What Should John Boehner Do?

Kaiser asks the health cognoscenti

One of the more interesting and informative pieces of journalism to cross my computer screen in recent months was a story from Kaiser Health News that was a simple compilation of answers to this question: If you ended up in an elevator with Rep. Boehner, what single thing would you urge him to do about health care in this country?

It was sort of a man-and-woman-on-the-street interview with people whose jobs revolve around health care in some way, ranging from selling insurance, advising politicos, and working in Washington think tanks to running trade associations, hospitals, and advocacy groups. As readers of my posts know, I am a big fan of MOS stories, as we call them in the trade. It is a way for journalists to connect with their audiences—a connection noticeably missing in much of last year’s reportage about reform and in this year’s conversation about Social Security.

Asking people what they think about this or that serves up lots of fodder for journos hungering for stories. And a careful reading of the responses to the Kaiser question didn’t disappoint. The answers reveal clues about what we can expect from yet another protracted debate on health reform.

What struck me most was the absence of a strong commitment to providing insurance, private or otherwise, to the growing number of uninsured. Most of the thirty-six people Kaiser featured didn’t mention them. Heavens! I thought that was the reason the war was fought in the first place. But we should know by now that the reasons for going to war are not always the ones that keep combatants fighting until the bitter end. Sara Rosenbaum, a lawyer who chairs the department of health policy at George Washington University, was the only one with a bold comment about the uninsured. Here’s the advice she gave Boehner:

Please think about the 50 million uninsured, a number that will surely grow exponentially in the coming years and that will swallow us all. Stable and affordable insurance is in the national interest. It can be achieved only through a shared commitment to a system in which all members of society pool their health and their resources. Government plays a vital role in protecting us all.

A few others laced their answers with a passing nod to the uninsured. Dr. Bruce Siegel, who heads the National Association of Public Hospitals and Health Systems, said we are on our way to covering almost every American with health insurance: “Let’s not turn back now.” Thomas Johnson, CEO of Medicaid Health Plans of America, said the top priority was making sure there’s access to everyone provided in an efficient manner, and then he suggested finding out whether the cost of expansion is affordable for the feds and the states.

I was also struck by the parochialism of their answers, which points to a lack of consensus on what to do next. Many wanted Boehner to first address their own concerns. Rose Ann DeMoro, whose organization the California Nurses Association and the National Nurses Organizing Committee supports a single payer approach, wants Boehner to allow states to experiment with that idea on their own. Georges Benjamin, executive director of the American Public Health Association, asked Boehner to make sure people don’t die needless deaths from preventable disease—not an unexpected plea from someone in the public health business. Dr. Elena Rios, president of the National Hispanic Medical Association, wants to continue building safety net clinics, along with a strong effort for disease prevention in the Hispanic population.

Louis Goodman, CEO of the Texas Medical Association, asked Boehner to immediately act on the scheduled fee cut for doctors, which he called “a gaping wound in Medicare.” In plain English, that’s the 30 percent cut in revenue he claims doctors will experience soon. A few listed the concerns of small business as their top priority for Boehner. Janet Trautwein, head of the National Association of Health Underwriters, recommended changing the law to make it more workable and business-friendly so employers can continue providing coverage.

Some responders thought Boehner should first deal with the nation’s finances. Alan Murray, deputy managing editor and executive editor of The Wall Street Journal online, suggested that “government spending has to be brought under control” by making some tough decisions about Medicare. Charles Scott, a Republican state senator from Wyoming, said: “the biggest thing to do is deal with the Medicare deficit. It’s about to eat our lunch.”

Other comments were puzzling, like those from former HHS Secretary Donna Shalala and Ron Pollack, who heads Families USA and who was the leading consumer advocate for what finally emerged from the sausage grinder. Shalala, who worked for Bill Clinton for eight years, suggested that Boehner review the legislation with two former administrators of Medicare, Mark McClellan and Gail Wilensky. Both worked for Republican administrations. She didn’t mention the Democrats who served under her as administrators. Maybe she figured Republicans wouldn’t talk to a Democrat anyway.

Pollack’s thing as one of reform’s chief cheerleaders was covering the uninsured, so I was surprised to see him put tort reform at the top of his list. Pollack did say he would tell Boehner to stop the “political and useless rhetoric about repealing” the law and look for areas of consensus. Apparently tort reform qualifies.

It was not surprising that several people preferred to repeal the law or parts of it. They didn’t like it in the first place, and seemed to be saying they would use their political muscle to get rid of what they don’t like. The list of repealers included Christie Herrera, who works for the American Legislative Exchange Council; Bruce Josten, an executive vice president at the U.S. Chamber of Commerce; Grace-Marie Turner, president of the Galen Institute; and a vocal consumer advocate named Jamie Court, representing a consumer watchdog based in California. He recommended that Boehner repeal the individual mandate and replace it with some kind of scheme that would allow sick people to buy insurance only at certain times of the year. Insurers would have to take all comers, even if they were at death’s door at the time.

A few other clues are worth mentioning. William Hoagland, once the right hand man to former Senate majority leader Bill Frist and now vice president for public policy at Cigna, said we cannot afford to subsidize families and individuals with incomes up to 400 percent of the federal poverty level, about $88,000 for a family of four and about $43,000 for individuals. That tells me that the individual mandate requiring people to buy insurance, penalizing them if they don’t, and giving tax subsidies to those who need help paying the premiums might be on its way to unraveling. Was Hoagland signaling something?

And was Michigan Republican Dave Camp, who will most likely assume leadership of the powerful House Ways and Means Committee, firmly in the repealers’ corner? He advocated bringing costs down by lowering premiums, and said he had an option to do that. Journos, keep an eye on that one!

In the spirit of man-on-the-street journalism, I invite you, dear readers, to post a comment or two offering your own advice to the next Speaker of the House.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman. Tags: , , , ,