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Where will health care fall on the list of national priorities?
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Throughout his successful campaign, President-elect Barack Obama ran on a broadly appealing platform of hope and change that enticed many individuals to become newly active in the political process. Having secured victory, our new President-elect will confront challenges often faced by politicians who have promised a lot and now must deliver. In Obama’s case, two clear challenges are the large number of different interests invested in what are hoped to be new opportunities for affecting governance and a backdrop of domestic and global financial uncertainty that will make new government spending difficult.
When it comes to health care, there are a few schools of thought that guide prediction of Obama’s early moves. One says that health care will be relegated to back burner status while Obama works to achieve some degree of fiscal discipline in the face of a large deficit and weak economy. The other sees an opportunity for health care reform as part of what has colloquially been referenced as a “‘New’ New Deal.”
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Obama has given a few early signals that he may be more inclined to the latter approach than the former. He has indicated that Americans shouldn’t worry about the size of the deficit over the next two years, as fixes to the economy may not address the deficit foremost. And, there are signals that health care reform will be viewed by the new administration as a method of job creation and thus economic stimulus.
Sensing opportunities for a new shot at health care overhaul, likely participants in the coming discussion are taking sides and attempting to define the rules of engagement. Key players who have already spoken or who are poised to speak include Senate Finance Chairman Max Baucus (D-MT), who recently released a white paper entitled “Call to Action: Health Reform 2009;” Senator Edward Kennedy (D-MA), a longstanding advocate for health interests, who plans to introduce his own reform proposal; former Senator Tom Daschle, the new nominee for the Secretary of Health and Human Services, who wrote a book earlier this year entitled Critical: What We Can Do About the Health Care Crisis; Harvard economist David Cutler, President-elect Obama’s health advisor throughout the campaign who was influential in crafting his health plan; and PhARMA, the pharmaceutical industry’s lobbying group, which has recently released advertisements against Medicare negotiations for drug prices. Observers of national health policy who want to follow the emerging battle for reform should probably become familiar with the opinions of these thinkers.
What will this mean for the practice of oncology, and what does any of this have to do with oncology fellows?
First, Obama made several promises during his campaign directly relevant to oncology research and practice, which will come up for consideration as part of his new health agenda. For example, he pledged to double funding for cancer research, including strengthening the NCI, NIH and FDA’s cancer activities with enhanced central coordination of a national cancer plan; to reorganize the health insurance market in part by creating the National Health Insurance Exchange, possibly enhancing access to and affordability of expensive cancer treatments for patients in need; to improve preventive care coverage for all Americans; to improve access to clinical trials, with a goal of doubling current enrollment; to improve outcomes through rewarding performance and sponsoring comparative effectiveness research; and to provide additional support for cancer survivors and their families. These ideas will all cost money, but the tab for health reform will be high and some of these oncology agenda items will likely be part of the bill in one form or another.
I believe that oncology fellows are in an important position to affect and ultimately be affected by many of the above interventions. Two former co-residents of mine, one of whom is now an oncology fellow at the Dana Farber Cancer Institute, founded a group called “Doctors for Obama” during the campaign to bring together medical professionals who supported the proposed Obama health care plan. The list of signatories in support of the group included chancellors of major academic centers, national health policy experts and other leaders from around academic medicine. The founders hope to capitalize on this support to reorganize this potentially powerful collection of interests to advocate for implementation of key elements of the plan.
Additionally, efforts to cut costs in order to save money to finance expensive elements of the health agenda will likely focus on high expense areas of medical practice, such as oncology. As trainees at major academic medical centers, oncology fellows will be growing up with some of these initiatives and will be helping to ensure that efforts to cut costs in turn reward quality and do not sacrifice outcomes.
The year ahead promises to be particularly interesting for health system reform and may be relevant to our area of practice. Participating in this process offers an opportunity to influence the end result.
William Wood, MD, is a second year Hematology/Oncology Fellow at the University of North Carolina, Chapel Hill and is a HemOnc Today Editorial Board member.