[新聞] Inclusive Obama healthcare approach invites a fight

Source: Thu Mar 5, 2009 5:34pm EST, Retuers
By Maggie Fox, Health and Science Editor - Analysis

WASHINGTON (Reuters) - A White House forum on healthcare started on Thursday and included a range of players, from health policy experts who want guaranteed health insurance to lawmakers who want to focus on saving money. But any eventual reform is likely to be a patchwork of compromises.

President Barack Obama has said he wants a wide buy-in to whatever plan emerges.
He knows that healthcare reform has defeated many before him. But he also knows he has three big advantages this time: the ballooning cost of private and public health insurance, the economic recession, and widespread agreement that the U.S. system does not work any more.

He is framing his healthcare reform proposals as a way to fix the economy, create new jobs and reduce deficits.

"This time, the call for reform is coming from the bottom up and from all across the spectrum -- from doctors, from nurses, from patients; from unions, from businesses; from hospitals, health care providers, community groups," Obama told the opening session of his meeting.

Yet in almost the next breath, he made clear he is going to allow, even encourage, a debate about how to get there.

What is needed:

* Coverage for some or all of the 46 million Americans who do not have health insurance.

* A way to reduce premiums employers and the 160 million people who get health insurance through their jobs.

* Ways to cut the ballooning costs to state and federal governments of Medicare and Medicaid, the government healthcare programs for the elderly, which threaten to overwhelm budgets within the next 15 years.

* A way to trim and coordinate the way Americans receive care -- one that allows sharing of medical information while reducing unneeded tests and procedures, preventing mistakes, and enhancing health instead of focusing on disease.

ALL OPTIONS ON THE TABLE

"Every option must be on the table," Obama said. "Now, as we work to determine the details of health care reform, we won't always see eye to eye. We may disagree -- and disagree strongly -- about particular measures."

House of Representatives Republican Leader John Boehner was quick to oblige with some fighting words.

"Taxpayers cannot afford to subsidize a bureaucratic takeover of healthcare with a massive tax hike on all Americans, particularly in these troubled economic times," he said in a statement.

"In addition, we believe families and their physicians should make decisions about what treatments are 'appropriate,' not government bureaucrats."

A residue of mistrust dating back to earlier attempts to overhaul the healthcare system persists.
"We saw interest groups at the beginning of that health reform initiative sound supportive," said Judy Feder of the left-leaning Center for American Progress Action Fund, who worked on former President Bill Clinton's failed attempt to overhaul the system in the 1990s.

"They then turned and used all their resources to fight reform and ensure failure," said Feder, who blamed the private health insurance industry in particular. "This time we are not going to let them get away with it."

Feder believes Obama will allow some debate but will not let it delay his delivery of some kind of overhaul of the system the end of the year. "I don't think we should confuse his open door with being a doormat," she said.

Obama has made clear that outright nationalization of the healthcare system, as in countries like Britain and Canada, is not on the cards.

"The other things being proposed will not work," said Dr. Steffie Woolhandler, a Harvard University medicine professor who helped found Physicians for a National Health Plan, which advocates such a system.

The middle ground appears to lie in a combination of expanding federal programs such as Medicare, some kind of legislation to broaden the offerings from private insurers, and gentle encouragements to streamline medical care delivery.

"We want to see a system where people have a choice of public and private health insurance plans," said Health Care for America Now's Richard Kirsch.

(Editing by Chris Wilson)