The New RomneyCare: Introducing The Old Status Quo
Posted Sep 27 2012 10:01pm
Posted on | September 25, 2012 |
Nearly a decade ago, I participated in a collaborative gathering of health policy leaders each year at the Sundance Mountain Lodge in Monument, CO. The group, called the Health Sector Assembly, is still in existence. As veteran reporter David Broder wrote in 2003, “Organized by Roy Pfautch, a veteran of the American Medical Association, and largely financed by pharmaceutical firms, it has developed not specific legislation, but sets of detailed principles for reducing the ranks of the uninsured, handling the health-care needs of the elderly and financing long-term care.”(1)
One of those principles, voiced early and often by participants like Steven Schroeder MD, former head of the Robert Wood Johnson Foundation, was that the status quo was no longer the next best option to a non-negotiated deal. Ron Pollock of Families USA echoed the same sentiment when he said, “In the past, everyone had something in the current system that was their top priority to protect. Now, everybody agrees that the status quo is not even a good second choice.”(1)
Eight Health Sector Assembly meetings later, many of these same individuals (notable among them the leaders of PhRMA), lent their support to Obamacare which is already bringing expanded coverage and some level of national coordination to this chronically hyper-segmented sector. Case Closed! Well, not exactly…
….as we witnessed during Scott Pelley’s interview of Mitt Romney on CBS’s 60 Minutes this week.(2) Governor Romney has reversed his own opinions on a wide range of policy issues over the past four years, but none more notable than health care delivery.
If one were looking for a live metaphor of our deeply segmented, expensive, and dis-integrated health care system, a number one candidate would be hospital emergency departments. These valued community based resources, spread relatively evenly across America, have been the fall-back position for a system that is uneven, often inaccessible and highly variable. There were 136 million visits last year, up 10% over the prior year. 15% of those visits were by uninsured and 8% were classified as non-urgent.(3) Addressing the inappropriate use of the Emergency Department has been widely viewed by experts everywhere as low-hanging fruit …including (until this week) Mitt Romney.
In 2007, Governor Romney said, “When they show up at the hospital, they get care. They get free care paid for by you and me. If that’s not a form of socialism, I don’t know what is. So my plan (in Massachusetts) did something quite different. It said, you know what? If people can afford to buy insurance … or if they can pay their own way, then they either buy that insurance or pay their own way, but they no longer look to government to hand out free care. And that, in my opinion, is ultimate conservativism.”(4)
President Obama apparently agreed, modeling this part of the Affordable Care Act on Romney’s plan. By 2010, Romney’s views remained consistent. Asked if he believed in Universal Coverage, he replied,“Oh, sure. Look, it doesn’t make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility, particularly if they are people who have sufficient means to pay their own way.” (4)
In his book, No Apology, the governor further explained, “After about a year of looking at data and not making much progress we had a collective epiphany of sorts, an obvious one, as important observations often are: the people in Massachusetts who didn’t have health insurance were, in fact, already receiving health care. Under federal law, hospitals had to stabilize and treat people who arrived at their emergency rooms with acute conditions. And our state’s hospitals were offering even more assistance than the federal government required. That meant that someone was already paying for the cost of treating people who didn’t have health insurance. If we could get our hands on that money, and therefore redirect it to help the uninsured buy insurance instead and obtain treatment in the way that the vast majority of individuals did before acute conditions developed the cost of insuring everyone in the state might not be as expensive as I had feared.”(5)
But that was then, two years ago, before a Presidential Primary forced him to deny his own creation. Cornered by a promise to repeal Obamacare, he must now explain how those currently covered by the law, and soon to be disenfranchised should he be elected, will survive. His answer on 60 Minutes suggests that the Health Sector Assembly was wrong about the status-quo. Governor Romney, in a startling reversal of his own values, falls back on a crumbling, and wildly expensive safety net stating, “Well, we do provide care for people who don’t have insurance. If someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.”(2)
That comment drew a rebuke from Dr. David Seaberg, president of the American College of Emergency Physicians (ACEP). “Emergency care is not health insurance. All patients need health insurance that gives them access to primary care doctors and medical specialists, as well as high-quality emergency care.”(3)
Increasingly, in politics, it’s hard to make a sharp right turn and not be noticed. In health care politics, power players like those who attend the Health Sector Assembly, know there is no going back. Governor Romney could have been, and should have been, in the front of the pack on health care reform. Regrettably, he’s chosen a back seat.