Health Care Reform In The Next Administration

By Meagan Murray

Oct. 23, 2008 - - No matter who wins on November 4th, there's one thing for sure: neither the health care reform plan advocated by Barack Obama, nor that favored by John McCain, is going to be enacted as is. So says Drew Altman, a frequent and highly-regarded commentator on health care who is president and CEO of the Henry J. Kaiser Family Foundation, one of the nation's largest foundations devoted to health care issues.

"My view," said Altman, whose long resumé includes heading up New Jersey's Department of Human Services and a senior role in the Health Care Financing Administration during the Carter Administration, is "it will be a centrist deal, or no deal at all."

Altman shared his thoughts in New York Thursday as the speaker of the latest installment of the Maxwell School/Public Agenda Policy Breakfast series, which regularly brings together policymakers, academic and business leaders to discuss current issues.

Altman pointed to the health care insurance system now in place in Massachusetts as an example of what will need to happen if any kind of wide-ranging reform is to be approved. The Massachusetts plan, he explained, is an example of consensus-building – in which a coalition was put together and the final law had elements from both ends of the ideological spectrum.

Drew Altman (right), president and CEO of the Henry J. Kaiser Family Foundation, talking about the possibilities for health care reform, with Robert Siegel of National Public Radio, at the Maxwell School/Public Agenda Policy Breakfast.

"We are at one of these moments of opportunity when there is at least a possibility for bigger health reform," said Altman. "The new president has to make health reform - bigger health reform - an early and top priority. The question is whether you go after something smaller that would be easier to agree on, or you seize this moment and try and go after something big."

Altman acknowledged that the recent downturn of the economy in the housing and banking sectors has overshadowed rather than highlighted the need for individual security in areas such as health care. The overshadowing, he observed, relates directly to a disconnect between legislators and citizens regarding the timeliness of restructuring the health industry.

"Our polls and surveys find that many American people are truly struggling – postponing care and skipping medications because they can't pay their health care bills," he said. "So, in the public's mind, it is about economic security and their health care bills, as much as anything else."

Altman suggested that policymakers reframe their vision of health care as a major component of the present economic strain.

"Health care is being defined now by affordability," he said. "It's been defined by the American people not as a health care problem but as a pocketbook issue. And the train that is leaving the station in the Congress is the 'economy train' and legislation related to that, so unless the issue is reframed as an economic issue… I think it will get pushed aside over the next several years."

Even with the hyped attention of other economic aspects constantly in focus, health care has played a major role in the 2008 presidential race.

Senators Barack Obama and John McCain have offered health care plans with starkly different approaches. You can find out more about health care policy options in Public Agenda's Voter's Survival Kit on Health Care. Senator Obama's health plan is designed to expand coverage by building on the current system of government programs and private insurance.

McCain's plan instead focuses on a free-market approach, with tax-free medical savings accounts and tax credits for some to address affordability issues.

"I've been really frustrated with the way the health reform debate has evolved so far," he said. "At best they [the candidates' health care reform plans] represent a statement of direction and a device of a political campaign, that will then morph hugely as others get into the act, like Congress and interest groups."

Altman argues that instead of focusing on the details of the candidates' plans, Americans should instead focus on the fundamental differences between the candidates' visions for health care. The Kaiser Foundation, said Altman, has created a website, Health08.org, which allows Americans to do just that – keep track of how health care is addressed in the 2008 election.

"It is a national shame that we have so many people without health insurance coverage," Altman said toward the conclusion of the discussion. "I know there are more or less efficient ways to cover 47 million people, but I've almost reached a point where I don't care how we do it, just as long as we do it."

Meagan Murray is an intern at Public Agenda.