Whither Health Care Reform without Teddy?

I love this picture of Ted and Victoria Kennedy, taken by Matthew J. Lee of the Boston Globe. The picture was taken in May of 2008, after Ted Kennedy had been diagnosed with brain cancer; he had been released from Massachusetts General Hospital earlier that day. It shows his love of life, and love of living.

With the passing of Senator Kennedy last week, folks across the country were looking back, some even benevolently, on the Kennedy family and legacy. It’s a rich tapestry, filled with both the very obvious highs and lows, but also tinged with great nuance. Teddy the painter, Teddy the sailor, Teddy the history buff, Teddy the practical joker…and on and on.

Some of the more touching moments over the past several days of mourning were the younger Kennedys talking about what Uncle Teddy meant to them, as a father, uncle, grandfather, stepfather, and friend; the intercessions at his funeral by the younger generations, offered up in EMK’s own words as prayers with great poise; and of course the tales told by Senators John McCain and Orrin Hatch, and by Vice President Joe Biden at the memorial service at the JFK library, which added layers and colors to the picture as well.

Among the questions being raised now that Teddy’s gone is what will happen to health care legislation. There’s no question that getting national health care implemented was a life-long goal, and one that we are teetering on the brink of accomplishing. While he had not been present in the Senate for a very long time, he was working behind the scenes, the consummate politician, helping others try and keep the legislation moving along. Recall that, at different times in the debate over the past several months, what’s been discussed as vital to our country are covering the uninsured (which includes not only those who apparently can’t get insurance, but also those who choose not to), saving money (by reducing unnecessary services, but certainly not by ‘rationing care’), and by improving quality (through incentives to those who practice medicine well and drive positive outcomes, but definitely not about improving the quality of end of life care;, heaven forbid that even get discussed). And of course, through all of this, we must bring the evil insurance companies to their knees and get them to change their ways.

Sadly, however, we can’t cover more people, and reduce costs, and not ration care, and pay more for the care that’s provided, and bring an industry to its knees all at the same time. Even Teddy realized long ago that you can’t get everything in one fell swoop – you have to take incremental victories along the way. Incrementally, we’ve achieved S-CHIP, health insurance for children. Incrementally, we’ve achieved HIPAA, the Health Insurance Portability and Accountability Act, which requires that certain prior insurance coverage count against waiting periods under new insurance, and defines how those waiting periods are determined. Incrementally, we’ve gotten COBRA laws , which allow a person to continue their health insurance when they're between jobs, and helps make the HIPAA protections more secure. And under new legislation passed earlier this year, COBRA coverage can be subsidized by the government, reducing the burden on folks during these difficult economic times.

In this article in Newsweek, Senator Kennedy talked about the incredible health care he was able to get for himself as he underwent his treatment for brain cancer, and also when he was injured in a plane crash back in 1964; and how he’s been able to obtain the best possible care for all three of his children at various times when they were in the midst of health crises of their own. He was able to get this level of care for two reasons – one, he’s a Kennedy, and both the name and the money behind it open doors. The second reason he’s been able to get this care is because he has the best insurance in the country – the Federal Employee Program (FEP), which offers great benefits, tons of choice, and pretty much carte blanche in terms of coverage. And again, like being a Kennedy, these are benefits that the vast majority of Americans cannot access – even those with health insurance - because most plans are not as rich as those offered under FEP.

Knowing that the vast majority of Americans are neither Kennedys or beneficiaries of the FEP health insurance plan, what do we do now? Do we give up on health care reform, now that its greatest champion is gone? Or do we renew our emphasis on getting some consensus on what we need to have as critical health care reform, get that part done this fall, and then continue working on it until we have all of it figured out? I would choose the latter option, plain and simple.

If we agree that all Americans need to have health insurance as our first priority, then we mandate insurance coverage, plain and simple, and we come up with ways to enforce that mandate. This includes making young, healthy people who get coverage, whether they want to or not.

If our highest priority is that we eliminate waiting periods on health insurance benefits, as that’s preventing people from being covered, or causing people to lose their savings, homes, etc., then that’s what we focus on, that’s what we figure out how to pay for, and we get it done.

If instead our highest priority is cost savings, then we adjust the Medicare reimbursement methodologies (which are the basis for many private insurer reimbursement calculations) AND we get reductions from Big Pharma on drug costs. These actions should not only reduce outlay in payment for benefits, but also should reduce or hold the line on premiums paid.

Whatever we do, we must do quickly enough that the states have time to respond, adjust their regulations to align with the new federal statutes, and make appropriate changes in their programs as needed. This is critical, because whatever comes down the pike at the federal level will certainly have consequences at the state level, 50 times over. Taxes, safety net programs, benefit mandates, subsidies, costs for businesses (including insurance companies) and individuals are all in play in this debate once the feds decide what we're going to look like.

I’m not so naive to think there wasn’t a political motivation or undercurrent to some of the tributes to Teddy; after all, while you can take the Kennedys out of politics, you can’t take the politics of out the Kennedys. I also don’t agree with everything he ever said or did, but instead recognize him as a human being, flawed as are we all. But I think we can learn from his undeniable drive, determination, and ability to achieve consensus as we try and solve this animal that is health care reform.