What People Are Saying

Some of the debtors sitting forlornly in this city’s old stone bankruptcy court have lost a job or gotten divorced. Others have been summoned to face their creditors because they spent mindlessly beyond their means. But all too often these days, they are there merely because they, or their children, got sick.

Wes and Katie Covington, from Smyrna, Tenn., were already in debt from a round of fertility treatments when complications with her pregnancy and surgery on his knee left them with unmanageable bills. For Christine L. Phillips of Nashville, it was a $10,000 trip to the emergency room after a car wreck, on the heels of costly operations to remove a cyst and repair a damaged nerve.

Jodie and Charlie Mullins of Dickson, Tenn., were making ends meet on his patrolman’s salary until she developed debilitating back pain that required spinal surgery and forced her to quit nursing school. As with many medical bankruptcies, they had health insurance but their policy had a $3,000 deductible and, to their surprise, covered only 80 percent of their costs

There are four main ways the reform we’re proposing will provide more stability and security to every American.

First, if you don’t have health insurance, you will have a choice of high-quality, affordable coverage for yourself and your family — coverage that will stay with you whether you move, change your job or lose your job.

Second, reform will finally bring skyrocketing health care costs under control, which will mean real savings for families, businesses and our government. We’ll cut hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid and in unwarranted subsidies to insurance companies that do nothing to improve care and everything to improve their profits. Third, by making Medicare more efficient, we’ll be able to ensure that more tax dollars go directly to caring for seniors instead of enriching insurance companies. This will not only help provide today’s seniors with the benefits they’ve been promised; it will also ensure the long-term health of Medicare for tomorrow’s seniors. And our reforms will also reduce the amount our seniors pay for their prescription drugs.

Lastly, reform will provide every American with some basic consumer protections that will finally hold insurance companies accountable. A 2007 national survey actually shows that insurance companies discriminated against more than 12 million Americans in the previous three years because they had a pre-existing illness or condition. The companies either refused to cover the person, refused to cover a specific illness or condition or charged a higher premium.

As the political debate about how to pay for and pass health reform grows louder and more contentious, we shouldn't lose sight of the reason we're even having this conversation: We have a huge, once-in-a-lifetime opportunity to improve the lives of all Americans, insured and uninsured alike.

Health insurance is fundamentally about peace of mind. If you have good insurance, you don't have to worry about an accident or sudden illness. You know that whatever happens, you and your family will be taken care of.

We can't eliminate all disease. But through health reform, we can give every American access to quality, affordable health insurance so that if they do get sick, they have the best chance possible of getting better without bankrupting their families.

The current health-care system gives insurance companies all the power. They get to pick and choose who gets a policy. They can deny coverage because of a preexisting condition. They can offer coverage only at exorbitant rates — or offer coverage so thin that it's no coverage at all. Americans are left to worry about whether they'll get laid off and lose their insurance or wake up from surgery with a $10,000 bill because they didn't read the fine print on their policy.

We can't afford to reform health care.

We can't afford not to. Medical costs account for one-sixth of domestic spending and are headed upward. They are handcuffing families and workers, and strangling federal and state governments. Plans being considered by Congress present daunting up-front costs. But reform, done the right way, will mean savings for families and businesses — money that can be pumped into the economy. Unfortunately, some Republicans seem content to stymie any Democratic plan on health care without putting forth any measures of their own.

“Why start diverting attention from this really bad piece of work (the Democrats’ plan)?” U.S. Rep. Roy Blunt of Missouri asked last week, when suggesting GOP House members may not propose a health care bill. Sorry, but Republicans don’t get off that easily. The default plan is the status quo, which, as Obama noted last week, is “guaranteed to double your premiums, cause more Americans to lose their coverage and create larger budget deficits over the next 10 years.”

Republican politicians must stop promoting the greatest myth of all: That somehow we will stumble into a system in which all Americans can have all the services they want, and no one will have to pay for it.

Today, we have by far the most expensive health system in the world. We spend 50 percent more per person on health care than the average developed country, according to the Organization for Economic Cooperation and Development. We spend more on health care than housing or food, the McKinsey Global Institute reported.

Nationwide, health care costs consume 18 percent of our gross domestic product. If we continue on our current path, health care costs will consume 34 percent of our GDP by 2040, and the number of uninsured Americans will rise to 72 million, according to the Council of Economic Advisers.

Even though we spend more than any other nation on health care, we aren't healthier. Only three developed countries have higher infant mortality rates. Our nation ranks 24th in life expectancy among developed countries. More than one-third of Americans are obese.

These statistics are the signs of a system that is both unacceptable and unsustainable. They also show us the high cost of doing nothing. If we choose the status quo, more Americans will be uninsured, costs will continue to rise, and every American's health care will be at risk.

“At some businesses, in fact, health care is the highest expense after salaries—with devastating consequences. Owners must skimp on vital investments like marketing and research. Some can’t hire the people they want because top candidates demand premium coverage. Or they end up understaffed because of the high cost of insurance—and lose potential clients as a result.

At the same time, to keep costs in check, countless companies are slashing coverage or dropping it entirely. Some are turning to freelancers or offshore workers instead of hiring full-timers and locals. And some would-be entrepreneurs find insurance so onerous that they’re not even starting a business in the first place.”

