What We Learned: What Lies Ahead for Health Care Reform?

Last week I had the pleasure of attending a panel discussion at The Atlantic Philanthropies on “The Historic Passage of Health Care Reform in the United States: How Did We Get There and What Lies Ahead?” It was a valuable learning experience and insights came from both the featured speakers and the participants in the audience Q&A.

Before going into the substance of the discussion, it should be noted that this was the very first event held in Atlantic’s new conference center in Tribeca.  Atlantic has promised to make the space available for the use of its grantees and partners. So if you are planning an event in New York City and have a relationship with Atlantic, keep that space in mind.

The panel was comprised of E.J. Dionne, columnist for The Washington Post, Judy Feder, Professor of Public Policy at Georgetown University and Senior Fellow at Center for American Progress, and Richard Kirsch, National Campaign Manager of Health Care for America NOW!

Moderator Marcia Smith started off the discussion by asking the panel to reflect on what had been learned in the process of watching health care reform efforts unfold.

Richard Kirsch began by saying that his organization had functioned as a “midwife” to the birth of reform legislation and helped make it happen by telling the stories of people and how they were being adversely effected by the system. And, they worked to get large numbers of legislators to sign onto their stated principles. He said his main take-away was that they “had made grassroots and net-roots the basis of their work – and that’s what works.” He added later that bringing together the largest possible coalition of progressive organizations to advocate for reform had been essential and that “you could never win health care from inside the beltway.”

Judy Feder said that she had several take-aways.  One was that a major challenge in the process of getting to reform success was convincing those who already have health care coverage that reform was indeed in their best interest, “and that has yet to be done, really.”  Another lesson is that legislators will respond to the message that “you have more to lose from allowing the status quo than in taking action.”  And also that “every progressive fight is going to require absolutely 100% effort because the margin of victory is for the foreseeable future going to be so very close.”

E.J. Dionne said that he came away thinking the lesson is simply to “keep comin’ at ‘em!” You have to have patience and hang in there in the fight, you need to have a “formula ready” to start with, but accept that there will be some defeats along the way, and keep on going. He added later that there is something to keep in mind about polling on health care and that is that “most people in polls say they are happy with their health care insurance because at the time they are being polled they aren’t experiencing any health crisis that requires them to deal with their insurance companies, aren’t being denied coverage or having to put out large outlays. Wait until they aren’t healthy, then the polling results would be different!”

As the conversation unfolded, Judy Feeder reflected on the significance of what was passed. “What we passed was a national commitment to make sure everyone is insured, we expanded Medicaid, and we set a floor of coverage for everyone with subsidies. AND, we have established a public system for long-term care – that’s HUGE!”

The discussion then moved toward “what next” and Feder said, “the opponents of reform are not going away, so we really need to deliver on implementation.

She said cost containment remains the most challenging thing that hasn’t really addressed.  “For one thing, Medicare needs to become a more effective player to force cost containment, and then the rest of the system will follow.” She also noted that for people who previously had health insurance coverage, premiums are going to keep going to go up, and since the Obama Administration now “owns” health care in America, they better do something to address that. Additionally, she said actually enrolling people in the plans will be a challenge, since things will be different from state to state. And yet, having the federal government engage in aggressive enrollment efforts while simultaneously avoiding the perception of “federalizing” health care is very important. She also warned that “we didn’t get enough money in the legislation for the subsidies, and that’s going to be a big problem.”

E.J. Dionne said that he is hearing a lot of Republican strategists advising their ranks to “stand down” from opposing health care reform now because they aren’t really able to identify particular pieces of the legislation that people want to repeal (except the mandates and the taxes, which are basically the keys to sustaining the popular aspects of the legislation).

Richard Kirsch said that, even after the passage of the legislation, his organization will continue its campaign to highlight the injustices and bad practices of the insurance industry because it is important in the continuing fight for improving the system.

One audience member asked what was being done about the $50 million campaign of the insurance industry to undermine reforms.  Judy Feder said it is essential to engage now on cost containment.   Another participant asked a related question about whether or not we were ever going to move away from the fee-for-service model of health care delivery that does so much to maximize payments rather than improve care.  Richard Kirsch said that Massachusetts is now the place to watch for debate on cost containment. He said, “Everyone agrees that the delivery system reforms need to happen, but the challenge is fighting the entrenched special interests.” There are many possible ways to go about cost containment, price controls, benefits limits, changing the payment/delivery system.  “We know the pharmaceutical companies, the doctors and others in the healthcare delivery system will fight against cost containment, but we need to figure out who has an interest in cost containment and bring them together to fight for it.  Obviously employers, business coalitions, taxpayers associations, municipalities, states all have an interest in cost containment.  We need to broaden our thinking about who else has an interest in cost containment and organize them.”

As the session drew to a close, E.J. Dionne provided a bit of philosophical advice to progressives for future efforts based on the lessons of health care reform: “In every fight, you need both patience and impatience.  But you need them in different measures at different points in the struggle.  I wish I had a secret formula for when and how much.”

The Atlantic Philanthropies has said that it will post video of the session to its site.  We’ll post a link here when one is available.

The link is now live at: http://www.atlanticphilanthropies.org/atlantic-events