Health Care Policy with New Administration, Congress to go Beyond Insurance Debate

President-elect Obama and Congress will undoubtedly wrangle with health care in 2009, but the action will go beyond the debate over health insurance coverage, according to a Georgia State University public health professor.

Reform will also encompass public health measures, prevention efforts, beefed-up regulatory enforcement, and investment in health care technology, said Russ Toal, associate professor and Distinguished Fellow in Health Policy at Georgia State.

“I want to be quick to note that there is much that can be done without expenditure of money. And much of it can be done quickly,” said Toal, who gave his remarks Nov. 5 Public Health Grand Rounds lecture. “Public health is far broader than health insurance matters.”

Even in the face of difficult financial times, the government can take measures to improve health care in the United States, including the improvement of health-related regulatory enforcement by agencies like the Occupational and Safety Hazards Administration, the Food and Drug Administration and the Environmental Protection Agency.

Peeling back the laws passed in recent years which make it harder for people to declare bankruptcy — an option considered by many who face huge medical debts — would also help, Toal said.

Prevention and education programs are essential in addressing chronic illnesses which run up health care costs, while changing rules which forbid the federal government from negotiating drug prices could reduce increasing costs for prescriptions, he added.

Other public health efforts which might be addressed next year include raising the federal excise tax on tobacco products — which has been done in several states to help discourage tobacco use — as well as improving nutrition labeling laws on food products.

However, parts of the debate will include the discussion of expense — including health insurance for the uninsured, as well as increased military health care expenditures, Toal said.

Health insurance is also a component of the policy debate, and Obama proposes a version of the health care plan enacted by former Massachusetts Gov. Mitt Romney that allows those with employer-provided insurance to remain in their plans, while giving those without insurance a chance to purchase subsidized coverage from a pool of private insurers. Proposals also include enacting “re-insurance” for people who face extremely high, catastrophic costs.

Getting any measures passed, though, requires policymakers and politicians to go through intense legislative wrangling.

When the 111th U.S. Congress and President-elect Obama take their oaths of office in January 2009, one party will control both the legislative and executive branches. But this does not mean that a new administration will be able to get all of its proposals through quickly, Toal said.

Not all Democratic senators will agree to certain proposals, and Republicans will maintain enough seats to allow for filibusters — a legislative maneuver which can let a minority party stymie or kill legislation.

And just as with this year, health care was a top campaign issue in the 1992 election, when Democrats took control of both the executive and legislative branches. That led many in public health to believe that reform would happen under the Clinton Administration, but Toal said reform was stymied by a commission that took 10 months to produce a 1,300-page bill that got nowhere.

“I hope that President-elect Obama understands that he needs to strike quickly,” Toal said. “The new administration must move to put people in place quickly, and send a message to those throughout the federal government about what we must do, and that people will be held accountable.”

Overall, Toal said that with a new administration, there could be a new spirit of service not seen since the Kennedy Administration, leading more people — including Georgia State health sciences students — to work for the public good, even though the hours are often long and the pay much lower than in private industry.

“The impact of a revitalized and energized work force cannot be underestimated,” he said.

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