I'm on the Hill this morning for a Senate Finance Committee Hearing on "Rising Costs, Low Quality in Health Care: The Necessity of Reform." This is one of the hearings that's supposed to lay the groundwork for the Finance Committee's upcoming "Prepare for Launch" health care summit, which is in turn, supposed to lay the groundwork for the Committee's 2009 push for comprehensive reform. Hearings are interesting not so much for the testimony of the speakers as their very presence at the witness table. Hearings are convened by the majority and the witnesses chosen to say largely what the majority wants said, and to represent constituencies the majority feels need to be represented. So what emerges is, in general, the case the majority is hoping to use as support for their legislative push. On one level, then, you can take hearings as dry policy disquisitions. On the other, you can understand them as a rare look into the legislative strategy and substantive emphases of the chairman. The first witness was Paul Ginsberg, president of the Center for Studying Health System Change, who made two main points. First, "By any measure...U.S spending on health care is greater than other developed countries. In 2006, the United States spent $2.1 trillion, or 16 percent of GDP, on health care, translating to $7,026 annually. But unlike other developed countries, which provide near-universal coverage, 47 million people in 2006 were uninsured." Second, "the enormous amount of money spent on medical care in the United States does not appear to buy us outstanding health. By almost any measure, ranging from infant mortality to preventable deaths, the United States does not measure up well against other developed nations." Then came Elizabeth McGlynn, from RAND. "In 2003," she said, "my colleagues and I published, in the New England Journal of Medicine, the first national, comprehensive study on quality of care for adults. We examined 439 indicators of quality for 30 clinical areas. We found that on average, American adults received just 55% of recommended care for the leading causes of death and disability. To make that more concrete, participants in our study needed an average of 16 health care services -- like mammograms to screen for breast cancer, flu shots, and medications to control blood pressure and blood sugar --over a two year period and they received about 8 of them. We spend nearly $2 trillion and we get it right about half the time." Felicia Fields, group vice president for human resources at Ford, noted that her company spent $2.2 billion on health care last year, or about $1,000 per car. And Arlene Holt Baker, executive VP at the AFL-CIO, reported the results of a survey of her union's members that showed a deep anxiety about keeping and paying for their health care. "Nearly all survey takers with insurance, 96 percent, say they are somewhat or very concerned about affording coverage in the next few years." She also mounted a vigorous defense of employer sponsored coverage -- an enduring goal of the AFl-CIO.
