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John Podesta, Dick Morris, Senator Bill Frist

The Nashville Health Care Council (NHCC) seized the opportunity presented by the convergence of political cognoscenti in town for the Presidential Debate '08 at Belmont University's Curb Event Center to assemble a panel of national healthcare policy experts to discuss the imminent presidential race and healthcare reform. Senator Bill Frist, MD, who is now a partner at Cressey & Company served as moderator.

The breakfast meeting, held at Vanderbilt Marriott on the morning of the second debate, was packed with NHCC members and guests. Sponsors of the event were Aon; Boult, Cummings, Conners and Berry; the Federation of American Hospitals; and Integrated Medical Systems (IMS).

Discussing the need for drastic revamping of the American healthcare system, the panel consisted of:

• John Podesta, president and COO for the Center for American Progress. Podesta served as chief of staff to President Bill Clinton.


• Dick Morris, a former Clinton adviser, consultant to IMS, and a Fox News contributor.


• Chris Jennings, president of Jennings Policy Strategies and former senior healthcare adviser to President Clinton.


• Charles "Chip" Kahn, III, president of the Federation of American Hospitals and an expert on policy and healthcare issues.

Caroline Young, president of the NHCC, welcomed guests, commenting on the appropriateness of the Nashville setting for a healthcare discussion.

In introducing the panel, Frist commented that anyone who uses a crystal ball should be prepared to "eat crushed glass." He noted it has been five years since the last substantive discussion on healthcare reform in 2003, and he asked the panel to look at the reality of effecting change and to predict what will happen in the aftermath of the election.

Podesta said that everyone knows the problem with healthcare: spending a lot and not getting enough. He pointed out that despite healthcare expenditures, the United States ranks 31st in the world in life expectancy.

He predicted that the town hall format of the second debate would give the candidates an opportunity to deal with real problems, a prediction that did not prove true as candidates spouted rote campaign phrases.

Morris voiced a gloomy prediction that any chance for real healthcare reform for the country "went out the window" with the financial bailout/rescue bill passed by Congress in the preceding weeks and said that the new president would essentially be a "trustee in bankruptcy." He said he feels the country is headed into three-to-four years of global depression/recession that the new president will be powerless to change.

Jennings said that at first blush meaningful healthcare reform would seem to be off the table, but he offered six reasons for why progress could happen under the next administration. He said the people who know healthcare best know that reform is necessary. The question, he continued, is "Do we know how to do what we need to do" to fix healthcare? He observed that it would take a firm commitment and presidential leadership to make this a priority.

Jennings added that failure to act would have "substantial and negative consequences to our economy. It would be a significant failure of any president not to do so."

Kahn was more optimistic. He said that the election doesn't hinge on healthcare and predicted that –– since a new president only gets limited priorities –– with Congress primed for actions on child welfare and pent-up demand to act on "gargantuan" deficits, there would be action on Medicare but no overhaul.

Kahn said he regretted that neither presidential candidate seemed to have a complete plan: Obama's, he noted, doesn't cover everyone and McCain's probably wouldn't result in much cost containment. Kahn added that "I wish they both had done more research."

Morris felt the candidates see healthcare as a constituent service with the fundamental issue for most people being that they want good healthcare services and want them now.

"My worry is that without real cost containment of the service delivery level, you are headed inevitably toward rationing … not even so much because of the limitations on government money. That's part of it, but that's not the most important. There are only so many doctors to go around and so many nurses to go around," he said.

Forecasting that restricting supply would cause demand to explode, he warned, "Wait until the public starts being told 'no'."

Kahn predicted that early on in a new administration issues like family leave and expansion of the CHIP program would be addressed but, beyond that, his crystal ball was cloudy. He pointed out that no one would have predicted 9/11 or the recent bailout.

Jennings said that a reformed American healthcare system wouldn't look like other country's systems and that it would be a public/private partnership.

"It's not going to be just about governments taking control or individuals being responsible. It has to be both," he said. Jennings added, healthcare would never have first dollar coverage but if we're smart, we would wind up with a system that is clinically based and has some cost sharing built into it.

He urged a new administration to avoid rhetoric and focus on "getting something done."

Jenning also said the only way to bend the curve of continually rising costs is to invest in IT to maximize efficiency. However, Kahn pointed out that IT is a tool, not an outcome, and what really needs to change is how the United States delivers healthcare, which would involve significant investment.

Wrapping up the meeting, Frist pointed out that he had followed the advice of NHCC Chairman Tom Cigarran to run the meeting "like heart surgery — start on time and end on time."

Speaking to reporters after the meeting, Kahn said he hoped focus would be put on process and outcomes and called for healthcare reform writ large, not piecemeal. Calling either presidential proposals "menus" or icons that are not complete plans, he described Obama's plan as "not universal, expensive, complicated." In contrast, he viewed McCain's plan as an effort to get individuals more engaged in their own healthcare insurance plans to let the market drive down costs.

"It is a bridge too far to move to a single payer system," Podesta commented. He felt there were flaws in McCain's plan that "throws people out of the employer base at the mercy of insurance" and would like to see Obama's plan "go a little further."

He added, "It is a policy choice not to act," and advised, "We can't make the 'perfect' the enemy of the 'good.'"

Frist pointed out that even with widely differing opinions, the panelists had engaged in a civil and respectful discourse on varying points of view.

He added, "There is no place better to have this discussion than in Nashville, which has helped to shape the nation's healthcare landscape for the past four decades and is home to a diversified industry with growth segments and a strong professional services infrastructure supporting the healthcare community."

Nashville-based healthcare companies account for $45 billion in annual revenue and more than 310,000 jobs globally, and Nashville-based hospital management companies own or operate approximately half of the investor-owned hospitals in the United States.

Although panelists indicated they felt Obama's prospects in the election were very good, Frist warned that it was "way, way, way" too soon to predict how the election would turn out. Over the coming days, weeks and months, the American public will find out if the experts' predictions were on the money or missed the mark.

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