By Emily P. Walker, Washington Correspondent, MedPage Today December 18, 2008
Washington -- Despite promises of a healthcare reform bill in the first 100 days of the new Obama administration, legislation will likely not be enacted until 2010, said a senior House Democrat.
Issues such as the State Children's Health Insurance Program, physician payments, and integration of health information technology into the system must be ironed out first before being folded into a bill, said Rep. Pete Stark (D-Calif.), who chairs the House Ways and Means Health Subcommittee.
Stark made the comments Wednesday during a teleconference held in connection with a new academic report on healthcare reform.
A Medicare-like, government-run plan alongside private plans will help control costs while providing coverage for more people, said the report's author, Jacob Hacker, Ph.D., professor of political science at University of California Berkeley.
Part of that cost control would come from the lower rates at which public plans such as Medicare and Medicaid generally reimburse physicians and hospitals, compared with private insurance, Dr. Hacker said.
Stark appeared unsympathetic to physicians who might take a financial hit if patients moved from their private plans into a public plan with lower reimbursement rates.
"We're overpaying the hospitals and the doctors," Stark said, referring to private plans. "Medicare is paying the right amount."
He said that he has little sympathy for high-rolling surgeons who might see their income decline from taking in more patients with public insurance.
"A heart surgeon in Los Angeles [who] wants to make $700,000 rather than $400,000 doesn't get much sympathy from me," he said.
The reform proposal offered by President-elect Obama during his campaign contains a Medicare-like plan for those under 65, as does a separate plan of Sen. Max Baucus (D-Mont.) (See: Senate Finance Committee Chairman Unveils Healthcare Reform Plan)
According to Stark, for any public-private hybrid plan to work, it must require that everyone be insured.
"You can't allow selection by insurance companies, or allow young, healthy people to stay out until they're sick," Stark said. "Everybody has to be in, whether they pay or their employer pays."
Obama's plan does not include an individual mandate for everyone, just for kids. It does, however, require that employers either provide health insurance for all employees or else give them the money to purchase their own plan.
The government-run plan recommended by Dr. Hacker would give subsidies to those who cannot afford health insurance.
Dr. Hacker said the public plans are in a better position to spearhead innovations reorganizing payment structures to move some money away from specialists and toward primary care physicians.
They are also more likely to find alternatives to the fee-for-service system for physician payment, develop quality measures for value-based purchasing, require public reporting of quality measures, and test new technology.
The report, "The Case for Public Plan Choice in National Health Reform," was sponsored by the Campaign for America's Future, a Washington-based research organization.
Under Dr. Hacker's plan, private insurers would be encouraged to compete with the public plan, but insurance companies have argued they would be at a disadvantage.
http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/12225
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