If health reform doesn’t go through…

Marketplace Staff Jan 19, 2010

If health reform doesn’t go through…

Marketplace Staff Jan 19, 2010


Kai Ryssdal: It’s entirely possible that the health care debate we’ve been having in this country the past year or so is going to come down to a single vote in the United States Senate. The vote that belongs to the brand new junior senator from Massachusetts. Since it’s going to take 60 votes to pass a health care bill, the results of today’s special election in the Bay State to fill Ted Kennedy’s old seat will have out-sized influence. So we decided to play a little bit of what if. Here to do that with us is J.B. Silvers. He’s a professor of health systems management at Case Western Reserve University. Professor, good to have you with us.

J.B. Silvers: It’s good to be here.

Ryssdal: So this is one of those hypotheticals that politicians hate to answer. So I figure I’ll ask you instead. If things work out in the next couple of days and weeks, that health care does not pass, will this whole debate have been for nothing?

SILVERS: No, I don’t think so, on two scores. One, it’s clearly energized an awful lot of people in the health care industry to think about how they should be doing business. And secondly, I think people on the private sector who are purchasing health care have thought a lot more about how they might change things, too. And then finally in terms of the health care policy folks, nothing ever goes away, it just gets kept in a trunk and pulled out next time around.

Ryssdal: So what positives have happened in the last year of debate that we’ve had in this country that you think might actually stick around?

SILVERS: Well, we’re going to have to fix the way insurance works, particularly for small business and individuals. The insurance companies don’t like it, they agree to change. Clearly the people involved don’t like it, they would like to have a change. The question is what do you have to do and that’s bringing a lot more people into the pool. So that was the deal. You bring more people into the pool, and we’ll stop doing bad things like preexisting conditions and things of that sort.

Ryssdal: That is the insurance pool, right? They get 30 million more customers, and those profits and then they take care of some other stuff.

SILVERS: Exactly.

Ryssdal: Now you have in earlier days served as a CEO of an insurance company and a health care concern, so let me ask you the get inside the mind question here, do you think some of the people running health care industries in this country now are saying, man, I’ll be really happy if this bill does not pass?

SILVERS: There clearly are some in that category, but in this case, it’s really interesting because the negotiations that took place ahead of time, basically got all the warring parties to the table, and struck deals with them that were acceptable, not only acceptable but actually positive. I’ve never seen a health care reform attempt that actually had most people supporting it, except for the Republicans, of course, including the insurance companies surprisingly.

Ryssdal: So we got people to the table is what you’re saying.

SILVERS: We got them all to the table.

Ryssdal: What about the president’s statement that he made a number of months ago in which he said doing nothing on health care is actually a choice, costs will runaway, we will be unable to sustain any of this. Where do you think that’s going to take us?

SILVERS: Well, this was in my view the first step. This had to do with access and equity. So we got to get everybody to the table, we got to get them all covered, and get rid of some of the obvious inequities, particularly around the insurance market. The next step was cost, and this bill did not directly address cost, it indirectly addressed it. But it set in motion some things that would potentially be able to, as we say, bend the curve. It wasn’t going to bend it directly, but that’s the huge challenge, and he’s absolutely right about that. If we don’t deal with that, we’re in big trouble.

Ryssdal: Sounds like you’re saying as painful as it was, this was a good exercise to have gone through.

SILVERS: Oh, I think it’s absolutely a critical exercise to go through. It would be better if we actually came out with something that got passed. But it has definitely changed the way people think. I don’t think, given that there’s so much agreement about it, I don’t think the hospitals and the docs and all the other parties will go away from it. I think they’ll be some residual thing even if doesn’t pass the way it’s structured right now. There is a chance, unlike the Clinton reforms, where we just gave up, this one might actually have a second wave.

Ryssdal: J.B. Silvers. He’s a professor of health systems management, also banking and finance. He’s at the Weatherhead School of Management at Case Western Reserve University. Professor, thanks a lot for your time.

SILVERS: Great, thank you so much.

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