“…Across the country in Oregon, business owner Paul Ward has discovered the many compromises it takes to set up health coverage for a small business. The founder of Web- and multimedia-design company Media Mechanic LLC, based in Tualatin, Ore., outside Portland, is in the process of trying to replace contract workers with three new full-time staffers. He wants local employees who know the market and can help establish the young business. But competition for high-tech workers is fierce, and the best workers demand benefits, Mr. Ward says.

The cheapest plan he found will cost about $400 per employee in premiums, assuming the employees are young and healthy. Covering employees’ spouses and children would run as much as $800 per employee per month—if the company covers 100% of employee premiums and 50% of the spouses’ premiums. That’s simply too much to handle, Mr. Ward says, so he plans not to offer family coverage, and he’ll likely cover only half or two-thirds of his employees’ premiums. That’s a tough pill for Mr. Ward to swallow; in Michigan, where he grew up, workers’ rights reigned supreme, and he believes employers should offer the fullest possible coverage for their staffs.

Even with those concessions, health insurance is likely to come in as the company’s No. 2 expense—second only to wages, and edging out rent and utilities. “It’s less money I can spend on marketing, and less money I can spend on investment in the company,” Mr. Ward says.”

“Hospital emergency departments across the region are overflowing with patients who have been battered by the recession and are increasingly using hospitals as their primary source of health care, according to local and national health officials.

At the District's Providence Hospital, emergency room visits increased by 13 percent in the past year. In Montgomery County, the number of patients seeking free care at community clinics designed to divert people from emergency rooms rose by 43 percent, many of them referred by hospitals.”

“…A national debate is underway about how to reduce health-care costs and provide medical coverage to everyone. Diverting people from emergency rooms -- which are an inefficient and expensive way of delivering basic health care -- is a central issue, said Larry Gage, president of the National Association of Public Hospitals and Health Systems.”

Health insurance is supposed to offer protection — both medically and financially. But as it turns out, an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured.

Too many other people already have coverage so meager that a medical crisis means financial calamity.

One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital.

He and his wife, Claire, filed for bankruptcy last December, as his unpaid medical bills approached $200,000.

"From the young to the old, from rural ... communities to the inner cities, both the insured and uninsured, 17 million Americans rely on community health centers every year to help them stay healthy," she said at Unity Health Care Inc.'s Upper Cardozo Health Center.

Mrs. Obama listed obesity, diabetes, heart disease and high blood pressure as diseases that community health centers can fight through preventive care. She expressed particular concern about the importance of teaching children to eat healthily.

"But to be effective in this fight, you're going to need more help, you're going to need more resources," the first lady said.

The $850 million will include $2.5 million to Upper Cardozo for 20 new examination rooms. According to Mrs. Obama every health center that applied will receive at least $200,000.

As part of the Obama administration's push for health-care reform, Ms. Sebelius released "health care status quo" reports on each of the 50 states in conjunction with the conference call.

Pennsylvania's numbers, compiled from several different sources, paint a picture reflective of what Ms. Sebelius said is happening nationwide: One in 10 state residents are without health insurance and, for those fortunate to have coverage, insurance premiums have doubled since 2000.

The numbers "represent real people and families across the country," she said. "Americans are demanding reform."

The secretary released figures for Oklahoma and all states on health care costs, the number of uninsured people and health problems. She called on Congress to pass health care reform legislation.

"In states across the country, health care costs are going up, and families are struggling to get the quality care they need and deserve,” Sebelius said.

"We cannot wait to pass reform that protects what works about health care and fixes what’s broken.”

“In states across the country, health care costs are going up, and families are struggling to get the quality care they need and deserve,” HHS Secretary Kathleen Sebelius said in a conference call with reporters. “We cannot wait to pass reform that protects what works about health care and fixes what’s broken.”

Part of what’s broken in Indiana, the agency said, is the rapidly increasing cost of health insurance and the pinch it puts on employers and workers.

Obama supports a government-run health insurance program to compete with private insurers. Congressional committees have been wrestling with writing a bill that would cost less than $1 trillion over 10 years.

“Frankly, states get pretty mixed reviews of the quality of care they provide,” said Health and Human Services Secretary Kathleen Sebelius in a conference call with reporters.

“More than numbers and facts, they represent real people and families who…are being crushed by the high costs of health care.”

Eleven percent of Kansans reported that they declined to see a doctor because of costs, HHS said. In Missouri, 15 percent chose not to go.

The report says high costs keep about one in ten Kansans and Missourians from going to the doctor. It also shows the average premiums that families pay for insurance in both states have doubled this decade.

Sebelius says this and other data from the report demonstrates the immense problems with health care throughout the country.

SEBELIUS: "Every day in America, families are being crushed by high cost of health care that threatens their financial stability, leads them exposed to high premiums and deductibles, and puts them at risk for possible lost of health insurance."

Citing data that health insurance premiums in Iowa have increased 88 percent since 2000 and 10 percent of Iowans are uninsured, Sebelius said it's time to make reform a reality.

"These are more than numbers and facts, more than statistics on a page," she said about data the federal agency released showing that health insurance premiums in Iowa have increased 88 percent since 2000 and 10 percent of Iowans are uninsured.

