N.H.’s Changing Workforce: Detour on the road to health reform

Concerns over cost and questions about the government’s role in the delivery of health care led to a stalemate in health-care reform discussions in Washington before Congress’s August recess — a stalemate fueled by a litany of myths and truth-twisting from critics and special interest groups that has created an atmosphere of confusion and fear.

So says David Certner, legislative policy director for AARP. According to Certner, “the debate over health care has gone off the track over the last couple of months. We’re now debating issues that don’t even exist and moving away from the key issues.”

Certner, who discussed health-care reform efforts with NHBR in a recent conversation from his Washington, D.C., office, said he wanted to dispel what he says are some of the myths and bring clarification to misunderstood information surrounding the whole subject.

1. Government involvement in disseminating medical care: The Federal Coordinating Council for Comparative Effectiveness Research, formed as part of the American Recovery and Reinvestment Act to support research focused on the medical and cost-effectiveness of certain treatments, has been the fuel for rumors that the government would get the ability to dictate what medical care or procedure is given to a patient.

In reality, the legislation specifically states, “None of the reports submitted under this section or recommendations made by the Council shall be construed as mandates or clinical guidelines for payment, coverage, or treatment.”

According to Certner, “This is one of the issues that saw bipartisan support before the beginning of this year. The purpose behind this council is to insure that providers and patients have the best information available on what procedures and drugs work best.”

2. Creation of the “Death Panel”: Perhaps one of the most emotionally packed myths regarding the current House bill is the creation of a “Death Panel,” which supposedly mandates that doctors and elderly patients meet regularly to discuss end-of-life planning, including euthanasia.

“This is another absolute absurdity and another issue that had bipartisan support,” Certner said. “What this bill does is ensure that doctors will receive compensation for time spent counseling patients on end-of-life topics, including things like living wills and medical care. These meetings will take place at the request of the patient and will not be mandatory.”

3. Introduction of a public option and who will pay for it. A taxpayer-supported public option for health insurance is something proponents feel is essential to the success of health reform. In addition to encouraging greater competition among private insurers, thus bringing costs down, the public plan will provide Americans who do not have access to affordable health care through their employer with an affordable option, proponents argue. Opponents, however, say a public option would put private insurers out of business.

Despite claims that 200 million Americans are expected to continue taking advantage of their employee-based health insurance, the question of funding the public option remains unanswered and presents lawmakers with their greatest challenge.

“We’re not exactly sure how this will be funded. This is one of the biggest issues being debated right now,” Certner said. “Where are the money and the savings going to come from? While none of the proposals being considered would cut Medicare benefits or increase costs, there are substantial savings to be found in the Medicare system.”

While AARP opposes any cuts to Medicare benefits, there are savings that will help lower costs, such as weeding out waste and inefficiency.

For instance, according to Certner, lawmakers estimate $150 billion could be saved by cutting back on the 14 percent subsidy to Medicare Advantage — the private plan option for Medicare members. Negotiating reductions in market basket updates for hospitals could account for another $150 billion in savings. Addressing prescription drug costs and addressing fraud within the Medicare system also are expected to contribute to additional savings.

As for the bigger picture, said Certner, “the fact is right now 10 percent of our GDP goes to health care, and we’re on our way to 20 percent. While the issue we hear about is the cost to the federal government — this is the federal government’s single largest and rapidly rising cost — the broader issue is what this is costing state governments, employers and individuals. Our small businesses are having a problem finding and affording coverage while larger employers are finding health-care costs squeezing out their other benefits. And for individuals, health-care costs just keep rising and eating up more and more of their earnings.”

He added that the United States “can’t stay on this trajectory. We’re spending too much on health care and not getting enough value for it. There is a fair amount of consensus on what needs to be done in Washington, the question is, can we turn the corner and get back to some of the basics?”