise, I have uncovered a broad-based consensus of opinion across a diverse spectrum of organizations and people in favor of meaningful healthcare reform. You would never know this from watching the news which on this issue seems to be unable to sort fact from fiction or to report on this national consensus, instead favoring the titillation of extremist arguments.

For my analysis, I investigated the positions of the following organizations:
The American Medical Association
The American Nurses Association
AARP
Phrma – the Pharmaceutical Company lobbying group
America’s Health Insurance Plans (AHIP) – the health insurance lobbying group
The Business Roundtable – an organization of large company CEOs
The Chamber of Commerce – an organization of small businesses
The Kaiser Family Foundation – a non-profit focused on health issues
Consumers Union – publisher of Consumer Reports

In addition, I read through two recent polls:
The Kaiser Foundation’s recent public opinion poll (September 2009)
The New England Journal of Medicine’s recent poll of AMA doctors

From this research of their stated positions, proposals and research, I found that all of the organizations and polls appear to support:

1. Universal care for all Americans based on the requirement that all Americans must have health insurance with help for those who can’t afford it.
2. Governmental definition of a basic level of insurance for all Americans
3. Reform of the way Medicare pays benefits, which are currently based on activity rather than outcomes
4. The creation of a private insurance marketplace in which insurers compete based on government defined plan formats – basic, enhanced, premium, etc (this element only seems to be opposed by the Chamber of Commerce)
5. A multi-state system that would allow insurers to enter all states rather than the current system where, in any given state, fewer insurers compete. This would likely be done through item 4 above.

The one defining characteristic of disagreement is in the “Public option”. On this issue, the Nurses Association, AARP, Phrma and Consumers Union support a public option. In addition, the polls of AMA doctors and of the public support the public option. The AMA, AHIP and the Chamber of Commerce oppose the public option. The Business Roundtable and the Kaiser Foundation reveal no opinion on the public option that I could find.

So, overall – there is near universal support for significant healthcare reform and the establishment of national standards and a national marketplace: from industry associations like Phrma and AHIP to medical associations like AMA and ANA to consumer groups like AARP and Consumers Union to business groups like Business Roundtable and the Chamber of Commerce (although the Chamber’s position is very squirrelly – while they state that they are in favor of reform, their pre-canned “letter to your congressman” basically says they don’t like any of the proposals currently out there).