Congress Goes Beyond Hill for Health Care Rx


WASHINGTON — Sen. Ron Wyden (D-Ore.) says that the answer to America's health care problem does not lie with Congress—at least, not initially.

“I spent 2 years studying what went wrong in the Clinton debacle,” he said at a meeting sponsored by America's Health Insurance Plans. Sen. Wyden was referring to President Bill Clinton's unsuccessful health care reform effort in the 1990s. He also looked at a similar effort in the 1940s by President Harry S Truman.

His conclusion: “There is a remarkable parallel in 60 years of failure. … For 6 decades, the effort has involved trying to write a piece of federal legislation in Washington, D.C. [But] the special interests would attack the legislation and each other, and everything would fail.”

Instead, “I decided to go 180 degrees the other way,” he said. “We'll start it outside [Washington].”

In March, Sen. Wyden, along with Sen. Orrin Hatch (R-Utah) and Comptroller General David Walker, announced the formation of the Citizens' Working Group on Health Care. The group is composed of 14 people from across the country, including physicians, health advocates, hospital administrators, academicians, nurses, and a union representative. Health and Human Services Secretary Mike Leavitt will serve as the 15th member.

The group is one result of a new law known as the Health Care That Works for All Americans Act, which was cosponsored by the two senators. One thing the group will do, according to Sen. Wyden, is “tell people where the $1.8 trillion spent on health care actually goes. … I think people will be pretty surprised.” The information will be made available online as well as in booklets and in libraries.

The group also will hold public hearings to get input on what should be done to reform the system. “No one has walked the public through the choices and tradeoffs that come with a health care system that works for everybody,” he said. “We're now going to have a real debate about how we create a system that works for everybody.”

After publishing the spending information and listening to public comment, the working group will develop recommendations on a system that works for everybody.

“When they have the tentative set of recommendations, they go back to the public again for another crack, so people will get to weigh in twice,” Sen. Wyden said. Then the proposals go to Congress, and all committees with jurisdiction over health care will hold hearings within 60 days of getting the recommendations.

Although there is no mandate for Congress to take any further action on the recommendations once it has held hearings, “you will have a citizens' road map of where the country feels we ought to be headed in health care, and if at that point the Congressional committees decide they want to ignore what the citizens have to say, then it will be really clear who they're siding with—powerful Washington interests rather than the citizens,” he said.

Sen. Wyden gave an example of the type of issue he hopes the group will address. “We know that a big chunk of the health care dollar gets spent in the last few months of someone's life. And we know in many of those instances, the best doctors and hospitals can't do anything to increase the quality of the person's life.

“So the question for the country that the political leaders have been ducking—and that they aren't going to be able to duck any longer—is, in those kinds of instances, do we want to start spending more money on hospice and in-home services and less on expensive treatments and interventions, and use the savings for children, pregnant moms, and people who've fallen through the cracks in the system? It's a difficult conversation to have, but this is the kind of issue that we've got to” talk about.

Even semantics can be difficult, Sen. Wyden noted. “It took me three months to negotiate the title of this bill. When we started, the Democrats wanted the words 'universal coverage,' but the Republicans said, 'We're not going there; that's socialism.' The Republicans wanted to call it universal access, but the Democrats said, 'We're not going there; no one will ever get anything.'”

Finally, the senator proposed the current title.

For more information on the working group, go

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