CLEVELAND – To get an idea about what healthcare plans may look like in the near future and whether healthcare innovation will be a priority for the 111th Congress, the Cleveland Clinic invited Sen. Ron Wyden (D-Oregon) to speak last week at its annual Medical Innovations Summit.

Wyden may play a larger role in laying out what any new healthcare system will look like in the U.S., particularly if the so-called Healthy Americans Act (HHA; S. 334), which he co-sponsored, is enacted into law. HHA is one of the most talked-about new approaches to extend healthcare to all U.S. citizens.

This bipartisan bill is designed to revamp healthcare as Americans currently know it. The bill is designed to lower healthcare costs by improving benefits, assisting lower- and moderate-income families in paying for private insurance and providing new opportunities to people to save from competition among health plans. The bill also is designed to provide true portability of coverage and encourages preventative and needed care.

Prefacing his remarks, Wyden noted that during a previous panel that he had watched at the summit, an audience polling question about the likelihood of meaningful healthcare reform legislation being passed in the next year had yielded a 60% 'nay' response. "I understand the skepticism," Wyden said, but added that there are several reasons to be more optimistic.

He noted that the U.S. economy has three primary legs – healthcare, of course, being one of them. The other two are financial services and energy independence. "I do not think you can get the economy back on track unless you fix healthcare and certainly from the standpoint of the long term, you cannot get the economy back on track unless you fix healthcare."

So why should Americans be optimistic of impending healthcare reform?

First off, Wyden cited the HAA, which is being co-sponsored by 17 senators (nine Republicans, eight Democrats). In the past 60 years, he noted that there has never once been a major group of Democratic senators and Republican senators actually co-sponsoring legislation to get everybody covered."

The second reason is that the Congressional Budget Office (CBO) has scored the HAA as "budget neutral" two years after implementation, "and in the third year, we actually start bending the cost curve downward." He noted that the Lewin Group, "the gold standard for analyzing healthcare plans," reached the same conclusion as CBO.

The third reason for his optimism, Wyden said, is that after visiting with 80 senators he sees the makings of a "real ideological truce emerging in the U.S. Senate on healthcare."

He said that Democrats have been right on the idea that all Americans should be covered, because otherwise "the people who are uninsured shift their bills to the insured."

The Republicans have been right, he said, on the proposition that there should be a very wide berth for the private sector with any plan. "The private sector is absolutely essential in terms of encouraging innovation and encouraging private sector choices." Wyden said that HAA "melds together" both ideologies into a working whole.

He said the healthcare scenario will play out in a stepwise fashion, with the bellwether event being the passage of a comprehensive children's healthcare program, which he said has bipartisan support as well as the interest of President-elect Barack Obama. "That's the touchstone event. How is that going to be integrated into the larger issue of broader healthcare reform?"

The next question that will come up is whether to then look to see what incremental steps can be taken to improve healthcare or to as Wyden said he advocates "be bold." He argued that the "bold approach actually saves money and really stands as a paradox to the incremental steps that aren't going to produce the same savings, certainly nowhere near as quickly."

While he noted that some might see this as a contrarian notion given the country's current budgetary woes, "bold reform, because you change the incentives that drive behavior, is actually going to produce far more significant financial savings than going at this in an incremental way." He added that there will be a "spirited debate," in the Senate and the House about which approach will be best for the country.

Wyden noted that with HAA, everyone is guaranteed a basic "floor" coverage of healthcare, with those wishing to spend more for extra bells and whistles being able to do so if they want to.

Another way to bring about broader reform in healthcare, he said, is changing the insurance model in this country.

Wyden charged that the current model is "inhumane." He said it is about "cherry-picking" healthier people and sending the sicker people to government programs "that are much more fragile than they are."

He said that the new insurance model, in which a larger majority of Americans will be required to participate, will be completely different than today's flawed one. "It is going to be a different private insurance model. The companies are going to compete on the basis of price benefit and equality rather than who is the best at scouring risk and unloading those people with the most serious health problems."

Wyden noted another crucial element to fundamental reform that is linked to the HAA is a need for personal responsibility, meaning virtually everyone will have to pay something for their healthcare, and one is essentially enrolled when they become employed via the tax code. Currently, Wyden said guaranteed government subsidies are being squandered on costly emergency room care, when they should be used for prevention and primary care. "We have worked best as a nation when we have linked rights and responsibilities and I think that is a key element of reform as well."

While some have argued for a single-payer system in the U.S., he said he believes that is "more than the country or Congress would accept."

Wyden said he believes that people in this country are ready for bold changes in healthcare "provided they are carefully explained." He added that healthcare costs in this country will never go down until workers see what they are losing out on in terms of take-home pay and are given the opportunity to gain as the result of a cost-effective purchase.

"We do both of those things in the Healthy Americans Act," he said. "We're trying to realign the incentives so that healthcare choices in America can be, or at least resemble the kinds of choices we make everywhere else, where people really do have a greater sense of personal involvement."