"What we know is that every day in America, families are being crushed by the high cost of health care that threatens their financial stability, leaves them exposed to higher premiums and deductibles and puts them at risk for the possible loss of health insurance as employers struggle to provide adequate health coverage," Sebelius said in a conference call with reporters.

“All it takes is a stroke of bad luck to become one of the 46 million people without insurance or the millions who are not able to afford (health care),” Sebelius said. “We know that every day in America, families are being crushed by the high cost of health care.”

Meanwhile, in the Senate, Baucus said he's continuing to work on crafting a health reform bill to be released this summer.

The Associated Press reported Thursday that a group of bipartisan senators led by Baucus has made progress on holding the cost of the legislation to a $1 trillion target, and determining how to finance it.

She says about 783,000 people in Maine get their health insurance through their employer at an average family premium of more than $14,000 a year.  In the past nine years, she says, average family premiums in Maine have jumped 105 percent.

Moreover, she says the quality of care in Maine is rated as average, due in part to a lack of preventive care.  She says 13 percent of Maine children are obese, 15 percent of Maine women over age 50 haven't received a mammogram in the past two years, and 27 percent of men over age 50 have never had a colorectal cancer screening.

Self-employed with no health insurance, Dorothy Carmona began descending into debt in 2004 when she had a stroke. Next, the housing crash ruined her title business. Then last fall she was diagnosed with aggressive lung cancer.

It all came to a head this month. With a lender about to foreclose on her Pembroke Pines townhouse and years of medical bills now making up more than half the $125,000 she owes other creditors, Carmona filed for bankruptcy. Days later she learned the cancer had worsened.

"It's been one nightmare after another," said Carmona, 48, a single mother whose teenage daughter lives at home. "I'm ruined. I have nothing. They tell me I have five months to live. Right now I'm in a frightened mode. I don't know what's going to happen to me."

Carmona is the face of a growing national issue: Health care costs are driving people to financial ruin. The problem fuels a push to extend medical coverage to the roughly 50 million uninsured and under-insured Americans.

A Harvard University study this month found that 62 percent of U.S. bankruptcy cases in 2007 were caused by or inflamed by medical bills. That's up from 50 percent in 2001 and 8 percent in 1981.

Every time his kids were hit with an ear infection or illness, Christian Burk hoped and prayed it would go away.

Not only did he want them to get better, the Omahan knew a trip to the doctor would get expensive because the family didn't have health insurance.

"You're always thinking, 'Is this the sickness that will put us under?'" he said.

Burk shared his experience Friday with the nation's top health official. Kathleen Sebelius, the U.S. Health and Human Services secretary visited Omaha for a roundtable discussion with local residents and to tour Alegent Health's Lakeside Hospital…

…Sebelius told the group that Obama and Congress are trying to find solutions. She said the current health-care system has erratic quality and cost.

"We can't continue in the same direction," said Sebelius, former governor of Kansas.

Proposals have included a government-sponsored insurance program. Others include requiring people to purchase insurance if they can afford it and taxing employer-provided health benefits to help pay for coverage for the uninsured.

“At Safeway we believe that well-designed health-care reform, utilizing market-based solutions, can ultimately reduce our nation's health-care bill by 40%. The key to achieving these savings is health-care plans that reward healthy behavior. As a self-insured employer, Safeway designed just such a plan in 2005 and has made continuous improvements each year. The results have been remarkable. During this four-year period, we have kept our per capita health-care costs flat (that includes both the employee and the employer portion), while most American companies' costs have increased 38% over the same four years.”

“Safeway's plan capitalizes on two key insights gained in 2005. The first is that 70% of all health-care costs are the direct result of behavior. The second insight, which is well understood by the providers of health care, is that 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity). Furthermore, 80% of cardiovascular disease and diabetes is preventable, 60% of cancers are preventable, and more than 90% of obesity is preventable.”

“At Safeway, we are building a culture of health and fitness. The numbers speak for themselves. Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant. When surveyed, 78% of our employees rated our plan good, very good or excellent. In addition, 76% asked for more financial incentives to reward healthy behaviors. We have heard from dozens of employees who lost weight, lowered their blood-pressure and cholesterol levels, and are enjoying better health because of this program. Many discovered for the first time that they have high blood pressure, and others have been told by their doctor that they have added years to their life.”

The Diageo/Hotline Poll finds that 62% of voters support the President enacting a major overhaul of the U.S. health care system, with 38% of voters strongly supporting a major overhaul. For the most part, support for major reform is strong across the board, though there are differences in support based on partisan affiliation, age, and income levels.

The Poll also finds supporters of health care reform bring a sense of urgency to the issue: among those who do support a major overhaul, the vast majority (94%) says that it is important for Congress and the President to pass health care legislation this year.

“Black women in the District suffer from obesity, diabetes, heart disease and generally poor health in alarmingly high numbers, and white women do not. That is the finding of a study released early today by the Kaiser Family Foundation. The study said there is a large disparity in the incidence of certain chronic diseases between black and white women. Kaiser's study was based on data compiled by the Centers for Disease Control and Prevention and the federal Current Population Survey from 2004 to 2006. The study reflected health statistics in the states and the District.”

