Opposition to healthcare reform to be the centerpiece of Burr’s re-election effort

by Keith Barber

Sen. Richard Burr shakes hands with an audience member after the Healthcare Conference and Case Competition on the campus of Wake Forest University on March 19. (photo by Keith T. Barber)

Sen. Richard Burr said the foundation of his re-election campaign will be the Republican Party’s effort to repeal the healthcare reform bill passed by the US House of Representatives late Sunday night.

Burr made his rebuke of the healthcare reform package during the Healthcare Conference and Case Competition at Wake Forest University on March 19.

“I think this is a devastating direction for the American healthcare system,” Burr said.

Burr’s statement came in response to a question from a Wake Forest undergraduate student regarding Senate Republican Leader Mitch McConnell’s statement that he would introduce legislation to repeal the healthcare reform enacted by House Resolution 3590, which passed 219-212 on Sunday night.

The ranking member of the Senate Armed Forces Veterans Committee and a 1978 graduate of Wake Forest University, Burr opened the conference by stating that he had asked event organizers to throw out the written questions and that he would only take questions from students. Burr also said the one thing Democrats and Republicans could agree upon is that the healthcare system in America needs to be reformed. The debate is over as to whether or not it requires putting more money into the system.

“The president said early in this process that the main objective of healthcare reform is to drive healthcare costs down,” Burr said. “Well, I’ll ask you MBA students, if you’re going to drive costs down, does it really require more money to drive costs down? Or does it require reforms that address things that cost?” Burr said the first thing he would like to see is the elimination of cost shifting by having transparency in how the American people pay for healthcare services.

“There’s no secret as to why there’s been an inflation rate in healthcare that’s been unsustainable,” Burr said. “It’s because when you’ve got so many areas that shift to one area. Every time they begin to tweak down, it raises the inflation rate on the private pay side.”

Burr also cited tort and liability reform as another key to driving down costs. Due to medical malpractice lawsuits, doctors are practicing “defensive medicine” and ordering multiple tests when a single test would suffice, he said.

Burr conceded that tort reform “is not the silver bullet” that will transform the healthcare system. The one-term senator also spoke of an “a la carte” approach to healthcare insurance would allow young people to decide on their level of coverage rather than having an employer decide for them, thus bringing down their premiums.

Burr characterized the yearlong debate over healthcare as overly focused on coverage expansion rather than cost containment.

“Coverage expansion comes easy depending on how much money you’re willing to devote to it,” Burr said. “Cost containment means that you have to make difficult decisions.”

Burr referred extensively to his co-sponsorship of the Patients’ Choice Act of 2009 during the forum.

“I believe I’ve got a right to be critical of anybody’s plan because I’ve laid mine on the table, and I was first,” Burr said. “There’s a blueprint out there that really embraces everything I think we need to do as a country.”

Along with Senators Tom Coburn (R-Okla.), and Reps. Paul Ryan (R-Wis.) and Devin Nunes (R-Calif.), Burr introduced a bill that pledges to “give every American the opportunity to choose the health care plan that best meets their individual needs,” according to the bill’s summary.

The Patients’ Choice Act proposed the utilization of state-driven exchanges “to facilitate real competition between private plans and give Americans — for the first time — a choice of health care plans,” according to the bill’s summary.

Universal access for all Americans to quality, affordable healthcare was one of the core concepts of the bill. However, Burr acknowledged that the bill failed to insure millions of uninsured Americans.

Other core concepts included an emphasis on preventative care, transparency and greater competition in the healthcare marketplace, offering greater choice and fairness for all medical patients, vigorous participation by states in the insurance exchanges, keeping the federal government out of the healthcare business.

The Patients’ Choice Act was introduced in May 2009, and was referred to the House Ways and Means Committee, where it remains to this day.

