With all the focus on the economy these days, health care reform has taken a bit of a back seat in the media. However, providers, including long-term care facilities, need to keep an eye on this issue. Although only a few months into his term, President Obama has already started to develop initiatives to gather input on health care reform and to stimulate grass-roots support for the reform process.  

In December 2008, the Presidential Transition Team invited Americans across the county to host and participate in Health Care Community Discussions to talk about how to reform health care in America. More than 9,000 Americans in all 50 states and the District of Columbia signed up during the holiday season to host Health Care Community Discussions and thousands more participated in these gatherings. After each Health Care Community Discussion, hosts were asked to fill out a Participant Survey and submit a group report to the Presidential Transition Team summarizing the group’s main concerns and suggestions. A detailed report of the findings from these Health Care Community Discussions, including an Executive Summary, has been posted by the Obama Administration on a new federal website at www.HealthReform.gov. The report provides an interesting array of thoughts about the U.S. health care system, including the following concerns:  

  • The current system is “broken” with respect to the adequacy, affordability and accessibility of health insurance coverage;  
  • Health care is not affordable or affordable only for some;  
  • Many Americans do not have access to appropriate health care services because they lack insurance or
  • have pre-existing conditions, health care services for the uninsured are available only through hospital emergency rooms, and there is an overall shortage of health care providers;  
  • The quality of health care in the U.S. is uneven, with certain services being overused and medical errors on the increase; and  
  • The current system is too complex, espouses the wrong values emphasizing treatment over prevention, is based on a health insurance market that is linked to employment, with ever-increasing gaps in health insurance coverage resulting in a large number of uninsured.  

Participants in the Health Care Community Discussions offered many solutions and suggestions for improving the health care system in the U.S. A great number of these ideas are inconsistent or appear to reflect a lack of understanding about many aspects of the current system. However, a number of principles for a reformed U.S. health care system emerged from these discussions, including the need for a system that is: (1) fair and inclusive, with some form of universal coverage; (2) patient-centered and choice-oriented; (3) simple and efficient, with improved outcomes for patients; and (4) comprehensive as to the types of services covered, with mental health services available at some level for all citizens. Not surprisingly, participants were divided as to how to address these broad principles and the proper role of government versus market, business and individuals.  

Several specific suggestions emerged from the discussions that may shape future Congressional action on health care reform, including:  

  • Development of a health insurance exchange, which would increase options for purchasing health insurance and potentially offer better rates because of larger purchasing pools;  
  • Reduction of prescription drug costs, perhaps through government negotiated pricing for drugs with pharmaceutical companies or standardized pharmaceutical costs through a government acquisition program;  
  • Use of research, standards and other incentives for high-value health care, including more information for consumers about the quality of available providers;  
  • Simplification of billing and information technology supporting electronic medical records;  
  • Education on health and wellness, a focus on preventive services, and promotion of healthy lifestyles; and  
  • Expansion of the capacity of the current health care system by increasing available providers and developing of primary care clinics.  

As far as suggestions for future engagement on the topic of health care reform, participants in the Health Care Community Discussions supported a White House Summit on Health Reform, which President Obama has already convened. Additional community meetings, town hall meetings, and Congressional hearings on C-SPAN were also suggested. Clearly, providers should be alert to the fact that health care reform is moving forward, and we should all expect to hear more about this issue in the months ahead.