“…According to the study, 36 percent of black women were overweight or obese, compared with about 10 percent of Hispanic and Asian women in the city. More than 7 percent of black women suffered from diabetes, compared with 2 percent of Hispanic women and 3 percent of Asian women. Fewer than 1 percent of white women suffered from diabetes, and 7 percent were overweight or obese.”

“…a series of recently released studies show that, even over the short-term, people with health insurance are in almost as dire straits as those without. That means it is pretty much in all of our interests to fix what nearly everyone these days agrees is a profoundly dysfunctional system.

“Exhibit A is a new GAO report. It found that between 2003 and 2006, wait times in many hospital emergency rooms, particularly those in urban areas, increased; that hospitals continued to put ambulances on "diversion" because their emergency departments were full, and that the practice of "boarding" patients in the emergency department because beds were not available in the main hospital "has become a typical practice in hospitals nationwide.

“For Exhibit B we turn to the National Opinion Research Center and the benefits consulting firm Watson Wyatt Worldwide, courtesy of the policy journal Health Affairs. A study out just this week finds that those of us lucky enough to have insurance provided by our employers are getting less and less for our premiums. According to the study, average out-of-pocket spending for adults with employer coverage rose by 34 percent between 2004 and 2007; from $545 to $729 annually…

“Exhibit C also comes from Health Affairs. It is a study by Todd Gilmer and Richard Kronick of the University of California, San Diego.

“They updated a model that they found some years ago accurately predicted that the number of uninsured tracks the affordability of health insurance. In other words, the gap between the cost of health insurance and how much people earn determines how many people go without coverage.

“Using that model, they predict that, without policy change, by next year the number of uninsured will rise by at least 6.9 million, to an estimated 52 million people, accounting for just under one in five members of the nonelderly population.”

President Barack Obama Tuesday urged lawmakers not to delay overhauling the U.S. health-care system, calling the window before the Senate's August recess a "make-or-break" period for legislation. "We can't afford to put this off," Mr. Obama said at the start of a meeting with 24 Senate Democrats.

Earlier Tuesday, the White House released a report outlining the expected benefits to the economy of containing health costs… "Health-care reform is not a luxury; it's not something I want to do because of campaign promises or politics," Mr. Obama said. "This is a necessity."

The report out Tuesday, compiled by the Council of Economic Advisers, estimates that a 1.5-percentage-point cut in the annual growth rate of health-care costs would raise real gross domestic product by more than 2% in 2020 and by almost 8% in 2030. That kind of growth would add $2,600 to a typical family of four's income in 2020, according to the White House.

“Sebelius and DeParle are the tag team for Obama's most ambitious domestic policy goal: an overhaul of the nation's health care system, which eluded President Clinton in 1994. The two "working moms," in Sebelius' words, are charged with chaperoning a measure through Congress that's likely to cost more than $1 trillion.”

“The president also has two pragmatists whose goal, like his, is to work with Congress rather than dictate to it, as the Clinton administration did. Given leeway, Congress is forging ahead with a goal of passing comprehensive legislation this year. "Nancy-Ann and the secretary are going to be pushing the ball up the hill, but they haven't designed the ball," says Chip Kahn, president of the Federation of American Hospitals.”

“Even in a good year, Kelly's U.S. health care costs are more than its domestic profits. Kelly operates in 39 countries. The United States is the only country where this statistic is true. Further, the cost of health care in the U.S. is rising dramatically faster than our ability to raise prices or adjust wages.”

“Health care is the issue that jeopardizes worker productivity and creativity, key sources of the U.S. economy's global competitiveness. Today, too many employment decisions are motivated by health care access rather than where our citizens can make innovative and productive contributions to society.”

“Our nation's economy faces many immediate threats. It also faces many long-term challenges that must also be addressed before we can truly rebound from these economic crises. If you are worried about job growth and competitiveness, you should be working to fix our health care system. Health care reform is a challenge that must be met.”

“When I give public talks on health care reform, the question I receive most often is "given the government’s fiscal situation, how can it make sense for the government to take on new spending commitments as part of health reform?" The answer is two-fold. First, health care reform has two components: cost containment provisions and expanded coverage. In the near term, the impact of expanded coverage will temporarily dominate, and health care reform will therefore temporarily increase government spending. Over time, however, the impact of the cost containment provisions will accumulate, and the net impact will be a reduction – and perhaps a dramatic one – in government spending. Second, while we are waiting for the cost containment provisions to take hold, we are insisting that health care reform be deficit neutral. In other words, the Administration is committed to a health care reform that is at least deficit neutral over 10-years -- and deficit-reducing, potentially to quite a significant degree, over the longer term.”

“We have the greatest doctors and medical innovations in the world, but more and more Americans are on the outside looking in to a world of progress and discovery that is denied to them because they cannot afford quality healthcare. That's wrong - and it's about to change.”

“President Obama knows it's time to act and he's providing impressive leadership. And I am thrilled to be working with my colleagues on both sides of the aisle to help bring forward the legislation that will build on what's already working and fix what's broken.”

“To achieve these changes, all must share the responsibility and the costs - businesses, government, healthcare providers, and individuals alike. Health reform will benefit all our citizens, reduce the financial burdens on our nation's businesses, and put the healthcare industry itself on a sustainable basis.”

