They're Off (And Running)!

The race for health care reform has apparently begun in earnest, and while many squares on the grid of possible outcomes are occupied, it's far too early to hazard even a wild guess.

The health care industry -- six groups representing doctors, hospitals and manufacturers of drugs and medical devices -- was first out of the gate, releasing a letter in advance of Monday's meeting with President Obama in which they pledged to cut the rate of growth of national health care spending by 1.5 percentage points a year, for each year in the next decade.

The pledge on behalf of private industry, described by Obama as a "watershed moment," comes against a backdrop of numerous proposals for increased government involvement in health care. If the brakes really are applied to health care costs -- and as Sen. Chuck Schumer (D-NY) notes, "It's a goal and a good goal... but it's hardly locked in stone" -- we are told that would add up to savings of over $2 trillion.

But by what means? What exactly would be cut, and at whose expense? Then there's the matter of how to pay for the coverage we do provide, a subject the Senate Finance Committee is now examining, as House Democrats promise to act on health care by July.

These questions are not details that policymakers can afford to ignore if major health care reform is to go forward with the informed consent of the public. Surveys have shown that while there is a great deal of interest in more affordable health care, available to a wider swath of the public, there is also a lot of doubt about whether various proposed changes would bring about desirable results.

"What the groups have said is that they are stepping up to do whatever they can to bend the cost curve" and "that they are committed to find cost savings in their own sector," said Robert Zirkelbach, spokesman for America's Health Insurance Plans, one of the six groups represented at the White House meeting.

No real details there.

"None of these steps," said Obama, "can be taken by our federal government or our health care community acting alone." Or without a great deal of public debate. Some early voices taking positions in the battle among the three basic approaches to reform, namely, national health insurance, public insurance for some, and letting the marketplace sort out the problem:

• the New York Times, in an editorial endorsing what it calls a moderate approach of having a public insurance plan compete with private insurers, but with regulations aimed at making this a fair fight;
• Scott Gottlieb is a former Medicare [click here to see the new projections on that red ink] official and doctor, and is currently a health care industry investor and a fellow at the American Enterprise Institute. In a Wall Street Journal op-ed piece, he argues that the "surest way to intensify flaws in the delivery of health care is to extend a Medicare-like 'public option' into more corners of the private market." He cites an estimate that newly available public insurance could send two-thirds of now privately-insured individuals to the public side of the fence, and suggests that doctor's incomes could be pushed down by as much as 20 percent, causing them to consolidate into busier practices with less time for quality health care. Gottlieb's prescription instead is for doctor's pay to be linked to health care outcomes, a process he says has begun at the largest health insurance companies.

Public anxiety over health care has emerged repeatedly in public opinion surveys, including in the report we are releasing today, "Impressions of HIV/AIDS in America," in which focus group participants showed empathy for those who are living with HIV and expressed concern that individuals who are not in high-income brackets might not have access to the medical care they need.

"Take Magic Johnson, for instance," said one focus group participant, in Birmingham, Ala. "He was able to live this long, and he is as healthy as he is, because of the amount of money he has... I would think maybe his wealth acquired him better medicines than maybe the poor people. You might get some medicine, but it might not be as good as what he has."

In a similar vein, a Gallup poll late last year found 29 percent of Americans said either they or a family member had put off medical treatment in the previous twelve months because of cost. That number jumped to 39 percent among those who earned under $30,000 and 61 percent among people who were uninsured. Access to health care and the cost of health care meanwhile were rated, by 30 percent and 25 percent respectively, as the nation's most urgent health problems, easily outpacing obesity (12 percent), cancer (11 percent), heart disease (2 percent), AIDS (2 percent) and diabetes (2 percent).

But the public sends mixed signals on this subject: while 79 percent say they are dissatisfied with the cost of health care in this country, and 72 percent rate health care coverage here as "only fair" or "poor," 89 percent say they personally are covered by either private or federal insurance, and 83 percent say "excellent" or "good" describes the health care they personally receive. Even more interesting in terms of contrast: 67 percent rated their own health care coverage as "excellent" or "good," and 58 percent were satisfied with the total cost they personally pay for health care.

Which may explain why, even though nearly three-quarters (73 percent) described the U.S. health care system as either "in a state of crisis" or at least having "major problems," 49 percent said they'd prefer to maintain the current system based mostly on private health insurance -- only slightly more than the 41 percent who favored replacing this system with a new government-run health care system.

Question wording counts: in this survey, participants weren't given a third option, so we can't be sure if they'd prefer another choice.

To learn more about this issue and consider which options you favor, see our Citizen's Survival Kit and our issue guide on health care.

May 15th Update: Health care industry leaders say Obama has overstated what they are committed to do in terms of cutting costs. The New York Times reports they say their promise is to slow health care spending in a more general way and is not a pledge to specific year-by-year cuts. The director of the White House Office of Health Reform, who at one point Wednesday said Obama "misspoke," now says the president did not - - and that his remarks "accurately described the industry's commitment."