“I think the three fundamental things for healthcare reform — cover as many people as you possibly can; invest in prevention, wellness and chronic disease management, and create a structure that is financially sustainable well into the future,” Burr said. “Accomplish those three things, I’ll sign on to anything.”

Burr quickly added the bill passed by the House Sunday night accomplishes only one of those three priorities — the expansion of healthcare coverage.

Burr said the Patients’ Choice Act would have paid for itself by making healthcare provided by an employer “a taxable event for everybody.” Under Burr’s proposal, the money raised by taxes levied against individuals for their healthcare benefits would be used to give every American family a $5,700 tax credit and every individual a $2,700 tax credit to purchase pay for their private insurance.

“That’s how we financed the addition of 30 million additional covered lives through private insurance with zero additional cost to the taxpayer, “ Burr said.

Lawmakers must continue to push for decreasing costs in the healthcare system, he said. Burr suggested the idea of outcomebased reimbursements for physicians and hospitals.

“That’s really dangerous though,” Adam Hyde, an economist at the Wake Forest Business School, said, interrupting Burr.

“I know, but the data is there to make that transition and it can only be made if the transparency exists on both sides of the table,” Burr responded.

“You give physicians an incentive to turn away very risky patients at a point like that,” Hyde pointed out.

“Understand that’s what is in the current bill penalizes a physician who has high-cost patients,” Burr retorted. “What doctors would tell you is when you have a difficult case, you look for the person in that field that’s the best one to send them to, and usually that’s the person that always gets the toughest ones. So we’re already talking about penalizing the person who is the best at accomplishing a difficult task.”

“They’re willing to accept those patients because their payments are not based upon getting bad outcomes for those patients,” Hyde said.

“But the payments aren’t sufficient if in fact you limit it to a single service,” Burr retorted. “The outcome-based is more applicable to the hospital than to the doctors right now.”

After the forum, Hyde said the idea of outcome-based reimbursements for physicians raises a host of problems.

“If you tie (a physician’s) income to let’s say the death of that patient, and it’s not their fault, then they’re going to be reluctant to accept that patient and treat them at all — that’s a huge problem,” Hyde said. “And you have to make these agreements incentive compatible with physicians and the insurance companies and the payments, but you have to give physicians an incentive to treat these people.”

Despite a difference of opinion on the outcome-based model, Hyde said he agreed with Burr on many of the Senator’s criti cisms of the healthcare reform package.

“I think he was absolutely right in the sense that the bill doesn’t address the major issues,” Hyde said. “It addresses expanding coverage to people who don’t have it, but there’s all this talk about bending a cost curve, and none of the things they have touched on bend the cost curve at all. Some of them may lower cost in the short term, but you still face the same problem of cost growth over the long term.”

Hyde said he also agrees with Burr on the idea of allowing healthcare insurance companies to compete against each other as a cost saving measure.

Burr threw out a barrage of statistics about how the healthcare reform package passed by Congress is going to be paid for, and how Medicare, Social Security and the national debt will be severely impacted.

Notwithstanding Republican skepticism, the Congressional Budget Office has stated the healthcare reform package will cut the budget deficit by $143 billion over the next 10 years and by $1.3 trillion over the following 10 years.

Burr concluded the forum by saying if Americans would change their lifestyles, healthcare costs could be reduced immediately. Not everyone agreed with Burr’s statement.

Dusty Joy, a lung cancer survivor, pointed out that every year, tens of thousands of non-smokers are diagnosed with lung cancer.

“A healthy lifestyle is not the silver bullet,” Joy said. “Just because we live a healthy lifestyle doesn’t mean we’re not going to get a disease.”

Joy said she lost her job and is currently on COBRA insurance. Due to her pre-existing condition, she describes herself as a “ticking time bomb” in the eyes of health insurance companies.

“I’m the picture of good health, but with a preexisting condition of lung cancer, no health insurer wants to touch me,” she said. “And being unemployed, there is a high-risk pool with this state but that’s very expensive, so we’ll see what happens.”