WASHINGTON (Reuters) – When Shirley Hunter reviewed her finances to make sure she could afford to retire in 1999, she never banked on health care costs more than doubling in less than a decade.

Now the 74-year-old former California kindergarten teacher finds herself under financial pressure. Despite taking lodgers to help pay the bills, she worries about losing her home or having to choose between mortgage, food and health insurance.

“I’m on a fixed income. Nothing else is fixed,” Hunter said. “I can’t afford to travel right now or anything. It’s very disappointing to work like I did and then have this happen.”

Hunter, who told her story to a community healthcare discussion in Costa Mesa, California, is one of millions of Americans looking for President-elect Barack Obama to make good on his campaign promise to tackle the U.S. healthcare crisis.

Obama’s choice to lead the reform effort, former Senate Majority Leader Tom Daschle, testifies at his Senate confirmation hearing on Thursday — beginning a process to change the nation’s healthcare that could be one of the most ambitious and expensive undertakings of the Obama presidency.

The United States spent $7,421 per person on health care in 2007, some 16 percent of Gross Domestic Product, but does worse in many areas of care than other developed countries.

Employers complain that rising healthcare costs put them at a competitive disadvantage in the global economy, driving up the price of everything from a car to a cup of coffee. This has become more acute during the current economic turmoil.

“We can’t afford to put domestic priorities like health care on the back burner,” said Obama spokeswoman Jen Psaki. “This will certainly be a priority for him and for the new administration once he’s sworn in.”

Daschle and his team have helped organize thousands of grass-roots meetings across the country to try to understand the health problems people face and the changes they want.

Some 8,500 people signed up to host the sessions like the one Hunter attended in Costa Mesa. Daschle himself attended two — one in an Indiana firehouse and the other at a Washington, D.C., senior center.

Feedback from people contacted by telephone after the meetings shows the scope of the problem.

“As a nation we’re spending way too much money and we’re not getting much value for it,” said Dr. Allan Wilke, a family practitioner who attended a discussion with other doctors at a medical center in Huntsville, Alabama. “I think we all know the system has got to be fixed.”

COVERING THE UNINSURED

The doctors’ biggest worry was the 46 million uninsured who put off going to the doctor until they visit a hospital emergency room, a costly form of care for conditions that are often preventable.

“I think that was probably the major concern — the number of people that don’t have insurance, that end up getting sick and using the emergency rooms for their primary care,” Wilke said.

Expanding health insurance coverage was a frequent topic. Teenagers who participated in a discussion sponsored by Planned Parenthood in Utica, New York, worried about workers who earn too much to receive government-sponsored health care but cannot afford health insurance.

Preventive care came up at the session in Alabama, where obesity is a problem, and again in Frankfort, Kentucky, where a group of health professionals and public health officials met.

“Prevention was the big topic for us,” said Anne Donworth, a hospice executive at the Frankfort discussion. “As a society we need to focus more on emphasizing taking good care of yourself and … early diagnosis and prevention measures.”

The industry’s economic structure also was seen as flawed.

Attorney Kenneth Zwick, who attended the session in Costa Mesa, said he thought the profit motive warps how the healthcare system works.

“As long as insurance companies, who I sometimes litigate against, are as concerned with their bottom line as they are with the health of their people … we will never have, I don’t think, an effective or appropriate healthcare system,” he said.

The Alabama doctors discussed placing more emphasis on paying for preventive care.

“If you incentivize the system so that the quality measure is lower blood pressure, better control of diabetes, etcetera, etcetera, if you pay me to do that, you’ll get what you pay for,” Wilke said.

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Tags: Obama healthcare

By choosing former Senate Majority Leader Tom Daschle to head his healthcare reform effort, President-elect Barack Obama got more than an old congressional hand with a policy book on his resume.

Obama has also picked up a hardheaded political strategy for his push to overhaul the nation’s healthcare system. Guided by lessons from President Clinton’s healthcare debacle 15 years ago, Daschle has put a premium on cooperation between the White House, Congress and major healthcare interest groups, many of whom agree that major action on healthcare is vital.

Daschle, who will lead both the Department of Health and Human Services and a new White House Office of Health Reform, favors moving decisively to seize political momentum and, if necessary, cut off opposition, something he said Clinton failed to do in 1993.