“Change is never easy, but the status quo is no longer acceptable to any except those who profit from the current broken healthcare system. We cannot afford to wait - or to fail. And we will do neither. And when successful reform takes hold, the American people will wonder what has taken us so long.”

“Sheryl Weldon, owner of Commerce Welding & Manufacturing Co., saw health-insurance payments increase to more than $800 monthly per employee from about $200 five years ago. With monthly revenue down 10% since December, Ms. Weldon stopped providing health coverage to employees, including one being treated for prostate cancer, for the first time in the 64-year-history of the Dallas sheet-metal company. Ms. Weldon and several of her 14 employees are going uninsured and the third-generation business owner is struggling with the emotional toll of the decision. ‘I have a terrible time handling that I can't give them that coverage,’ says Ms. Weldon, 52 years old. ‘How do you expect someone to be at their job everyday and perform if they can't be healthy?’”

“In March, after losing a large client that accounted for more than 50% of revenue, Kelly Reeves canceled health insurance for her three employees. Ms. Reeves, president of seven-year-old public-relations firm KLR Communications, says she had to choose between that and laying off an employee. Ms. Reeves says turnover is a concern even in this slack job market, but she has told her employees she understands if they leave for a job with medical benefits. Should business pick up, she plans to reinstate health insurance but provide less expensive coverage. ‘You want to attract good talent and benefits are important for that,’ says Ms. Reeves.”

“Now there's another issue on the front burner that requires Congress' immediate attention. This one looks all too familiar: health care.”

“The last time there was momentum in Washington to overhaul health care, it was more than 15 years ago -- early in the Clinton administration. Since then, the cost of health care has skyrocketed. Virtually everyone has felt it. Americans are looking to Congress and the Obama administration for health-care reform. This time, it must happen.”

“Two areas in particular have hit the wallet of nearly everyone: Prescription drugs and health insurance. More than 7 million people age 50 to 64 were uninsured in 2007 -- a 36 percent increase over 2000. Prescription drug prices jumped at least 12 percent per year throughout the 1990s and continue to increase at twice the rate of inflation.”

“As we take up the challenge to revive our economy, one thing is very clear: We can't get our economy back on track without fixing the health-care system. As a registered nurse, cancer survivor, family and professional caregiver by turns, I know how important it is to have health insurance that covers treatments and prescriptions.”

“I was fortunate to have most of my care covered — others are not.
Surveys show that health care is Americans' top personal economic concern. The cost of health-care coverage for the average worker has doubled and health insurance premiums have tripled over the past decade, but wages haven't kept pace. According to a new report released by the New America Foundation, by 2016 Arizona residents will have to spend more than $25,000 or nearly 46 percent of the median household income to buy health insurance for themselves and their families — an 85 percent increase over 2008 levels.”

“The good news is that the work to improve the health-care system has already begun. The White House budget proposal… lays down a significant marker for major action on health-care reform this year.”

“With the foundation of real reform taking shape, now is the time to move forward. Despite our world-class hospitals and cutting-edge research and technology, we have a health-care system that costs too much, delivers too little and is a looming threat to our financial future.”

“We must fix America's health-care system now, not in spite of our economic crisis, but because of it. Creating a health-care system that emphasizes access and quality while reining in costs is essential to the future of our economy. Together, we can find a way to solve our health-care crisis and put working families and our economy first. America cannot afford to wait.”

“Healthcare costs for Americans who get medical coverage through an employer hit a record $16,771 per family this year, and they are having to pay more themselves, a report released on Monday showed.”

“…Costs grew by an average of $1,162 per family this year from an average of $15,609 last year, the report said.”

“President Barack Obama has set a goal of signing into law by the end of this year legislation that would overhaul the U.S. healthcare system, seeking to cut costs and ensure that millions of people now without health insurance get coverage.

The new report is the latest to illustrate the high cost of healthcare in the United States, whose system is the world's most expensive. Healthcare costs burden many U.S. businesses and families and eat away at federal and state budgets.”

The parallel moment on health care came on Monday when a coalition of six key interest groups, including the Service Employees International Union and trade associations representing hospitals, doctors, drug manufacturers, and the insurance industry, pledged to Obama that they would take steps to reduce health spending by as much as $2 trillion through 2019. Critics correctly noted that the groups did not commit to specific actions that would generate anywhere near such savings. (The administration says they are coming.) But that missed the larger point: The announcement moved these groups, many of which furiously opposed President Clinton's universal coverage plan, significantly further toward embracing Obama's reform agenda. "They want to be on the train," one administration official said.

...Both the health care and climate-change proposals still face many obstacles before passage. But these early steps show that Obama’s instinct for inclusion could allow him to expand his political coalition even while advancing two of his party’s top priorities. That’s how lasting majorities are built.

“We’re beginning to see why. The president’s refusal to back away from fixing health care — and fixing it soon — apparently is bringing many heretofore reluctant parties to the table. Good. This is a healthy start.”

“Unlike 1993, their concerns are mostly shared by employers. Spiraling costs have driven many employers to support a change in the status quo. The domestic automobile industry is only the most visible example of how health care has overwhelmed too many corporate bottom lines. Between 1993 and 2007, according to government statistics, costs for health care doubled, rising from $3,500 per person to $7,400 per person. In 1993, health care cost the country $900 billion. By 2007 it was $2.2 trillion. This can’t continue.”

