With the House and Senate unveiling draft descriptions of their health reform bills, national health reform activities are heating up.  The escalating focus on health reform by Congress and all interested parties was illustrated by the cover and contents of last week’s National Journal.

The cover of the June 13th issue of the National Journal featured Karen Ignagni, head of the American Association of Health Plans (AHIP), the health insurance trade association. The main story inside is about Karen Ignagni, and leaders of other key groups, including Dan Danner (NFIB), Andy Stern (SEIU), and Ron Pollack (Families USA), and how their groups are working much more cooperatively than in the fierce fighting days of the early 1990s. (The interesting point about Karen Ignagni that the article notes, but does not highlight, is that she used to work for the AFL-CIO, and thus does not come out of the Gordon Gekko mold that is sometimes used to characterize the health insurance industry, i.e. profit above all else.)

Aside from the 8 page cover story, the inflammation of health reform on the national stage is evident by the magazine’s coverage of health issues in a poll, an article about a Member of Congress’ approach to her personal health challenges, two columns, two short notices, and 5 full page ads:

• National Journal Insiders Poll about “how important is it to President Obama that health care reform be bipartisan?” (74% of Democrats said very or somewhat important, as did 70% of Republicans)
• Article about Representative Debbie Wasserman-Schultz’s approach to her breast cancer diagnosis and treatment
• Clive Cook’s column “Health Reform’s Twisted Economics” about how the balance of priorities between coverage expansion and cost containment has tipped back and forth during the campaign last year and in the current legislative debate
• Ron Brownstein’s column “Insurance for Insurance” about how limiting the tax exclusion of health insurance may escalate concerns about the growing financial strain copayments and deductibles are having for people with health insurance
• Short notices about the bill giving FDA authority to regulate tobacco, and Sen. Conrad’s proposal to morph the public plan concept into co-operative organizations
• Kaiser Permanente ad about disparities in health insurance coverage
• Mars ad about their more nutritious products and eliminating advertising aimed at kids under 12
• McDonald’s ad about their healthier menu options
• Medco ad about how advanced pharmacy services improve clinical and economic outcomes
• Siemens ad about information technology for improving healthcare quality

Health Reform Outside of DC, i.e. the Rest of the Country
All of this coverage (and advertising) is consistent with the mainstream discussions about the fulcrum issues of cost containment, mechanisms for increasing coverage, (e.g. mandates on individuals and/or employers), and the public plan option.  But it should also be realized that this is not the context for health reform discussions across the country.

Last night I went to a gathering of about 60 people in Cambridge, MA interested in health reform.  Contrary to the national debate, their focus was almost unanimously how to push for a single-payer health system.  While this discussion is outside of the mainstream of the legislative debate, I’m sure in other parts of the country, (colored red on some people’s maps), similar groups are discussing how to advocate for limiting the government’s role and involvement in the health care system.  These discussions may be supportive of proposals for limiting the tax exclusion of health insurance premiums that are popping up in the middle of the national debates – even though Democrats’ cautious interest in this idea is based upon the many billions of dollars it could raise to pay for coverage expansion rather than any philosophical support for eliminating employment based health insurance, or dramatically expanding the individual purchasing market for health insurance, or limiting the government’s direct role in the health system.

What will happen?
An accurate crystal ball would be great to have right now, but the only thing that seems certain is that more proposals will be put forth by Congress and others, the Administration will continue to engage in the debate trying to get something substantive that achieves as much of their goals as possible, and many more articles will be written and ads placed in publications like National Journal and Roll Call.  When these ads start hitting the media and airwaves outside of DC it will indicate that the debate has reached the next level, i.e. stakeholder groups will then be trying to educate the general public and activate them to engage their Members of Congress and the Administration about specific proposals and pieces of legislative language that today are still in flux and draft form.