Summary

"Unless we fix our health care system--in both the public and private sectors--rising health care costs will have severe, adverse consequences for the federal budget as well as the U.S. economy in the future." This is one of the key messages that Comptroller General David M. Walker has been delivering across the country in town-hall style meetings, in speeches, and on radio and television programs. Using another format to explore issues with health care experts, Mr. Walker convened a forum at GAO on May 17, 2007. Attendees included health policy experts, business leaders, and public officials selected for their subject matter knowledge and representation of various perspectives. Participants examined health care cost, access, and quality challenges in discussion sessions led by distinguished economists Robert Reischauer and Mark Pauly and other leading health care authorities Carolyn Clancy and Suzanne Delbanco. Nationally known health insurance expert Leonard Schaeffer served as the keynote lunchtime speaker. At the conclusion of the forum, participants were polled for their views on points raised during the discussions. The poll was conducted using electronic voting technology that produced real-time, but confidential, results.

The discussion sessions focused on three interrelated topics: cost and personal responsibility; coverage of the uninsured; and quality, standards, and outcomes. The keynote speech focused on related policy challenges. The following are highlights from these discussions and the participant poll. The proceedings are not intended to reflect the views of GAO. Health care spending. Participants did not reach agreement on whether the federal government should have an aggregate spending limit, such as a percentage of the federal budget, but supported other measures, such as federal value-based purchasing, reformed tax treatment of health care, and limits on direct-to-consumer advertising of prescription drugs. Health insurance coverage. There was near unanimity that ensuring the provision of health care coverage for all Americans should be a federal responsibility. The group also strongly agreed that the federal government should assure the existence of a well-functioning health insurance market, whereas they did not agree on whether the nation should continue to rely on employer-provided insurance as the dominant method through which most Americans obtain their health insurance coverage. Performance measures. Participants strongly supported the federal government's taking the lead in developing new indicators of health system outcomes and performance. The group also strongly favored having a broad-based independent body develop national, evidence-based practice standards. Policy challenges. The keynote speaker opined that a limited window of time--about 8 to 10 years--remains for the health care community to engage in effective reform. After that, he noted, budget and national security concerns will dominate. Because neither purely regulatory nor purely market-based approaches are politically viable, pragmatism rather than ideology should drive health policy. He concluded that we need a blended strategy, stating, "We have to shape our future now or be its victim."