“We have encouraged Obama to put health care reform at the top of his agenda, and we’re glad he’s not backing away. Hang tough, Mr. President. It’s the right thing to do.”

“We understand this will be a difficult, expensive fight. But the alternative — a status quo of skyrocketing costs, massive waste of resources and 50 million of our fellows going without coverage — is unacceptable, morally and financially.”

“Despite two wars and an economic crisis, President Obama is poised to tackle health care now.

Yesterday, Obama declared "the stars are aligned" to pass his health-care agenda this year. No legislation has been introduced, but Obama has already won some key concessions in reforming health care.

On Monday, six industry groups including hospitals, doctors, drugmakers, and medical equipment manufacturers pledged to wring $2 trillion from their costs over the next decade. Those savings could help cover the nation's 45 million uninsured.

Last week, insurers upped their commitment to health reform by agreeing to end surcharges for women's medical coverage.

Earlier, the then-president-elect secured a key conditional agreement on access to health care when insurers agreed to accept all customers, regardless of past illness or disability.

So in just a few months, Obama has put in place some key building blocks needed to cut costs and expand access to health care.”

…."That's the kind of energy and determination that we need," the president said at the White House, standing on the south driveway with Pelosi and Democratic leaders of the relevant House committees.
"We are not going to rest until we have delivered," Obama said. "Our health care system is broken."…
…"We promised him that we will have this important legislation on the floor of the House before the August break," Pelosi announced. "Our goal is to have a healthier America."

In the early 1990s, the argument was all about covering the 37 million or so uninsured. In 2009, after much of the rhetoric on last year's campaign trail focused on the growing ranks of uninsured, the major thrust of health-care reform centers on something that affects everyone: the staggering cost of a system that threatens to devour the rest of the economy. And as a result, political momentum may finally be on the side of health reform...

...So how do you actually bring medical spending under control? Health-care experts say it is possible to cut it significantly without reducing quality. Indeed, they say more efficient medicine would be better medicine. By some estimates, as much as $700 billion of the $2.3 trillion that we spend on medical care each year is on unnecessary treatment that is not doing anything to make us healthier - and could even be hurting us. Obama Administration budget director Peter Orszag notes that all sides now are starting to agree that four big changes are needed...

[The] Health care industry promises to cut costs by $200 billion a year mark an “unprecedented” effort by the industry to work toward reform, U.S. Health and Human Services Secretary Kathleen Sebelius said Monday.

But Sebelius said while President Barack Obama wants to work with industry on health care reform legislation, he'll insist on basic principles that must be part of the overall package.

“He says health care has to be available to all Americans; less than universal coverage is not an option,” she told reporters in a conference call. “It has to lower costs ... and drive high-quality care. “We can't just keep paying what we're paying for right now.”

….“Everyone in the room ... understands that what's in place now is unaffordable, unsustainable and really unacceptable to most of the American public,” she said. “One of the really positive outcomes we have is a broad-based coalition that has never been together before.”

…. “Today was really a breakthrough day,” she said. “Everyone recognizes that the current cost of health care in America is unaffordable for businesses and families ... and that it's also unsustainable. We have to transform the system in order to lower costs.”

There has been a sea change in the long struggle over healthcare reform in Washington.

The last time a Democratic president took office promising major health reform, 16 years ago, the effort crashed amid fervent opposition by key groups in the healthcare industry.

Today, many of those same groups have voluntarily come to the table, ready to deal. On Monday, President Obama announced a commitment from a half-dozen health-industry trade groups to reduce the growth of healthcare spending significantly, with a potential savings of $2 trillion over 10 years.

Industry groups see that momentum is building toward reforming the system – and they want to be inside the tent affecting the outcome, not outside having decisions forced upon them...

... "What's brought us all together today is a recognition that we can't continue down the same dangerous road we've been traveling for so many years; that costs are out of control; and that reform is not a luxury that can be postponed, but a necessity that cannot wait," Mr. Obama said after meeting with representatives of the groups.

Doctors, hospitals, drug makers and insurance companies will join President Obama on Monday in announcing their commitment to a sharp reduction in the growth of national health spending, White House officials said Sunday.

The officials said the plan could save $2,500 a year for a family of four in the fifth year and a total of $2 trillion for the nation over 10 years. That could make it less expensive for Congress to enact comprehensive health insurance coverage, a daunting challenge facing the Obama administration…

In remarks prepared for delivery to health care providers on Monday, Mr. Obama says: “These groups are voluntarily coming together to make an unprecedented commitment. Over the next 10 years, from 2010 to 2019, they are pledging to cut the growth rate of national health care spending by 1.5 percentage points each year — an amount that’s equal to over $2 trillion.”

Dear Chairman Baucus and Ranking Member Grassley:

I applaud your leadership as the Finance Committee continues to work in a bipartisan way toward our shared goal of enacting meaningful health reform legislation this year. You took an important first step this week, by announcingproposals aimed at improving the value and efficiency of health care and reining in the rising cost of health care. The policies you proposed will cut down on waste, fraud and abuse, reduce medical errors and improve the quality of care for patients. Among your proposals are ideas we have long supported:

• Promoting primary care and prevention,
• Realigning incentives to promote high-quality care,
• Increasing transparency to empower patients and providers, and
• Reducing waste, fraud, and abuse.

