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Archive for Tuesday, May 12, 2009

Industry’s promises may not go far in health reform

May 12, 2009

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— In his quest to transform American health care, President Barack Obama appeared Monday to put his faith in pledges from some of the interest groups that helped scuttle reform 15 years ago, but the industry’s promises fell well short of the White House’s expansive claims.

“This is a historic day, a watershed event,” Obama said after a meeting with lobbyists representing doctors, hospitals, drug manufacturers and device makers. “Over the next 10 years — from 2010 to 2019 — they are pledging to cut the rate of growth of national health care spending by 1.5 percentage points each year — an amount that’s equal to over $2 trillion.”

In a letter to the president, however, the organizations made a more limited commitment.

“As restructuring takes hold and the population’s health improves over the coming decade, we will do our part to achieve your administration’s goal,” the six trade groups wrote.

Administration allies cheered the news that the once-recalcitrant health lobby is eager to join reform negotiations. But many offered a cautionary note that warm words from the industry cannot be mistaken for enforceable policy changes.

“It’s a goal and a good goal,” said Sen. Charles Schumer, D-N.Y. “But it’s hardly locked in stone.”

Obama has consistently framed his desire to overhaul the health system in the context of broad economic pressures. Health care spending nationwide is expected to increase by about 7 percent each year, a rate most economists argue is unsustainable over the long term.

Although experts agree that the health system is inefficient, squeezing out savings has proven difficult. Monday’s announcement, despite the fanfare, shed little light on precisely how the industry and government might achieve $2 trillion in savings over the next decade.

Despite the high-profile attention — complete with a photo opportunity in the White House State Dining Room — the industry offered up only a handful of ways to achieve significant cost reductions, most of which were included in Obama’s budget proposal.

“An unrivaled set of abstractions and posturing,” said Alan Sager, a professor of health policy and management at Boston University. Among the specific money-saving items listed in a White House document are streamlining billing procedures, investing in preventive care and offering financial incentives to hospitals that reduce readmission rates.

“It would be difficult to wring 1.5 percentage points out of this list of proposals,” said Robert Reischauer, former director of the Congressional Budget Office.

Many experts say it is possible to reduce the rate of growth in medical spending, but that it could take years to accomplish and it could involve painful tradeoffs for patients and providers.

James Rohack, president-elect of the American Medical Association, however, expressed optimism that even more inefficiency could be wrung out of the health system.

He described the 1.5 percent reduction as “a floor” to what could be achieved. “We can slow that growth even more.”

Reducing the rate of growth of health care spending by 1.5 percentage points would leave the federal budget deficit in the hundreds of billions of dollars, based on government data, and would leave health care spending growing faster than the overall economy, said G. William Hoagland, vice president for public policy at the insurer Cigna, which is a member of one of the trade groups that signed the letter.

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