White House maneuvers – national health insurance and care

White House maneuvers – national health insurance and care – column

Joyce Frieden

As our cover story documents, hundreds of interested parties–members of Congress, trade associations, public interest groups, business coalitions, labor unions, and others–have come out with their own schemes for national health care reform. In the midst of all these proposals, where does the White House stand?

The answer is hard to discern; no definitive proposal has come forth from 1600 Pennsylvania Avenue. To be sure, the Administration has made concrete suggestions in particular areas; for instance, it has put forth a proposal for malpractice insurance reform. (See B&H, September 1991.)

But other than a few specific proposals, nothing global has been forthcoming. “They have a new acronym about health care reform over at [the Department of Health and Human Services],” says one Washington lobbyist. “It’s NATO–No Action, Talk Only.”

HHS officials quarrel with that characterization. They say they are busy studying the problem and are awaiting the results of deliberations by several commissions before making a proposal.

Advise and dissent

One group that the Bush Administration is awaiting word from is the 1991 Advisory Council on Social Security. Every four years, the Secretary of Health and Human Services is required by law to appoint such a council to review the status of the Social Security and Medicare trust funds “in relation to . . . the adequacy of benefits, and all other aspects of these programs,” according to council literature. HHS Secretary Louis Sullivan, M.D., also has asked the group–often referred to as “the Steelman Commission’–to make “recommendations for more stable health care financing for the aged, the disabled, the poor, and the uninsured.”

Sullivan appointed the latest council on June 19, 1989. Chairing the 12-member panel is Deborah Steelman, former associate director of the Office of Management and Budget and Bush’s health care adviser during his 1988 Presidential campaign. Members include the AFL-CIO’s Karen Ignagni; Theodore Cooper, M.D., CEO of the Upjohn Company; and John Dunlop of Harvard University.

In July, the group issued an interim report, making specific recommendations on Social Security financing. But it has yet to issue a report on health care. Sources close to the commission staff say members are divided on the direction health care reform should take, and that the staff expects to issue a consensus report on “minor issues,” but not much else.

The official answer is somewhat different. “The staff wrote up over 50 ideas in draft format for council members’ review, and that’s where things are,” says council spokeswoman Teddi Pensinger. “A lot of draft documents are circulating. I would expect a final report by late fall.”

In addition to reviewing those proposals, the council has just concluded a series of eight public hearings on the health care issue held in various cities nationwide. It also is conducting “site visits” to talk to health care practitioners and others “about issues and problems related to health care,” Pensinger notes.

Horner’s corner

Another Administration group studying health care reform is the so-called Horner Commission, a five-member task force named for its original chairwoman, former HHS Deputy Secretary Constance Horner. The two-year-old commision, which includes Health Care Financing Administration head Gail Wilensky as well as Assistant Secretary for Management and Budget Kevin Moley, has continued despite the departure of Horner, who left for a job in the White House personnel office.

“At this point, the Secretary himself is likely to move into direct supervision of the task force,” says HHS spokesman Campbell Gardett. The group has been waiting for two reports before making a final proposal: the Steelman Commission report, and the recently released recommendations of the National Governors’ Association, Gardett asserts.

While no one is certain of the outcome, Gardett suggests that Sullivan’s latest speeches indicate the secretary’s answer is likely to be in favor of improving the current public/private system rather than doing a complete overhaul. A lot of people are waiting for that response to be made official.

COPYRIGHT 1991 A Thomson Healthcare Company

COPYRIGHT 2004 Gale Group