Dems, reps agree it's time for health care reform.

WASHINGTON -- The nation's health care system will be overhauled in a substantive fashion in the early days of the next administration, promised advisers to both presidential candidates at a forum sponsored by the journal Health Affairs.

Although the economy has replaced health care as the top issue for voters, there is still a hunger for change, and economic and health concerns are linked, said Democratic and Republican pollsters at the same forum.

Sen. Ron Wyden (D-Ore.), who has pushed for health reform for years, agreed that early 2009 will be the right time. "At this point you almost don't want to hope again," he said at the forum. But "this time, believe."

He said that he has visited with 80 of 100 senators in the last few months and that all were motivated to reduce the cost of health care and to increase coverage for the uninsured.

Sen. Wyden and Sen. Bob Bennett (R-Utah) have promoted their Healthy Americans Act (S. 334) as a solution, but Sen. Wyden acknowledged that no one piece of legislation was likely to be the be-all and end-all.

Democratic pollster Celinda Lake said that voters view health care as a right and that in particular, women regarded it as a value. Women are concerned that health care not cost too much and that cost constraints not lead to any shortages that result in long waits for appointments or less time with a physician. And women are likely to be the voting bloc that decides the 2008 presidential election, Ms. Lake said.

On the other hand, those currently without health insurance are the least likely constituency of concern, she said, noting that the strongest predictor of not voting is being uninsured.

Americans strongly believe in personal responsibility, choice, peace of mind, and security. They also "want an American solution," Ms. Lake said.

Most important, when it comes to health care, Americans are consumers, "not altruists," she said. That means they want to know how much it's going to cost them to cover the uninsured. "There is a real desire for change and a dramatic concern about rising costs."

Presidential candidate Sen. John McCain (R-Ariz.) seems to have tapped into these sentiments with his proposal to grant tax credits for health insurance plans, paying for wellness and eliminating waste in the system, Ms. Lake said.

Health care is inexorably linked with the economy--when the economy is bad, people worry about their health coverage, said William McInturff, a Republican pollster. In a poll his company conducted for the Robert Wood Johnson Foundation, the top two items cited to improve the economic situation for the average American were making health care more affordable and providing coverage for all Americans.

Of all respondents to that survey, 67% said they thought the number of uninsured would increase in the next 6 months. That's the highest percentage since his firm began asking the question in 2001, Mr. McInturff said.

Candidates' proposals--such as mandates requiring individuals to have insurance, a focus on prevention, and repealing tax cuts to pay for coverage--resonated, with 35%-45% of survey respondents saying they'd heard or read about such ideas.

Mr. McInturff predicated that if Sen. McCain becomes president, the senator would remain committed to health reform.

"I'm not sure I understand how Sen. McCain would advance cost control," said Dr. David Blumenthal, a senior adviser to Sen. Barack Obama's (D-Ill.) campaign.

The way to get affordability and value is to address cost and access, said Dr. Blumenthal, director of the Massachusetts General Hospital Institute for Health Policy, Boston. He is also professor of health care policy and Samuel O. Thier Professor of Medicine at Harvard Medical School in Boston.

Dr. Blumenthal said that it was relatively easy to curb spending in Medicare through budgetary caps, but that was not a good solution because it would just push the costs elsewhere.

Douglas Holtz-Eakin, a senior policy adviser to Sen. McCain's campaign, said that offering options to employer-sponsored health insurance could make Americans better consumers, and thus help drive down costs.

"You can achieve a stable, equitable system without dismantling the employer-based insurance market," said Dr. Blumenthal, disagreeing. He noted that in the 2008 campaign, it appeared that Republicans and Democrats had "traded hats" when it came to health care.

Democrats want to build on what is already there, and Republicans are proposing more radical change, he said.

But all agreed that reform was coming. "The next president will have to do health care reform, period," said Mr. Holtz-Eakin, adding that the next president will also have to get any plan through Congress, "and it will have to be bipartisan."

"Presidential leadership and vision will set an important tone and direction for the conversation," Dr. Blumenthal said. "It's wildly premature to say what that conversation will be," he continued, but added that Sen. Obama would stand by his promise to address health reform.

BY ALICIA AULT

Associate Editor, Practice Trends