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On November 6, ConnectiCare was the main sponsor for the New Haven Healthcare Heroes event that recognized several area physicians, nurses, and hospitals. Mickey Herbert delivered the following speech on federal healthcare reform at the event.

Speech from November 6, 2008

So, two days ago we elected a new President, a new Congress, and a new state legislature. What does this mean for health care reform?

In the interest of time, I'm not going to talk about state reform here in Connecticut except to say that the Connecticut State Senate will be changing in one meaningful way. When Democrat Anthony Musto defeated Republican Rob Russo in the greater Bridgeport area, the Democrats regained a veto-proof majority they lost last year when State Senator and Bill Finch, a Democrat, resigned his seat after being elected Mayor of Bridgeport and Rob Russo replaced Finch. Thus if the Connecticut legislature passes a health care reform bill, and Governor Jodi Rell is not happy with that bill, she may be more reluctant to veto it (as she did last year with the "pooling" bill) since she cannot be sure her veto will not be overridden.

At the federal level, before the election there were three different scenarios:

1. The first scenario had Senator McCain narrowly winning the Presidency and having to govern from the Center, where he most certainly would have been buffeted mightily by a Congress that is ruled by the Democrats. Senator McCain's health care proposals were based largely on removing the employer's tax deductibility of health insurance premiums and giving American’s a tax credit to purchase coverage on their own, but you can forget about those reforms passing, for two reasons. First, he lost the election, but secondly, even if he had won, the Democrats in Congress simply weren't going give his health care ideas the time of day.
2. The second scenario had Senator Obama winning big; the Senate would get to a filibuster-proof 60 votes, or nearly so, and the House would get to, or very near, a filibuster-proof 260 votes. This is a scenario where we could see a BIG BOLD EXPANSION of government involvement in our lives, the likes of which we haven’t seen since the FDR or LBJ years. President-Elect Obama has not proposed a single-payer, government-run or directed health care system, but he wants to employ a play-or-pay mandate on employers and will mandate that all children obtain health care coverage. He will also employ a National Health Exchange, or Connector, to facilitate all this, and there will be a government-directed health plan of some sort that will be offered as an option to private health insurance through an employer-sponsored system. It is very hard to be more specific on how all this will sort itself out mainly because we simply don't know enough yet about the specifics of his health care proposal. For instance, on the all-important play-or-pay requirement he would visit on the employer community, Senator McCain tried very hard to pin Obama down on how high this financial contribution from employers would have to be. There was a great article recently in the New York Times on this very point where David Cutler, a Harvard economist who is one of Obama’s key health care advisors, said: “We made a decision even before the plan was rolled out not to decide. It's not that there's a decision out there that we're not telling. It's literally that we've decided not to decide." This is the same position President-Elect Obama has taken with respect to Capital Gains taxes, and it may have been smart politics, but it continues to make business groups very nervous.
3. The third scenario had Obama winning, by a smaller margin than Scenario #2, and the President-Elect deciding to build a National Government with significant bi-partisan participation in his cabinet and deciding to run the government as a Moderate.

I believe that this is indeed what will happen. But make no mistake that President-Elect Obama will be pressured mightily by the left wing of his party to enact major new reforms right away, sort of a Big Bang Theory once he takes office. We are looking at a trillion dollar deficit next year, maybe even $2 trillion, so there’s a chance that health care reform will sit on the back burner for awhile. Obama himself has publicly said that he will sign a health care bill by the end of his 1st term (2012).

With no money and facing a huge federal deficit, Obama may elect to push for greater and greater regulation of the health care industry, something we in the industry refer to as "death by 1,000 cuts", or he may opt for the Big Bang solution and decide to push for as much reform as he can in his first two years of office, the budget be damned, on the theory that the Republicans may come storming back into Congress in 2010 (a la the Republican takeover of Congress in 1994 after President Bill Clinton’s first two years in office.) At this point we simply don’t know, which makes the future of health care reform in this country, at least in terms of its immediacy, so uncertain.

So what are the challenges and opportunities under President-Elect Obama's new administration, and a newly-seated Congress?

First, we will certainly seek and find ways to provide health insurance coverage for more Americans. There will be a combination of premium subsidies, tax credits, and government payments, and we will almost certainly expand the State Children's Health Insurance Programs (SCHIP) up to 300% of the federal poverty level. By aggressively seeking to find and enroll the uninsured who are already eligible for government programs, and by expanding SCHIP, we could reduce the uninsured in this country by nearly one-third.

We will see far greater emphasis than we have ever seen before in programs to encourage healthy lifestyles, and to manage chronic diseases. Health care must be better coordinated, with a vastly improved health care data and technology infrastructure, and it will be. Integrative wellness programs will flourish, and there will be much greater emphasis on becoming and remaining physically fit. We as a society will more aggressively seek to reduce obesity (1/5 of Connecticut residents) and smoking (1/6 of all Connecticut residents). If we don’t succeed in getting all of us to assume a lot more personal responsibility for our own health, we'll never "bend the cost curve" and health care will simply become less and less affordable for all of us.

One way or another, we will seek to deploy whatever mechanisms or mandates to encourage and possibly even require all Americans to get health care coverage. If you're an employer that does not insure all your employees, or at least make a contribution toward health care coverage for those employees, you better plan on being required to do so in some fashion. And if you as an individual are someone who “goes bare” and doesn’t choose to purchase some form of health care coverage, count on not being allowed to do that in the future, or having to pay a stiff penalty of some sort.

We'll need many more primary care providers, whether they be primary care physicians, nurses or physician assistants. The ratio of primary care providers to specialists is about 30-70 in Connecticut whereas in the future we need it to be about 70-30.

We must emphasize "health" more then "health care", "prevention" more than "intervention", and we will, you can be certain of that. And if you can imagine a major push toward healthier lifestyles, my guess is that you'll envision lots of innovative and creative ways we will meet the demand that will be created by this fitness and wellness phenomenon.

I certainly don't have a completely clear crystal ball about the future of health care in America, but I do have utter confidence that we will ultimately find a uniquely American solution to the health care challenges we face. As the Chief Executive Officer of one of our country's best health plans, I genuinely look forward to finding and implementing that uniquely American solution.