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Introduction
With the long anticipated march toward substantive healthcare reform under way, the eyes
of the healthcare industry are fixed squarely on Washington DC. For the remainder of
2009 and potentially beyond, Congressional leadership will be locking horns over how to
restructure the delivery of healthcare services in the United States with an eye toward
reducing costs, expanding coverage and improving quality. The Obama administration
fired an initial salvo at reform through its preliminary budget proposal submitted on
February 26, 2009. While this proposal included targeted actions toward certain subindustries
of the healthcare industry, it lacked significant detail on how reform would be
achieved. The proposal outlined certain principles that the administration would like to see
followed in the design of any reform initiative and recommended setting aside dedicated
funding to achieve that goal. With regard to specific action plans and structural changes to
the delivery system, the budget implicitly acknowledges they are better determined
through a healthy debate in the chambers of Congress. To that end, serious efforts are
under way in the Senate and House, led by teams from both parties, to have bills ready for
mark-up by late summer.
In anticipation of these proposals, as well as another possible wave of healthcare-related
legislation in the administration’s revised budget, the Credit Suisse Healthcare Research
team has compiled a cross-sector analysis of the options available to Congress and the
President in their attempt to expand access to healthcare services and reduce the rate of
medical cost growth. Specifically, using a December report published by the
Congressional Budget Office (CBO), entitled “Budget Options Volume 1: Health Care,” as
the “playbook” for future reform proposals, we provide our thoughts on the potential impact
of those legislative changes already included in the President’s preliminary budget, as well
as those that may emerge down the road. We comment on 85 measures identified by the
CBO and analyze the potential impact of those reforms we think are most controversial.
We also walk through an analysis of some of the major healthcare reform models already
introduced by members of Congress to get a sense for how access to coverage may
change under various proposals.
Before digging into our broad conclusions, we wanted to make a few summary
observations regarding the President’s initial budget proposal:
■ It is clear from the eight principles of healthcare reform outlined by the budget that the
administration is focused on expanding coverage to Americans that are currently
uninsured, improving the quality of care delivered, and lowering costs for those that
already have insurance coverage. As the list of policy goals below demonstrates, the
administration appears to weigh each of these objectives evenly, as there are three
that relate directly to health insurance access, three that relate to the cost of
healthcare, and two that relate to care quality.
Access:
o Guarantee Choice. The plan should provide Americans a choice of
health plans and physicians. People will be allowed to keep their own
doctors and their employer-based health plans.
o Provide Portability of Coverage. People should not be locked into their
job just to secure health coverage, and no American should be denied
coverage because of pre-existing conditions.
o Aim for Universality. The plan must put the United States on a clear
path to cover all Americans.
Cost:
o Make Health Coverage Affordable. The plan must reduce waste and
fraud, high administrative costs, unnecessary tests and services, and
other inefficiencies that drive up costs with no added health benefits.
o Protect Families’ Financial Health. The plan must reduce the growing
premiums and other costs American citizens and businesses pay for
health care. People must be protected from bankruptcy due to
catastrophic illness.
o Maintain Long-Term Fiscal Sustainability. The plan must pay for itself
by reducing the level of cost growth, improving productivity, and
dedicating additional sources of revenue.
Quality:
o Invest in Prevention and Wellness. The plan must invest in public
health measures proven to reduce cost drivers in our system – such as
obesity, sedentary lifestyles, and smoking – as well as guarantee access
to proven preventive treatments.
o Improve Patient Safety and Quality Care. The plan must ensure the
implementation of proven patient safety measures and provide incentives
for changes in the delivery system to reduce unnecessary variability in
patient care. It must support the widespread use of health information
technology with rigorous privacy protections and the development of data
on the effectiveness of medical interventions to improve the quality of
care delivered.
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