Some See Health Reform Gathering Momentum Early


Early signals from the incoming Obama administration have many physicians feeling optimistic about the chances for comprehensive health reform.

The economy is one reason that health reform may have a greater chance for success now than it did during the Clinton administration, said Dr. Nancy H. Nielsen, president of the American Medical Association. As more Americans lose their jobs, they are also losing their health insurance, she said, driving policy makers to address the issue of the uninsured. “There may be more tension for change now than there has been in the past,” she said.

President-elect Barack Obama addressed that tension head-on during a press conference last month to announce former Sen. Tom Daschle (D-S.D.) as his choice for Health and Human Services secretary.

The current state of health care in the United States—with rising premiums and the large number of uninsured Americans—is having a direct and negative impact on the U.S. economy, President-elect Obama said. “If we want to overcome our economic challenges, we must also finally address our health care challenge.”

In a move that many agree signals how serious Mr. Obama is about health reform, he tapped Sen. Daschle for not one, but two posts. In addition to serving as HHS secretary, Sen. Daschle is slated to serve as director for a new White House Office on Health Care Reform. Jeanne M. Lambrew, Ph.D., a health policy expert who coauthored the health care book “Critical: What We Can Do About the Health-Care Crisis” with Sen. Daschle, was chosen as deputy director of the new White House office.

Sen. Daschle's HHS position must be confirmed by the Senate; however, the health care czar position does not.

In another example of his focus on health care reform, Mr. Obama, along with congressional Democrats, have signaled their interest in including health information technology incentives as part of an economic stimulus package, said Robert Doherty, senior vice president of Governmental Affairs and Public Policy at the American College of Physicians. “I think the signals are positive.”

The Obama transition team appears to be learning from some of the mistakes made during the Clinton administration's attempt at health reform, Mr. Doherty said. For instance, there has been a much greater effort by the Obama staff members to be open about their process and to gather input from the physician community.

Physician societies are making their priorities known to the new administration, emphasizing the need for physician payment reform to be a part of any reform package.

The AMA is pushing Congress and the administration to enact permanent Medicare physician payment reform by eliminating the Sustainable Growth Rate formula, which ties physician payments to the gross domestic product. Without congressional action on the payment formula within the next year, physicians will be faced with a projected 21% cut in Medicare payments starting in 2010, Dr. Nielsen said.

If Congress chooses to throw out the SGR formula, they likely will need to authorize some fast-track pilot projects to test some of the most promising models for new payment systems such as global and bundled payments, said ACP's Mr. Doherty.

ACP officials are hoping that the Obama health reform proposal will include some of their top priorities—coverage of the uninsured and improving access to primary care physicians. The experience with the Massachusetts health reform law illustrates that expanding insurance coverage does not guarantee access to care if there are not enough primary care physicians to see all the new patients, Mr. Doherty said.

Shoring up the primary care workforce will require an increase in payments for primary care services, an emphasis on primary care in graduate medical education funding, and the creation of programs that would allow primary care physicians to eliminate their medical school debt, he said.

The American College of Cardiology did not respond to requests about its legislative goals for 2009.

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