The Finance Committee, in partnership with other key Committees, is doing important work to address the public’s urgent need for health reform. We welcome your ideas as we continue working closely with the committees to explore the many ways in which we can achieve the goals of cutting health care costs and assuring quality and affordable health care for all Americans.

Sincerely,

Kathleen Sebelius
Secretary of Health and Human Services

It would seem an unpropitious moment for President Barack Obama to renovate the American health-care system amid battles to prevent the collapse of the American banking system, conquer the worst recession in his lifetime, and defeat the enemy in Iraq and Afghanistan. But Mr. Obama is determined to try, and chances that he will have something to boast about by year's end look surprisingly good.

…Unhappiness with the status quo is greater. Despite expansions of government health insurance, more Americans lacked health insurance going into this recession than in 1994, and the number has risen since. Health costs continue to rise faster than nearly everything else and now equal to 17.6% of total U.S. output, up three percentage points from 1994. (Each percentage point amounts to $140 billion.) Employers and the government's Medicare and Medicaid are seeing unsustainable increases in health spending. And -- this is politically important -- so are American families, as premiums, co-pays and deductibles climb.

The White House heath-care summit in March was a visible manifestation that health providers, insurers and employers believe this may be the Year of Health Reform. Harry and Louise, the characters in the devastating commercials that the health insurers used to defeat Hillary Clinton in 1994, have decided it's smarter to ride the train than lie down in front of it.

White House political tactics are smarter. The American health-care system is complex; any legislation to change it will be complex. So the Clintons offered a complex plan, and it was ridiculed and attacked at its vulnerable points even by Democrats. Counseled by Washington insiders and Clinton veterans, Mr. Obama will issue no detailed plan. He will offer elements, and work with Congress so whatever emerges will be as much their plan as his. The parliamentary move to allow health legislation to pass the Senate with 51 votes (instead of the 60 it usually takes in the Senate) gives Mr. Obama and his congressional allies added leverage.

The message is smarter too: If you like your current health insurance, Mr. Obama promises, it won't change. White House polling finds that employed Americans worry more about the cost of their health insurance than the prospect of losing it in a layoff. So watch for the president to emphasize not how many uninsured he will cover, but how he will hold down ordinary Americans' health tab.

Democrats in Congress want to do this -- now. Mr. Obama and White House Chief of Staff Rahm Emanuel really want a deal this year, but so do Max Baucus, the Senate Finance Committee chairman; Teddy Kennedy, who sees this as the last political victory of his life; and the House and Senate leaders Nancy Pelosi and Harry Reid. To get a bill, they may even surrender on some elements long seen by liberal Democrats as non-negotiable. (For example: To cut costs, offer decent but bare-bones health insurance to those who lack it, rather than delivering on the promise to offer every American a plan as good as members of Congress have.)

Earnings from the nation's big health insurers show them losing members at a rapid rate, suggesting the ranks of uninsured Americans are surging during the recession.

The latest evidence came from WellPoint Inc., the country's largest health insurer with nearly 35 million medical-plan members. Reporting a 1.3% drop in first-quarter net income Wednesday, the insurer also said it had shed nearly 500,000 net members since the end of December.

While WellPoint had factored in a large decline, it said it was surprised by the nearly 325,000 members it lost to layoffs or workers otherwise opting out of employer coverage. "We haven't run into something like this before," said Ken Goulet, head of WellPoint's commercial division, during the company's earnings conference call with analysts.

Analysts and economists have said the number of uninsured almost certainly has risen by several million people since the U.S. Census Bureau in 2007 pegged it at 45.7 million. For every one-percentage-point rise in the unemployment rate, the number of uninsured has likely grown by 1.1 million, according to research by the Kaiser Family Foundation.

Kaiser estimates that of the nine million people expected to have lost employer-sponsored health coverage since December 2007, about four million of them currently are uninsured. An additional 3.6 million have likely enrolled in Medicaid or other public programs, estimates the foundation.

On Tuesday, UnitedHealth Group Inc., the second-largest insurer in terms of members, reported a 900,000 drop in the number of people enrolled in its commercial health plans in the first quarter, compared with the end of last year, many because of higher-than-expected layoffs at the insurer's employer clients.

It is unclear how many of those people have or will find coverage elsewhere or qualify for government insurance such as Medicaid. "It's probably not a surprise that with all these people losing jobs, a lot will lose their health insurance," said Paul Ginsburg, president of the Center for Studying Health System Change, a Washington, D.C., health-policy research group.

Hospitals say they also are seeing some signs of more patients without insurance. The hospital chain Tenet Healthcare Corp. said earlier this week that its number of admissions of patients with private health coverage declined 2% in the first quarter from a year earlier, while outpatient visits of insured patients slipped 0.4%, when adjusted for last year's leap-year effect. A study released by the American Hospital Association in November found that one-third of U.S. hospitals had seen a noticeable decrease in elective procedures, such as knee replacements, during recent months.

When Danna Walker left the second-floor conference room and returned tearily to her desk — where someone had already deposited a packing box for her belongings — her first thought was not of the 14 years she had worked for DHL or the loss of her $37,000-a-year salary.

