On October 29, five US Congressmen presented their competing legislation to enact Universal Healthcare Coverage: Senators Ron Wyden, Bob Bennett, Richard Burr and Tom Coburn, along with Representative John Conyers, Jr. The New School President and former Nebraska Senator Bob Kerrey moderated. In a remarkably amicable discussion, each side vied for the audience’s favor on their proposed Acts. Methodologies, funding and claimed savings varied widely.

   A relative sense of balance prevailed as far as characterizing the strengths and weakness of the US Healthcare system, unlike other public forums. Senators Bennett and Coburn were out front reminding attendees about the deficiencies of single payer systems, held up as models for the U.S. These include long waits for specialists and less innovation. A salient point was the existence of several interwoven systems, rather than one that could be easily manipulated. The crowd appeared to heavily side with John Conyer’s United States Health Insurance Act (HR676), the least friendly to current managed care players.

   Key provisions of each Act and related commentary are summarized below:

A) Health American Act sponsored by Bob Bennett ( R ) Utah and Ron Wyden ( D ) Oregon

Noteworthy for its bi-partisan backing, emphasis on community health systems, portability, competition and transition from employer to employee choice of plans. Cost containment claims of 1.48 trillion dollars over 10 years.  The sponsors correlate higher quality with lower costs. Funding comes from tax shift from high income to middle and lower income Americans. Senator Bennett shared the example of the Swiss National Health Plan which rebates as much as $25,000 to members who stay healthy over a five year period.

B) Every American Insured Health Act sponsored by Tom Coburn ( R ) Oklahoma

Senator Coburn has the most positive assessment of the current healthcare system, decrying its cost rather than quality. When murders and other factors not attributable to healthcare were backed out, he claimed the US had superior health outcomes to most Western systems. Adjusting the tax system is a primary driver. Health savings accounts are created to accrue tax credits. Allocates a strong role to states to creating more affordable and accessible markets. Six keys to first year savings of 200 billion dollars are reduced cost shifting, improved chronic care, cutting unneeded tests, increased competition, incentivized coverage of high risk patients and prevention. Senator Coburn argued against mandating coverage –citing the example of 15% of auto owners lacking mandating coverage. Tempering the admiration of some colleagues for Medicare, Coburn reminded of the 150 billion dollars in annual borrowing needed to sustain it, a rapidly rising figure.

C) United States National Health Insurance Act (HR676) sponsored by John Conyers, Jr ( D ) Michigan

Representative Conyer’s plan promised the most Federal government involvement – expanding the Medicare program to all Americans. Insurance plans bared the principal blame for rising healthcare costs and decreasing outcomes. First year savings of 50 billion dollars are driven by less paperwork and volume drug purchasing. Additional financing comes from a healthcare tax on the richest 5% of Americans. The rest comes from a 3.3% payroll tax. Protection against trial lawyers was conspicuously absent.  He said that issue should be addressed in other legislation.

D) The Universal Healthcare Choice and Access Bill sponsored by Richard Burr ( R ) North Carolina

Senator Burr is skeptical of the Federal Government’s ability to negotiate cost savings based on experience. He urges financial incentives that reward improved chronic care outcomes and preventative health, now lacking. Tax withholding and plan selection shifts from employers to employees. The increasing shortage of specialty doctors was cited as a consequence of reduced Medicare D payments.

   Congressional momentum is building for substantial and sustained intervention in the current system(s), regardless of Presidential Election’s outcome. Public sentiment will keep this a front burner issue for the foreseeable future. 

Article by Mike Taubleb. Mike runs Promenade Speaker’s Bureau, specializing in healthcare and insurance experts.