Medical Device Daily Washington Editor

The House Energy and Commerce Committee's subcommittee on health met yesterday to begin a review of the House's approach to healthcare reform, but the bill's authors had declined to release more than a few details of the plan prior to the hearing. Republicans on the panel expressed concerns over the lack of details on the proposal, including a failure to get the bill scored by the Congressional Budget Office. The cost issue was one of fundamental importance to some members of the committee as well as to some witnesses, but another issue was the lack of input on the text of the legislation from Republican members of the House.

Committee chairman Frank Pallone (D-New Jersey) said at the start of the hearing that healthcare reform "has eluded reformers ... since the beginning of the 20th Century, and made the case that "our broken healthcare system is a clear and present danger to the economic health of our nation."

Pallone also acknowledged at the outset that all is not comity and happiness in the House of Representatives. "Health reform generates great interest and controversy," he said, but he reiterated the case for an overhaul, stating that policymakers cannot "resign ourselves to minor reforms." He said all Americans should be able to access insurance, which will "guarantee access, quality and affordability." To those who oppose reform "simply for opposition's sake, I urge you to rethink your position," he said.

Rep. Michael Burgess, MD, (R-Texas) derided the available information on the draft as "pretty skimpy on the details," saying the information (see accompanying sidebar) fails to describe cost, among other things.

"Isn't it odd that we have nothing that pertains to financing" the proposed reforms, Burgess asked, adding, "I feel like we ought to emphasize the 'care' part of healthcare reform" before dealing with other issues, he said. He also asked whether CBO would score the bill before a vote comes up in committee

"Most importantly, coverage does not equal access," Burgess remarked, asking what the bill does "to ensure we'll have an adequate supply of physicians." He also said that claims of bipartisanship rang hollow. "Why have we been excluded from the drafting of this bill, only to receive it late last week?" he asked. The bill should be drafted "in the full light of day and not in the darkness of night."

Ralph Neas, CEO of the National Coalition on Health Care (NCHC; Washington), commenced his testimony by remarking that he is "heartened by the progress made by the three committees" on the draft legislation. Those committees, in addition to the Energy and Commerce Committee, are the Ways and Means and the Energy and Labor Committees.

Neas added that NCHC's members "believe that the time for action is now, this year." He reiterated the economic argument for reform, stating that "the fiscal crisis facing us cannot be addressed successfully" without an overhaul of healthcare.

Neas described the organization as a "rigorously non-partisan" group that is of the view that reforms must address each of five elements, a list that consists of universal coverage, cost containment, improved quality and safety, simplified administration, and equitable financing. "We believe that for reform to be effective," all five have to be addressed systemically.

Neas also made the case that the draft, the full text of which was not available by press time yesterday, "is appropriately ambitious in its scope and its recommendations" He added that "now is the time to be pragmatic and bold." Neas also argued for "expansion of existing public programs such as Medicare and Medicaid," as well as a public option, and argued that "shared responsibility and shared sacrifice" are needed to reform care "that is at once [both] morally and fiscally sound."

Sailing in a different tack was Stephen Parente, PhD, the director of the Medical Industry Leadership Institute (Minneapolis), who said the current effort is the seventh attempt at healthcare reform in the past century. "Will seven be the lucky number?" he asked.

Parente noted that his organization scored the two main Senate proposals using a methodology known as ARCOLA which he said had been peer-reviewed and developed with funding from the Department of Health and Human Services. The application of this methodology to the first iteration of the Senate Finance Committee's plan resulted in a projection of a 74% reduction in the numbers of the uninsured over 10 years at a cost of $2.7 trillion, whereas the proposal offered by the Senate Health, Education, Labor and Pensions Committee could cost $4 trillion over a decade to reduce the number of those without insurance by only 30%.

"One conclusion emerges every time we score a plan; none are revenue neutral," Parente said, adding that he would "humbly ask whether we recognize that we as a nation are on the verge of making a multi-trillion dollar gamble that more per-capita healthcare deficit spending will make us better off." He cited spending in previous decades as effectively eliminating tuberculosis, adding that some breakthroughs resulting from such an investment now may "eliminate whole diseases, like Alzheimer's." However, he urged the panel to recognize that "while it is not an unreasonable wager ... it is a wager nonetheless" that could permanently cripple the economy.