At this week’s Blue Cross Blue Shield National Summit, where Blues plans (along with their vendors/ partners) gather to learn from each other, the theme was “Navigating Change.” One of the keynote sessions featured former Governor and former Presidential Candidate Mitt Romney and former Senator Tom Daschle providing their perspectives on how to navigate proposed health care changes in the current, divisive political climate.”

One thing that everyone can agree on is the bottom line objectives of any kind of health care reform – better access to care, better quality, and lower cost. The debate is around how that happens and the role that government should play. There was much that both men agreed on, including the fact that any real change will absolutely require bipartisanship. They pointed to several recent examples that prove bipartisanship can be effective and is possible, including the passage of MACRA, CHIP reauthorization, and of the 21st Century Cures Act.

Here are highlights of their panel discussion, moderated by BCBSA President and CEO Scott Serota:

Governor Romney: The Massachusetts model vs ACA
Romney noted that Massachusetts’ plan was a precursor to ACA and that its genesis was the right-leaning Heritage Foundation, including mandated coverage. He observed that reform was much easier on a state level because there are so many differences between states. Massachusetts started with a 6% uninsured rate, while Texas is around 25%, so clearly, the same strategies would not work in both places. He viewed mandated coverages as a problem with ACA, but thought that the biggest issue that ACA faced was lack of non-partisan support. Romney knows firsthand the necessity for bipartisan support; as a Republican governor in a state with an overwhelmingly Democrat Congress, he had to find creative ways to work together to get anything done.

Senator Daschle: Critical factors to move health care reform forward
Daschle spoke about the public/private “collage” of health care that we have knit together in our country. He sees three factors for us for moving forward successfully:
1)   Affordability —  Cost-Sharing Reductions (CSRS) are an important component.
2)   Mandates — We need mandates in order to keep a balanced insurance pool. This can be seen as less politically charged if you consider there are plenty of examples in public policy where things are mandated, such as speed limits.
3)   Balance between public and private risk – Reinsurance is the way to achieve this, and Medicare Parts C and D are two examples where the balance has worked well.

What is the role of federal vs. state government in health care?
Daschle noted that a national framework for public policy is important, but one that recognizes differences between the states and allows for that diversity. Romney agreed that flexibility – in the form of waivers – is critical. He doesn’t think that the federal government imposing the Massachusetts plan on all states would make sense, since one size does not fit all, but he does support a set of federal minimum standards.

What’s likely to change in the current House bill once it gets to the Senate?
Romney thinks the current bill is a step forward but not perfect. He applauds the emphasis on HSAs and is not in favor of the reduction in Medicaid. In terms of what is likely to change? He points to having older people pay up to 5 times as much as younger people (instead of the current 3) and the ability to impose lifetime limits. Daschle is disappointed that there was no bi-partisanship and that it was not scored by CBO ahead of time (it will not be until 5/22). He is most concerned about getting clarity regarding CSRs so that we are no longer in a state of limbo.

Much discussion is focused on the financing of health care, but what about the cost?
Daschle notes that our “collage” of health care approaches is inefficient and that we need to move toward value-based payment, not fee-for-service, if we really want to control cost. He thinks of healthcare as a pyramid with wellness and preventive care at the base and complex and expensive procedures such as heart transplants at the top. We should focus on the bottom up, but instead, we focus on the top down, which is a fundamental flaw. He notes that without cost transparency, without consumers really knowing what something is going to cost before they purchase it, cost will remain hard to address. Romney advocated for more cost sharing, and not in the form of deductibles. He referenced the Swiss and French systems which require consumers to pay a percentage of the cost. He says this promotes greater consumerism as patients are incentivized to save money by shopping around. Contrast this to the US where many consumers are not price sensitive once their deductible has been met. Romney concluded by emphasizing that “states work”, and we should let them do so.

What’s the future of technology in health care?
Daschle says that technology and policy are what will drive change. Romney believes that technology changes in health care will be exponential and that as Marc Andreessen augured, software is indeed “eating the world.”