Harkin on health care: We cannot fail

NORTH LIBERTY - Sen. Tom Harkin, who was present for the ill-fated attempt to reform health care in the 1990s, Saturday confidently predicted Congress will get the job done this year.

"We're going to get this done," Harkin told about 200 people at an AARP national town hall forum on health care in North Liberty. "I'm telling you, we cannot fail. We've got to get this done."

The key difference from the Clinton administration's attempt to reform health care 15 years go is public support, Harkin said. In the 1990s, health care reform advocates didn't have insurance companies or business on their side and didn't even have broad support from labor unions.

"We have a critical mass," he said. "We didn't have a critical mass in the 1990s. I think we have ... it's moving the agenda."

Groups like AARP and Divided We Fail, a coalition of business, labor and consumers, are bringing attention to the shortcoming of the health care system. Much of their emphasis in on prevention and wellness, national AARP President Jennie Chin Hansen told the forum. Not only are those elements absolutely essential to controlling health care costs and improving health care, but they "offer us common ground on which we all can stand for health care reform," she said.

More than 75 percent of all U.S. medical expenditures are fro chronic conditions - heart disease, diabetes and obesity, Chin Hansen said. Only 5 percent of health care spending goes toward prevention of those diseases.

Harkin offered a starker picture: The U.S. spends more than $ trillion a year on health care or about 16 percent of the GDP, but ranks 37 in terms of health quality, about the same as Serbia. The U.S. spends twice as much per capita as European nations, but Americans are twice as sick with chronic disease.

So health care reform is not only a moral imperative, as Cathy Slasson, a registered nurse at University of Iowa Hospitals and Clinics and Iowa President of SEIU, called it, but a fiscal imperative, Harkin said.

"We've tried everything else and it has led us to bad health and the brink of bankruptcy," he said.

Congressional committees will ne marking up health care reform legislation this month and Harkin expects floor action before the August recess with final passage by October.

There are many details to be worked out. Harkin guaranteed there will be a "public option," but conceded later there is little consensus on what it will be. It could be Medicare for everyone or a plan managed by insurance companies. He thinks it's more likely to be an insurance option overseen by a public, non-profit entity.

He's leaning toward including an individual mandate - a requirement that everyone have insurance coverage - and, based on recent conversations, thinks the president is moving in that direction.

Whatever the final outcome, it will represent "dramatic change," Harkin said.

"We're not dancing around the edges," he said. "What we are planning to do will change the very fabric, the very fabric, of how we do health care. It's not just changing medicine. It's changing the kind of medicine we do. The way we do medicine."