It was of Jake. In three months, once her benefits ran out, how in the world would she provide health insurance for Jake, her mountainous, red-headed 21-year-old son, who had learned three years earlier that he had metastatic testicular cancer?

Since the day she was laid off in October, Ms. Walker and her husband, Russ, co-owner of a struggling feed store here on the outskirts of Houston, have mounted a largely fruitless quest to find affordable coverage for Jake’s pre-existing condition. Their odyssey has become all too familiar to millions of newly uninsured Americans who suddenly find themselves one diagnosis away from medical and financial devastation.

The Walkers, both 46, are among nine million people who have lost employer-sponsored insurance since December 2007, according to projections by the Kaiser Family Foundation. Some have qualified for government insurance, and others have bought individual policies. But an estimated four million have joined the ranks of the uninsured, heightening the urgency in Washington to close the coverage gaps in American health care.

Like many others, the Walkers live on a knife’s edge of risk. Without insurance to cover her high blood pressure or his diabetes, they defer doctors’ visits when possible and obtain their prescriptions — nine between the two of them — for $4 apiece at Wal-Mart.

But their primary concern has been finding insurance for Jake, who, after four operations, two stem cell transplants and round after grueling round of chemotherapy, has been cancer-free for a year.

“You realize how vulnerable you really are,” said Ms. Walker, who exhibits the maternal ferocity of a black bear. “You just — not give up — but you just feel that you’re at a loss, that you’re at your wits’ end. I ask myself, ‘Do I really have to lose my home to save my son’s life?’ ”

Recessions are tallied in numbers -- jobless claims, home foreclosures, plant closings and bailout dollars. Here at the HealthServe community clinic, [David] Talbot, the medical director, tracks the recession in days -- the number of days that patients wait to see a doctor.

Just six months ago, the clinic delivered same-day care to most callers, the gold standard from a health perspective. But in October the delays crept to four days, then 19 in November and 25 in December. In January, HealthServe temporarily stopped accepting new patients, and almost immediately 380 people put their names on a waiting list for when the crunch eases.

In North Carolina, more than any other state, the recession has triggered a burgeoning medical crisis. A steep rise in unemployment has fueled a commensurate increase in the number of people who do not have health insurance, including many middle-income families.

"I used to be upper middle class," said Amy, who called HealthServe every morning for weeks before getting in to see Talbot. "I've paid my taxes for 30 years."

In the past two years, North Carolina's number of uninsured has climbed 22.5 percent, the biggest jump in the nation, according to an analysis by the North Carolina Institute of Medicine, a quasi-state agency. Nationwide, about 22 percent of adults do not have health insurance. Here in North Carolina, 25 percent of adults -- or 1.8 million people -- have no coverage. An additional 9 percent are underinsured.

For most Americans, health insurance and employment are linked. Every 1 percent increase in the jobless rate translates into 1.1 million people losing coverage nationally, according to the independent Kaiser Family Foundation. North Carolina's unemployment rate has doubled in the past year to 10.7 percent, making it the fourth-highest in the country.

More than 100 people gathered at Christian Hospital for a health care forum headed by three members of Missouri's congressional delegation - Democrats William Lacy Clay and Russ Carnahan of St. Louis and Republican Jo Ann Emerson of Cape Girardeau. The panel also included insurance leaders, public health advocates, doctors and others from the industry.

Experts agreed that the nation's health care system suffers from several problems: inadequate access for the poor, too few primary care physicians, skyrocketing costs. They also cited a need for greater emphasis on nutrition and disease prevention.

Carnahan said 1.5 million Missourians were uninsured at some point during 2007 and 2008, and nearly four-fifths of them were from working families.

“We all know our health care system is broken,” Carnahan said. “It has become a burden on families, the economy.”

“For so many years we've kicked the can down the road,” he said. “We haven't made much progress. So I think this is squarely on the plate for us. It demands urgent attention.”

In one of the world's most advanced medical systems and one of America's wealthiest states, Foerter and her clinic are a lifeline for hundreds of poor and working-class residents of Nanjemoy, an isolated peninsula in rural southwestern Charles County. Dozens of people here live without running water, some in unheated trailers or shacks, just 37 miles from Washington. There is no grocery store and no gas station, no Laundromat or restaurant.

This spring, Foerter told them that the clinic's services almost certainly would be ending in the next few months. The recession has hit nonprofit health clinics hard. This one had lost $150,000 during each of the past 14 years, and other grants were drying up. The board of Greater Baden Medical Services, which runs the clinic tucked inside the Nanjemoy Community Center, decided it no longer could be sustained and voted to close it.

And then, just as some patients had given up on the idea of affordable medical care within their reach, they received word of a small miracle: Two weeks ago, the federal government announced that all but a handful of the nation's health clinics would receive a total of $2 billion through the federal stimulus package. Greater Baden was awarded $270,372, enough to keep Nanjemoy Health Services open for two years.

"The fact that someone stepped in and did something about the crisis that this was going to cause is reason for celebration," said Rick Campbell, a longtime patient who has multiple sclerosis. "It doesn't solve Nanjemoy's underlying issues, but it's a start."

Without the clinic, Foerter said, many people wouldn't go to the doctor at all, whether out of stubbornness or a lack of transportation, or they would wait until they needed an ambulance. Without the clinic, patients tell her, they might as well start making funeral arrangements.