Mitchell tackles health care at forum

PORTLAND – Former U.S. Senate Majority Leader George J. Mitchell, a native of Waterville, has accomplished a lot in his high-profile career, including sponsoring landmark federal environmental legislation, helping to bring peace to war-torn Northern Ireland and overseeing a comprehensive investigation into the use of steroids by Major League Baseball players.

Now Mitchell, along with a group of three other former Senate majority leaders, has turned his attention to the seemingly intractable crisis in the American health care system. On Wednesday, he was joined at the Eastland Park Hotel in Portland by a group of experts from Maine, Massachusetts and Vermont for a regional forum on health policy.

The 19 invited participants met with Mitchell and the health care project’s co-directors, Chris Jennings, who was a senior health care adviser to President Clinton, and Dr. Mark McClellan, who served under President Bush as administrator of the Centers for Medicare and Medicaid Services and as commissioner of the Food and Drug Administration.

One goal of the meeting was to gather information about lessons learned from innovative state-level initiatives, such as Gov. John Baldacci’s Dirigo Health Reforms. Participants also discussed the challenge of providing affordable health care coverage through private insurance companies, and strategies for improving the quality and effectiveness of health care itself while holding down the costs of providing that care.

Using information gathered from innovations and experiences at the state level, the ex-majority leaders’ Washington, D.C.-based Bipartisan Policy Center will make recommendations for a nation health system reform to the next U.S. president and members of the incoming Congress.

Speaking about the Dirigo Health Reforms at Wednesday’s meeting, chief architect Trish Riley of the Governor’s Office of Health Policy and Finance told the group that the multifaceted initiative has succeeded in saving money, improving care and reducing the number of uninsured Maine residents, but that the failure to identify a sustainable funding mechanism for the subsidized Dirigo Choice health insurance program remains an ongoing problem.

Riley said there was broad bipartisan support among Maine lawmakers, insurance companies, physicians and hospitals when the Dirigo measures were enacted in 2003, but that support has since eroded as problems have arisen. The process of developing consensus among the groups was arduous, she noted, adding that consensus should and could have been protected by the creation of an objective panel to prevent each “bump in the road” from being seen by critics as an opportunity to revert to business as usual.

Jon Kingsdale of the Commonwealth Health Insurance Connector Authority in Massachusetts told Mitchell that his state’s recently implemented program, which requires every resident to have insurance and every employer to offer it or face a financial penalty, already has stimulated competition among insurance companies and driven down the cost of coverage, especially for individual, nongroup purchasers. Benefit packages have also become more comprehensive, he said.

Kingsdale noted that Massachusetts was motivated to develop the Connector project in response to the threatened loss of $385 million in federal subsidies. The lesson, he said, is that “sticks are as important as carrots” when it comes to providing incentives for health system innovation.

In Vermont, the development of the Catamount Health Plan was largely driven by “the growing insecurity of health care consumers,” said James Leddy, a former state legislator and a consultant on health care reform. He said Americans perceive their health care as “a kind of lottery, or social Darwinism,” where only the lucky, the healthy and the wealthy survive.

In addition to providing health care coverage to Vermonters who don’t have insurance at their workplace, the state has also focused on improving the management of chronic conditions such as diabetes, heart disease and asthma. Individuals who participate in these disease management plans don’t have to pay co-payments, deductibles or other out-of-pocket costs. The state has also instituted a tax of two-tenths of 1 percent on medical bills to create a fund that helps small medical practices pay for electronic technologies, such as electronic medical records, that improve patient care.

Also speaking at the meeting were health insurance industry researchers and actuaries, physicians, health care administrators, public health experts, consumer advocates and others whose professions bear directly on the health care system. All agreed the nation’s health care system is in crisis, and while states may lately have served as the “laboratories” for innovation and improvement, they said it is time for federal leadership.

The forum was attended by about 130 nonparticipating audience members, including about a dozen state lawmakers, several state health officials, insurance industry representatives, and many members of private health policy and advocacy organizations.

It was the third of four such meetings planned by the Bipartisan Policy Center, the Washington, D.C. think tank and advocacy organization founded in 2007 by Democrat Mitchell and three other former majority leaders: Democrat Tom Daschle of South Dakota and Republicans Howard Baker of Tennessee and Bob Dole of Kansas. The first meeting took place in Washington in April. The second was held in Kansas last month. The leaders will hold one more regional meeting, either in Washington or in Tennessee, before drafting their report for the new president and incoming Congress. The group has already hammered out bipartisan recommendations on a number of divisive issues, including energy, transportation and national security.

“We are determined to demonstrate that it is possible to achieve bipartisan solutions to many of the major problems facing this country,” Mitchell said in his opening remarks.

During a 10-minute lunch break, Mitchell said he feels optimistic that the new administration and incoming Congress will take on the formidable task of reforming health care even while other worries, such as energy concerns and the shaky economy, plague the nation.

“There is clear consensus that health care reform is needed,” he said.

Noting that the health care sector makes up 16 percent of the nation’s gross domestic product, he said, “You can’t talk about the economy without discussing health care.”

But Mitchell acknowledged that entrenched special interest groups and deeply felt differences in political philosophy make the issue an especially divisive one. Even among the four members of the Bipartisan Policy Center, he said, it will be a challenge to arrive at a common set of recommendations.

“But we’ve got to try and reach agreement,” he said.

Mitchell said both presidential candidates and several key members of Congress have expressed interest in the work being done by the policy center.

On the Web: www.bipartisanpolicy.org