WASHINGTON, Dec. 3 (UPI) -- Healthcare policy promises to be a hot topic in Washington next year, according to think tank policy experts.
"It is clear that healthcare will be a real priority for this administration," Grace-Marie Turner, president of the Galen Institute, told United Press International. "It is genuinely refreshing because Republicans have always been weak on these issues."
Since the election, Karl Rove, President George W. Bush's chief political adviser, and other top officials have been making the rounds of think tanks and health care advocacy groups in an attempt to garner support for a far-reaching reform agenda. At the same time, congressional leaders are reportedly gearing up for policy efforts that may be at odds with the White House plans.
Turner, whose organization does research and advocacy work on market-based health care policy, said that for the first time, conservatives are energized by the prospect of pro-consumer plans that would allow more individual control of health care decisions and coverage.
This elation is fueled by post-election analysis that shows some Republicans were elected to the House and Senate in November on platforms advocating market-oriented reforms to Medicare and federal health policy, such as medical savings accounts for working and retired Americans.
Advocates of healthcare reform view this as proof that their policy ideas regarding problems -- including rising costs for Medicare and Medicaid, the increasingly cost of access to care in the United States, and continued lack of access to insurance for millions of Americans -- will have political legs in 2003.
"I have been working this issue for 15 years, and I can see a change in attitude among conservatives," said Turner. "Here is Al Gore talking about a single payer (healthcare) system, and they (conservatives) have a vision of a way the healthcare system can rely more on markets and less on governments."
Rove, for example, has been talking up the administration's health policy agenda, stressing the importance of making progress on the issue in the new Congress.
According to those who have attended meetings with Rove, he has outlined an agenda that focuses on medical malpractice reform, Medicare reform with the possible addition of a prescription drug benefit, and on government help for the uninsured.
According to one administration source, Rove is prioritizing policies that can help gain political capitol for Republicans in the 2004 election, but that also do not have large budgetary needs. Medical malpractice reform, for instance, is said to be a top priority of the administration precisely because it will cost little to implement.
Those who follow the issue also see the fact that the nation's trial lawyers are also major supporters of the Democratic party as a significant driving force behind Republican support for limiting damages in medical malpractice cases.
But Tom Miller, director of health policy studies at the libertarian Cato Institute, said that prospects for such a bill are limited, given the small margin of power the Republicans now hold in the Senate, which falls short of the 60 votes needed to kill a Democratic filibuster of such a measure.
"Don't hold you breath about that passing into law," Miller told UPI.
Not all of the administration's priorities reflect a minimal government investment. Turner said that some form of a tax-based plan for assisting people to get insurance is high on the White House agenda for 2004, although it is unclear whether the plan will take the form of refundable tax credits. Market-oriented conservative policy advocates like Turner have promoted such credits for some time.
Joseph Antos, a resident scholar at the conservative American Enterprise Institute, said reforming Medicare and possibly developing a Medicare drug benefit are other top issues for the White House.
Turner said although the focus on reforming Medicare may actually delay action on adding prescription drug coverage to the program, the prescription plan carries a great deal of political baggage following the failed Republican attempts to pass a measure this year and GOP efforts to make it a campaign issue.
"Everyone from both parties has a huge incentive to get something passed," she said. "There is a lot of momentum on this issue."
John Holahan, director of the Health Policy Center at the liberal-leaning Urban Institute, agreed that Congress would attempt to develop a prescription coverage bill, but that the budget deficit and a still-to-be-phased-in Bush tax cut are going to limit what might develop.
"If they do that in a serious way, it is hard to see how there will be much money to do anything about the uninsured with the budget deficit growing," said Holahan. "It (the deficit) certainly will control the kinds of things we're talking about in terms of solving these problems."
Although some key Republicans support the administration agenda, Antos said that leaders from both parties in Congress have somewhat different priorities in the near term.
"I think they are still very, very eager to do something on the Medicare giveback situation," he said.
Efforts to reimburse physicians, hospitals and other health care providers for at least some of the reduction made to Medicare payments in 2002 failed in this past session, but Antos said that plans are underway to get a bill to the floor in both houses of Congress in January.
He cautioned, however, that with the limited discretionary resources due to the budget deficit, a giveback would limit the possibility for action later in Congress on other costly health policy efforts such as a prescription drug benefit or tax credits for the uninsured.
Those issues, he said, hold more long-term political capital and could open the way to repairing more fundamental failures in the Medicare system. For example, other reforms could address the underlying reasons why it is necessary to continually cut back provider reimbursements in order to keep the Medicare's costs in check.
"To jump ahead and do something in January may provide political gains in the short term, but in the longer term it will come back and bite them." said Antos.
Turner said that the kind of free market ideas being discussed do not have to be implemented all at once. Instead, she said, their impact and cost could be ratcheted up over time.
"The thing about free market ideas is that they are very scalable," said Turner. "Getting market-based Medicare reforms into statute and on paper is really important. The same thing is true for the drug benefit."
She added that the alternative is a continued buildup of existing government entitlement programs or simply doing nothing.
"I just don't think there is any political will for either one of these (options)," she said.
Holahan said that the elation among conservatives over the possibility of market-oriented moves toward reform is counterbalanced by the fact that significant questions remain about how to make many policy ideas work.
For instance, he said that any tax-based plan for assisting individuals to purchase private insurance faces the problem of how to determine the underlying health status of people, along with the question of how to provide the credit (in voucher form or some other delivery mechanism.)
"I think there are some tough issues they will face in trying to implement that type of approach," said Holahan. "It is certainly going to be a step in the right direction, but it is not simply a matter of giving the individual control of his healthcare."
Despite the reform rhetoric, Miller said he believes that budget constraints and the power of the status quo will mean that Congress will be able to implement little in the way of significant reforms.
"They (policymakers) are not about to fundamentally rethink the healthcare environment," said Miller. "There are just going to do a little tweaking in the margins."
