Gov. Tommy Thompson (left) and Sen. Tom Daschle agree on the importance of healthcare reform.
Courtesy of America’s Health Care at Risk

AAOS Now

Published 11/1/2008
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Peter Pollack

Healthcare reform: Will 2009 be the year?

Daschle, Thompson find universal coverage, tort reform possible

“I believe very strongly that 2009 is going to be the biggest transformational year any of us in this room, or anybody across America has ever seen for health care,” Tommy Thompson, former Secretary of the U.S. Department of Health and Human Services and former Governor of Wisconsin, told attendees at the America’s Health Care at Risk meeting in Orlando, Fla.

According to Gov. Thompson, a confluence of factors will help persuade Congress to take strong action on healthcare reform in 2009. These factors include estimates that predict the Medicare fund may become insolvent by 2012, a provision in the Medicare Modernization Act that requires the next president to propose a fix for the Medicare fund early in his first term, and the termination of the State Children’s Health Insurance Program on March 31, 2009.

Surprisingly, both Gov. Thompson and former Senate Majority Leader Tom Daschle, who also addressed the conference, thought that Congress could finally reach agreement on universal health care and tort reform.

Coverage for all
“Finding a way to cover all Americans,” said Sen. Daschle, “is an idea whose time has come.” Even Republicans in Congress could accept a move toward a healthcare coverage mandate, agreed Gov. Thompson.

“You may have to disguise the word, but let’s be honest,” he said. “As soon as the election is over, you’re going to see a convergence of approaches.” Varying combinations of mandates, some government involvement, and the free enterprise system have been proposed by both presidential candidates and could be adopted.

“Maybe the term of choice ought to be individual responsibility,” suggested Sen. Daschle. “But in some way, if health care is a moral or a legal right, it also has to come with some responsibility, and we all have to live up to that responsibility.”

Prospects for liability reform
The subject of medical liability reform has been one of the most divisive healthcare issues faced by Republicans and Democrats.

Sen. Daschle called for increased transparency and use of best practices in the medical community as the first steps toward liability reform. He pointed out that structures do not exist to determine why the system breaks down and how to prevent recurrence. He believes that some level of medical liability reform is needed as part of a systemic change to increase transparency.

“If doctors subscribe to best practices,” he said, “and we have that transparency, the next step is to give them safe harbor and immunity from lawsuits so that they can cooperate and be part of a system to improve safety. I would support a health court, where we resolve these matters, and the creation of a compensation fund to deal with those who are ultimately, unfortunately, victims of whatever circumstances develop.”

Gov. Thompson also expressed his support for a health court or arbitration system for liability cases, and proceeded to address the issue of liability caps. He supports caps and agrees that caps decrease liability insurance rates, but stated that physicians are unlikely to see widespread support for caps until they can counter the influence that trial lawyers have.

“Doctors have got to learn how to play the game,” he said. Otherwise, he suggested, physicians should strongly consider alternative approaches to liability caps—alternatives that are more likely to pass Congress, given the current legislative environment.

“Arbitration is doable,” he said. “Arbitration, coupled with transparency and quality, is a winner. You should be able to put together a bipartisan package that will get that through.”

A global approach
Gov. Thompson added one caveat to consider in any attempt to redesign the healthcare system. Although Congress likes to conduct its business piecemeal, the only realistic approach to fixing the healthcare system is a comprehensive repair package.

“It’s only crisis or leadership that drives public policy decisions of the magnitude we’re talking about,” Sen. Daschle said.

Both Gov. Thompson and Sen. Daschle emphasized that solving the healthcare crisis involves more than just addressing physician reimbursement and quality of care. The rising costs of health care are placing an increasing burden on the U.S. economy.

“This is more than a health issue now; it is a huge economic issue,” said Sen. Daschle. “And it is a huge competitiveness issue. It’s how we’re going to be positioned as we look to our challenges throughout the world.”

“It goes back to our basic capitalist economic system,” said Gov. Thompson. “To compete internationally, we can’t pay 21 percent of our gross national product on health care while China pays 2.5 percent. Every country is spending less than we are in the United States. That’s why it is crucial for us to fix this problem. It requires Democrats and Republicans to put aside their partisan differences and do it for the good of our country.”

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaos.org