Obama Moves Health Care to the Front Burner

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Susan Walsh / AP

Senator Edward Kennedy

As part of the $3.5 trillion budget he proposed on Thursday, President Barack Obama is pushing for a down payment on universal health care, a reserve fund of $634 billion over 10 years paid for by higher taxes on the wealthiest Americans and savings from government programs like Medicare and Medicaid. By putting the funding on the table before the program has even been crafted, though, Obama is essentially putting the cart before the horse. Many health-care analysts hope to see more details of the President's plan during a White House health-care summit expected at the end of next week — but they may be looking toward the wrong end of Pennsylvania Avenue. Unlike the failed 1994 Clinton health-care-reform effort, this isn't going to be a bill that the Executive Branch drafts in isolation and then tries to ram down the throats of Congress. Instead, Congress — particularly a working group convened by longtime health-care-reform advocate Senator Edward M. Kennedy — is working on a consensus solution following the road map laid out by Obama. (See the top 10 medical breakthroughs of 2008.)

In fact, since the middle of last fall, Kennedy's group has held biweekly meetings that feel somewhat like a college class — albeit the most advanced seminar on health policy on the planet. There's a curriculum for each of the two-hour sessions; topics have ranged from benefits packages and employer mandates to tax treatment of health insurance, payment reform and prevention and wellness. Although they are about halfway through the agenda, participants say progress has already been made. The group agrees on broad principles like a focus on prevention, a commitment to cutting costs and universal coverage approached through the expansion of employer plans. But the group — so far on the friendliest of terms — has disagreed on whether coverage should be mandated or simply offered to all individuals, how much money is needed and what the proper role of government plans should be in the private system. And they haven't even gotten to some of the tougher parts yet, like how to make cuts in Medicare and Medicaid. (See pictures of health care in Iran.)

Taking part in these meetings, as was reported last week in the New York Times, are a diverse group of stakeholders: AARP, the insurer Aetna, the AFL-CIO, the American Cancer Society, the American Medical Association (AMA), America's Health Insurance Plans, the Business Roundtable, Easter Seals, the National Federation of Independent Business, the Pharmaceutical Research and Manufacturers of America (PhRMA) and the U.S. Chamber of Commerce. Most participants declined to comment directly on the talks, saying they were sworn to secrecy by Kennedy and risked expulsion from the meetings by talking on the record — though a few were willing to speak anonymously about some of the progress that has been made. Most were eager to praise the new momentum Obama has breathed into the talks this week, including the breakout session on health in his fiscal-responsibility summit on Monday, the underlining of his commitment to health-care reform in his address to the joint session of Congress on Tuesday and in his budget announcement on Thursday, and his announcement of a health-care summit for next week. "This is a frank and respectful discussion that essentially began in earnest on Monday," says Dr. Nancy Nielsen, president of the AMA. "What we're hearing from him is that there is an urgent need for health-care reform and that we also want to make sure that we get it right when we do those reforms."

Read "The Year in Medicine 2008: From A to Z."

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