Regardless of the degree of confidence or concern over a federal health plan, most speakers and presenters agreed that employers' burden in paying for health insurance is largely to blame for the current U.S. economic crisis.

Conservative Perspective


The other side of the aisle was well represented with high-profile speakers including Newt Gingrich, former Speaker of the House of Representatives and Founder of the Center for Health Transformation; and Mark McClellan, M.D., former CMS Administrator and FDA Commissioner, and currently Director of the Engelberg Center for Health Care Reform at the Brookings Institution.

Describing health care as a challenge and opportunity, Dr. McClellan said, "Growth in health care can be an engine or an anchor." He said that some health care spending has led to great value but persistent problems include inefficiency, overuse as well as underuse and misuse, medical errors and variation in costs. "We need short-term investment and long-term change," he said.

Dr. McClellan pointed out a chronic problem in government administration of any program when he said, "Under the current system, you are paid less for better care." This refers to the way bureaucracies operate by paying for services, actions, or activities, rather than providing incentives. He recommended we measure quality and cost using patient-level outcomes, instill accountability and build a process away from the fee-for-service model now in place. "Instead of paying more for more costs, how about paying more for better care?" he said.

Regarding the ideology that will guide reform he said, "My hope is we don't sidetrack the health care reform debate on this one issue of public versus private [plan design]." He added, "People trust doctors, not the government or insurers to make decisions."

Mr. Gingrich, while optimistic about the outcome, warned that "self-protection of people who don't want change" will present impediments to reform. He acknowledged that the requirement for electronic health records was "one of the few positive things" in the stimulus bill. But, he said, "My biggest fear is if the stimulus is spent the wrong way it will freeze technology at an immature point."

He noted, "Government bureaucracy is antithetical to entrepreneurial solutions" and advocated for a "decentralized structure with breathing room for entrepreneurs to solve local problems."

Some themes that kept recurring during the conference were the possibility of regionally organized health care delivery, individual patient responsibility for health, the important role of allied health providers, and the concept of the medical home.

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