Without reforms, health care will consume 40 percent of the nation's Gross Domestic Product (GDP) in 40 years, a health policy fellow said Thursday.
"Nothing says to me that our health system will self-adjust," Brian Hensel told a University of South Dakota audience.
Hensel works in the office of U.S. Sen. Jay Rockefeller (D-WV). Hensel emphasized he was expressing his views and not speaking on behalf of the senator.
Hensel oversees legislation in long-term care, end-of-life care and health information technology. He has worked on research with scholars in health communication, health informatics, medicine and social work.
Health care currently commands 17.6 percent of the nation's GDP, Hensel said. The figure will climb to 20.3 percent by 2018.
Any reform efforts need to be done well, Hensel said. "If the right changes aren't made, we'll be back to the table," he said.
Many people misunderstand the face of the nation's uninsured, which stood at 45 million in 2007, Hensel said.
"Of that figure, 70 percent are families with one or more full-time workers. They are mostly low-income families, who are inside 200 percent of the poverty level," he said. "And they're not all young. Half of them are 30-64 years old."
The Congressional Budget Office has estimated that health reform will cost $1 trillion over 10 years, compared to the current $35 trillion spent on health care, Hensel said.
During the forum, Mary Derby of the USD Business School asked Hensel how he would respond to those who like the status quo.
"What do you say to the 250 million Americans who are satisfied with what they have?" she asked. "Why should they change for the 45 million who are uninsured?"
The system can handle the costs of taking on the additional 45 million patients, Hensel said.
Since President Harry Truman's administration in the 1940s, polls have consistently showed that 80 percent of the nation values access to health care, Hensel said. However, Americans are also concerned about the cost of covering the uninsured, he said.
"As a country, we haven't grappled with it," he said.
President Obama addressed the nation Wednesday in a televised speech about health care. Hensel expected last week the president to lay out his expectations for what needs to be included in health reform.
"It's pure speculation, but I think (Obama) will be more specific," Hensel said. "I don't think he will introduce a whole bill of his own. He will say, this is what has to be included and be firm on it."
Audience members questioned the impact of Obama's address at this stage of the debate.
"I wish he had given his talk sooner," Derby said.
The House has released its legislation, while the Senate Finance Committee has not released a bill, Hensel said. Congress returned this week from its August recess.
Congress has talked about insurance subsidies focusing on individuals and small businesses, Hensel said. A firewall would keep the subsidies from extending to large businesses, since that would exert a major financial impact, he said.
The "public option," or offering of a government insurance alternative, has drawn strong debate, Hensel said. Polls show one-half of Americans would consider joining a public plan, he said.
Proponents say the plan would inject more competition and not carry the profit requirement, with less cost for marketing, he said. Opponents say the public option would drive private insurance out of the market.
"The opposition focuses more on the public plan rather than the (proposed) co-ops," he said. "Opponents say the public plan would create unfair competition, and it's a Trojan horse for bringing us to a single-payer system."
Polls show large segments of public distrust of both the government and insurance companies in the health care arena, Hensel said.
Health reform covers areas besides insurance, Hensel said. Those areas include research on comparative effectiveness of various treatments and the role of Health Information Technology (HIT).
Health reform also looks at prevention and wellness, Hensel said. Those areas include screening, immunization and lifestyle choices, he said. He noted one company that may tie its employee health premiums to the individual's Body Mass Index (BMI).
Reform can also come in the form of bundling health care payments rather than making payments at each site along the way, he said. A package could include payment incentives, bonuses for quality and penalties for patient re-admittances soon after a discharge.
When it comes to paying for reform, proposals include a income tax surcharge on wealthy individuals or a tax for "Cadillac or gold-plated plans," he said.
The Democrats currently lack the 60 Senate votes needed for cloture, or ending debate, Hensel said. Republicans could filibuster in order to block further legislation, reconciliation could be pursued, or a decision could be made to split the bills, he said.
"From the liberal wing, there is tremendous lot of pressure to support the public plan," he said. "The co-ops would have a stronger leg if the Republicans had embraced it as an alternative. Since (the GOP) didn't, Obama will likely go with the public option (over co-ops)."
One man in the audience noted the Democrats are divided on health care reform, similar to the 1994 defeat of proposals by then-President Bill Clinton and then-First Lady Hillary Rodham Clinton.
"You have a strong conservative caucus of Blue Dog Democrats," the man said. "They don't have to vote down (health reform). They just have to let the Republicans filibuster it."
In response to a question, Hensel said he hasn't heard much discussion on the impact of reform on the veterans health system and the Indian Health Service. Mental health also needs to be a key part of the discussion, he said.
The health care debate has been sidetracked by talk about "death panels," that don't appear in any bills, Hensel said.
"There is bad politics and blatant distortion," he said. "Such talk diminishes the debate. There are plenty of things to debate about what the government's role should be."
Much of the public's fear comes from the unknown, Hensel said.
"There is a fear of change," he said. "There is a fear of how this will impact my mom. Will it change how (the elderly) receive Medicare?"
If anything, the public needs to be more involved in the debate, Hensel said.
"We haven't involved the consumer that much in reform," he said. "That's a criticism of Obama, that he hasn't told the public that they need to sacrifice."
Audience members noted that health care access also carries a moral issue. In addition, many consumers don't know or can't learn the cost of procedures, which affects their ability to make decisions.
The health care debate has avoided other serious issues, one man said.
"If we were really serious about health care, we would look at tort reform and health savings accounts," he said. "We have 45 million uninsured, and a large number of them are illegal immigrants who shouldn't be using our health care system."
"Obama is just using this as a way of achieving a single-payer system," the man added.
Obama does envision a larger government role in health care, Hensel said.
"It's quite a situation (Obama) has inherited," he said. "Obama wants to change the fundamental direction of the country. He is criticized for taking on too much. … These need to be seen as investments for going in a different direction."
Much of the current health reform debate centers on insurance coverage, not the actual delivery of medicine, Hensel said.
"The providers have to figure out creative ways of doing things well," he said. "The VA uses innovative delivery. It's more lock-step and a top-down way of doing things. But health care doesn't always work that way."
Americans must decide whether health care is a right or a privilege, Derby said.
"The right wing is so concerned that the government will get involved in health care," she said. "But the government would not be so involved with the provision of service. It's more how to get access to more people and how we will pay for it."
Derby disagreed with an audience member who welcomed spending 40 percent of the GDP on health care.
"(That amount) spent on health care isn't more health care," she said. "It's less money for everything else."
The status quo isn't acceptable, Derby said. "The system is broken and can't sustain itself," she said.
While the right and left sharply disagree on health care, Hensel said he sees a general willingness in Congress to craft some sort of reform.
"I am optimistic," he said. "There is fear mongering (among some groups), but there is respect (among many) for these differences."
In the end, the public wants action, he said. "People want to do something," he said.
Doing nothing is unacceptable, he said. "Will we just kick the can down the road?" he asked.