Harold Pollack et al (49 of 'em) on Health Care: Open Letter

It's Time to Act

Harold Pollack

February 26, 2010

Dear Mr. President, Congressmen and Congresswomen:

Or health care system is in crisis. America has higher per-capita medical spending than any other industrial democracy, Health care spending continues to increase, and is projected to reach $3.3 trillion by 2019. Health insurance premiums are rising rapidly, particularly within individual and small group markets. Meanwhile, the financial security traditionally offered by health insurance continues to erode, with rapid increases in out-of-pocket spending. Rising public health care program costs are driving large, ultimately unsustainable state and federal budget deficits.

It is likely that more than 50 million Americans are now uninsured, with more losing coverage every day due to the twin challenges of deep recession and rising health care costs. Although this country has some of the best medical technology in the world, the quality and effectiveness of medical care often falls short of what every American deserves.

This week, the President put forth a proposal for finishing the job of enacting comprehensive health care reform with which Congress has struggled for the past year. Yesterday the President, House, and Senate leaders from parties spent much of the day in a nationally televised health care summit. This meeting identified areas of bipartisan agreement—many of which are already included in pending legislation. It also identified areas where future bipartisan agreement might be possible, such as malpractice reform. Yet the meeting also underscored the profound differences that separate the leadership of the two parties. Most notably, the President's proposal would cover 30 million people who would otherwise remain uninsured. The Congressional Budget office reports that Republican proposals would only expand coverage to 3 million.

We commend the President’s pursuit of bipartisan solutions. Yet the summit made plain that it is now time to move decisively and quickly to enact comprehensive reform. We believe that the only workable process at this point is to use the President's proposal to finish the job. After long debate, the House and Senate have passed two similar bills that do crucial things to improve US health care. All that needs to happen, if Republicans insist on blocking final improvements, is for the House and Senate to make the required adjustments and to pass these bills by majority vote in both houses. Given the likelihood of a filibuster, this legislation will likely require the majority-vote reconciliation process. Reconciliation has been used by both Democrats and Republicans to enact welfare reform, Reagan and Bush-era tax cuts, the state children's health insurance programs (SCHIP), and other key legislation. Reconciliation is an appropriate and justified mechanism to secure an up-or-down vote on this critical bill.

The President's proposal incorporates many of the best ideas proposed by Democrats and Republicans, patients, clinicians, and researchers. It combines and strengthens many elements of the House and Senate bills and repairs their deficits. It offers a strong foundation for comprehensive reform. Fully implemented, the President's proposal would:

Cover more than 30 million people who would otherwise go uninsured.

Provide financial help to make coverage affordable for millions of working families.

Strengthen competition and oversight of private insurance through insurance exchanges and increased regulation of private insurers and their rates

Provide unprecedented protection for Americans living with chronic illnesses and disabilities

Make significant investments in community health centers, prevention, and wellness.

Increase financial support to states to finance expanded Medicaid insurance coverage

Eliminate the Medicare prescription drug "donut hole"

Eliminate objectionable provisions such as special funds for Nebraska's Medicaid program

Reduce the federal budget deficit over the next ten years and beyond.

Provide a platform to improve the quality and economy of the health care system and to slow future growth of health expenditures.

We, the signatories of this letter, come from different perspectives. Some of us are long-standing advocates of progressive causes. Some of us are nonpartisan or identify as political moderates. From these differing perspectives, we agree on one thing: After months of extensive debate, expert analysis, and the historic passage of House and Senate bills, it is time to pass a final bill. The President's proposal provides a foundation for finishing this work -- and for future steps to build on this foundation..

It may be possible, as the President suggested, to incorporate proposals put forth by the Republican leadership. This proposal already incorporates many traditional Republican ideas for health reform, such as tax credits to help middle-income Americans pay for health care, organizing markets through health insurance exchanges, and creating a regulatory structure that allows insurers to sell coverage across state lines.

Time is short, however. If Republican leaders do not promptly offer constructive proposals in the context of comprehensive legislation that has already passed both the Senate and the House, Congress must move forward.

It is time to act....