He thinks delays by the Clinton administration and soft support from the left in the early 1990s allowed Republicans and industry groups such as insurers to kill the Clinton plan with a well-organized political campaign that made voters afraid of reform.

Daschle is urging a far more aggressive push by those advocating systemic change.

“This means going on the offensive,” he wrote in “Critical,” his recent book about healthcare, in which he singled out drug makers and insurers as potential obstacles to a successful overhaul.

“We cannot assume that the public recognizes the distortions and fallacies peddled by the reform opponents; we have to educate people on the emptiness of the anti-reform rhetoric,” he said.

Daschle has even suggested using the Senate’s rules to prevent opponents from filibustering healthcare legislation, a move that one senior Republican staff member warned would make it “extremely difficult” to get any GOP support for major reform.

Daschle, who declined to be interviewed, has specific — and potentially controversial — ideas about how to reshape the healthcare system.

Among other things, he envisions a new federal agency, which he calls a Federal Health Board, with the authority to set guidelines for what treatments and procedures are most cost-effective.

Daschle argues that the board, which would have authority over federally funded healthcare programs such as Medicare, would insulate medical decisions from political meddling by Congress and could help design a system for achieving universal coverage.

He also has called for a mandate to require all Americans to get health insurance and for the creation of a public insurance program to cover people who don’t get private insurance.

But more importantly, Daschle has provided a virtual road map for the kind of campaign the Obama White House and its allies will probably pursue in their effort to avoid the pitfalls that doomed Clinton’s effort.

“Most of the compelling lessons from 1993 and 1994 are political lessons,” said John McDonough, a senior health advisor to Sen. Edward M. Kennedy (D-Mass.) who helped develop Massachusetts’ groundbreaking overhaul and is drafting healthcare legislation that Kennedy plans to introduce next year.

Obama absorbed one of those lessons during the presidential campaign, carefully emphasizing that any reform effort would allow voters to keep their health coverage if they were satisfied with it.

Many in Washington, including Daschle, think Clinton made a crucial error by allowing his opponents to portray his plan as a threat to the healthcare Americans had.

The insurance industry famously exploited that perception with its “Harry and Louise” ads, featuring a couple fretting that the federal government would take away their ability to choose coverage.
Since election day, Daschle has been working hard to avoid another misstep he and others think helped sink Clinton.

In 1993, the White House wrote a massive healthcare bill after then-First Lady Hillary Rodham Clinton led a months-long task force that was widely perceived as shutting out key players in the debate, including congressional leaders.

“Relying so heavily on the task force certainly contributed to the eventual defeat of the president’s plan,” Daschle wrote in his book, noting that the process “only bred resentment among the people who weren’t invited to participate, and produced a ‘compromise’ without the input of key stakeholders.”

Today, Daschle talks frequently with interest groups and senior lawmakers, who in turn have taken pains to reciprocate with supportive comments about the new administration’s early moves. “There clearly is an openness to listen,” American Medical Assn. President Nancy Nielsen said Friday. “Fifteen years ago, physicians felt excluded.”

On Capitol Hill, Kennedy and Senate Finance Committee Chairman Max Baucus (D-Mont.) have received the new administration’s explicit blessing to develop healthcare legislation.

And Baucus, who had a rocky relationship with Daschle when the two were in the Senate together, recently praised the South Dakota Democrat for recognizing the need for congressional involvement. For his part, Obama has signaled his intent to tackle healthcare reform soon after he takes office — another difference from 1993, when Clinton waited nearly a year before his healthcare legislation was introduced in Congress.

By then, the administration had expended significant political capital balancing the federal budget and trying to pass the controversial North American Free Trade Agreement, a move that alienated many Democrats and liberal interest groups.

On Thursday, Obama said he wanted swift action. “It’s hard to overstate the urgency of this work,” he said. Taking another page from Daschle’s political playbook, the president-elect carefully framed a healthcare overhaul as an economic necessity and a moral imperative.

“Day after day,” he said, “we witness the disgrace of parents unable to take a sick child to the doctor, seniors unable to afford their medicines, people who wind up in emergency rooms because they have nowhere else to turn.”

Original excerpt from Los Angeles Times

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Tags: healthcare reform, Obama healthcare, Tom Daschle, universal health care

A coalition of liberal groups that includes major labor unions such as the Service Employees International Union and the activist group MoveOn.org announced today it will spend $40 million to make health insurance a major issue in the campaign, with Elizabeth Edwards, the wife of former Democratic presidential candidate John Edwards, as the one of the group’s main spokespersons. The group, which has dubbed itself “Health Care for America Now!” plans to spend its money running ads in battleground states, canvassing 45 states to get people to sign petitions supporting the initiative and trying to get every member of Congress to sign a pledge to expand health insurance to all Americans.

Meanwhile, on Capitol Hill, Democratic staffers are trying to set up a structure for getting a bill through Congress next year.

The staffs of Sen. Max Baucus (D-Mont.), the chairman of the Senate Finance Committee and Sen. Ted Kennedy (D-Mass.), who heads the Senate’s Health, Education Pensions and Labor Committee, are already meeting with key health care experts, including some from Massachusetts, which passed a landmark health care law two years ago.

In a series of meetings over the next month, Senate aides plan to meet with doctors’ groups, insurance companies, business associations and other key players in reforming health care. Their goal is to have the outlines of a health care proposal by the end of this year that can be introduced in the opening days of the next president’s administration.

“We want to create a mandate,” said Richard Kirsch, one of the leaders of the health care organization of the liberal groups, many of whom worked together to oppose President Bush’s 2005 Social Security plan.

Barack Obama has already pledged to make passing health care reform a centerpiece of his first term, and his campaign has recently added a group of advisers who specialize in the subject, including Elizabeth Edwards, Sarah Bianchi, a former Clinton White House aide and Neera Tanden, Hillary Clinton’s policy director during the primaries. Tanden is working as a domestic policy adviser, while Bianchi and Edwards are participating in campaign conference calls on health care with other experts.

“It’s important for this to be one of the first things that’s considered,” Edwards said in an interview, referring to the priorities of a new administration. “I’d like to see it on the agenda in 2009.”

The coalition of liberal groups is hoping to make sure health care is a priority even if John McCain is elected and to make sure the majority of Congress backs the goal as well.

McCain has also said he would make health care a major issue if he wins the presidency, but Democrats and labor groups oppose many of his proposals, as the Arizona senator is trying to transform the health care system into one in which individuals buy their own health care in a less-regulated market, which means they could have lower costs but also would assume more risk.

The new coalition, while not outlining a specific health care plan, has goals that resembled what Obama and the Democratic candidates proposed in the primaries, offering subsidies to people so health insurance is affordable to the 47 million Americans who currently don’t have it, creating new regulations that would prevent insurance companies from charging high prices or not offering insurance to people who already have chronic illnesses and allowing people to either buy insurance from a private company like Kaiser or enroll in a government-managed health care plan that would be run like but separate from Medicare.

But, even if Obama were elected, there’s no broad agreement on exactly how a universal health care bill would work, which is the problem Democrats faced in 1993 when the Clintons pushed the issue. Insurance companies, who drove much of the opposition in 1993, have signaled they would not support an approach like Obama’s, which add regulations for them but does not require all people to purchase health insurance. Democratic Senate aides are pointing to the legislation passed in Massachusetts in 2006 as a model. That legislation included increased subsidies for low-income people but also a mandate that all people in the state purchase insurance, something Obama has railed against on the campaign trail.

A bipartisan coalition that now includes more than a dozen senators is pushing a more radical health care reform in which people would buy coverage directly from insurance companies instead of getting it through their employers, with people getting tax credits to buy insurance in a more-tightly regulated system. Obama advisers had earlier largely ruled out that idea as too much of a drastic change for the vast majority of Americans who currently get their insurance through their employer.

While Obama has suggested ending tax cuts for people who make more than $250,000 a year to fund the health care subsidies, few Republicans will back what is effectively a tax increase, and some members of the GOP would likely need to support an agreement so it could pass in the Senate.

“It’s much easier to oppose something than get something passed,” Kirsch admitted.

By Perry Bacon Jr. of The Washington Post

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Tags: democrats, insurance, Obama healthcare, politics