Two years before Sarah Palin conjured “death panels" from her active imagination, Utah’s business elite devised its own far less infamous version. And depending on who you ask in Utah, then-Governor -- and current GOP presidential hopeful -- Jon Huntsman Jr. was all for it.
In 2007, the United Way of Salt Lake City, in an effort to come up with its own solution on health care reform, assembled a gold-plated committee of civic poo-bahs: white-collar elites from the city’s Chamber of Commerce and banking industries, a conservative bunch in an ultra-conservative state. The committee met regularly in an effort to craft a reform plan that they could support.
The committee took advantage of a time when everyone in Utah seemed interested in addressing this problem. “I loved the consensus that was formed there,” recalled Judi Hilman, executive director of the non-partisan Utah Health Policy Project. “I’ve never been more hopeful for Utah health reform than at that time. All the levers that you need to pull were pulled in that proposal.”
So what did the bigwigs come up with? Along with a mandate, they produced a progressive cost control measure that would have actually addressed one of the biggest issues facing reform: the sky-rocketing expenses associated with health care. The plan called for the adoption of an independent commission, or “Health Benefits Commission,” which would essentially rule on which procedures were clinically appropriate and which were just fattening the wallets of surgeons, drug makers, and medical device manufacturers.
In the pre-Palin era, advocates and insurance heavies agreed on the commission idea for Utah. This was not seen as something that would pull the plug on Salt Lake grandmothers -- rather, it would allow courses of treatment to be determined using medical knowledge. Dr. Joseph Jarvis, who served on the committee, says he was “encouraged” by the proposal. “It would be a huge change in the way health insurance is done,” he explained. “Right now, if there is a death panel, it’s behind corporate doors. They creatively deny benefits all the time. They don’t use clinical science to do that. They might claim that but they don’t.”
In Jarvis’ telling, the commission would formulate a basic benefit package that would be based on medically appropriate and clinical evidence. Useless surgeries for back pain? They wouldn’t be in the benefits package. Invasive procedures that show no better results than over-the-counter meds for acid reflux? Also not in the package. Under the United Way plan, Utah residents could still opt for that risky surgery for that ailing back, but they would have to pay for most if not all of it themselves. The more unnecessary the procedure, the less it would be covered by insurance.
According to a confidential draft of the United Way plan obtained by The Huffington Post, the authors wrote [PDF]:
We propose that an independent commission make coverage decisions based on these essential characteristics:
a) Treatments will be based on the lowest cost, generally-accepted alternative that meets the medical need.
b) Benefits will include financial incentives for healthy lifestyles (non-smoking, weight, others).
c) No deductibles are necessary because the co-payments/co-insurance structure provides appropriate incentives.
d) No out-of-pocket maximum is necessary because medically essential services are capped episodically and non-essential services are paid for out-of-pocket.
e) A combination of co-payments (defined amount) and co-insurance (defined percentage) that are tiered based on income (% of the federal poverty level) should be applied.
The independent commission should be appointed by the Governor, confirmed by the Senate, include 3-5 people, and include six-year terms. Members of the commission should include individuals with a mix of clinical knowledge and fiscal accountability. The commission will define the essential benefit package, provide coverage determination on an ongoing basis, and have rulemaking authority.
The commission will establish an appeals board to mediate disputes. This function will be structured like an administrative law judge. By law, there will be no additional recourse: neither providers nor insurers can be sued for denial of care outside of this venue.
Jarvis, an advocate for a single-payer style health insurance, considered the commission to be the United Way plan's most significant feature. Utah’s health care industry vets did as well.
Greg Poulsen, a senior vice president and chief strategy officer with Intermountain Healthcare, the largest insurer in the state, served on the United Way committee. In an interview with The Huffington Post last week, he too played up the cost-saving measures of the plan. He explained that the committee saw that any attempt at reform needed to try to rein in health care spending. “The rate of cost increase has been significant,” he said. “Like everywhere else, people worried about the rate of growth on health care costs and we were looking for ways to try and change that trend.”
Huntsman didn't just anxiously wait for this plan to be implemented from the sidelines. He lent staff support to the committee, recalled Bill Crim, senior vice president of community impact and public policy with the United Way of Salt Lake City. Crim was the lead staffer on the committee.
Norm Thurston, the governor’s health reform implementation coordinator, recalled attending some of the United Way meetings as well.
“Governor Huntsman’s staff was very much involved,” confirmed Bruce Reese, the committee’s co-chair. “We had really good involvement and monitoring from the governor’s office.”
These aren't just the recollections of a few. Newspaper accounts from the time repeatedly link the United Way committee with Huntsman. In an op-ed from Sept. 22, 2007 Reese writes in the Salt Lake Tribune: “The good news is that a new commitment and concensus are emerging to truly solve this problem. Through the United Way Financial Stability Council, the Salt Lake Chamber and the business community have teamed up with Gov. Jon Huntsman, legislative leaders...to develop a common sense, business-minded framework for addressing our health care challenges.”
To hear the Salt Lake Tribune describe it, the United Way plan had Huntsman’s support. The day the plan was set to be publicly released, the paper tied the plan -- including the commission -- to Huntsman, writing:
Coverage would be purchased from the private market, but at affordable prices. Benefits would encourage consumers to adopt healthier lifestyles without skimping on medical care. No one, not even the poorest families, would be denied basic care.
Such are the promises delivered in a blueprint for health care reform quietly authored by a think tank of 130 Utah business leaders and backed by economic and health advisors to Gov. Jon Huntsman Jr.
Jarvis, for one, believed the plan had Huntsman’s support. “I know that the governor’s office was very excited about this concept, the whole package,” he said. “Because of the commission -- I endorsed it. So did the governor. He was so enthused because he thought he had so many community leaders behind it. He had his staff immediately try to find sponsors in the legislature.”
John T. Nielsen, the governor’s adviser on health care reform whom one legislator dubbed Huntsman’s “voice and face,” attended the United Way’s planning sessions and liked the commission. “It struck me as not a bad idea,” he said. “I would not have personally rejected the idea ... I think it ran into legislative angst.” Nielsen, who said he did not recall the governor's opinion, would not confirm that he endorsed the entire plan.
The then-House Speaker David Clark argued that the plan couldn’t just be turned into concrete legislation. “It was concept -- 30,000 feet,” he said. The United Way eventually morphed into a new legislative task force that went on to develop the Utah Health Exchange. Clark doesn’t recall the governor or anyone in the governor’s office taking much of a position on the United Way’s proposals.
Over time, Huntsman’s support, by some accounts, decreased as well.“My sense was he was enthusiastic about it,” recalled Hilman. “He did kind of fade into the background sooner than many of us would have liked. He pulled back way too early.”
To Palin, the United Way commission would have screamed Death Panel, even if policy wonks aren’t saying it. The experts HuffPost contacted from the feds, a D.C. think tank and a state university in the upper Midwest refused to engage in a discussion about whether Palin would have labeled Utah’s effort a death panel.
But Huntsman’s camp’s reaction to this story is telling. In response to queries about the United Way’s plan, the campaign forwarded HuffPost a statement from the governor’s former chief of staff Neil Ashdown, who adamantly denied that his former boss endorsed anything death panel-related. “The governor was encouraged that the United Way brought a lot of parties to the table to begin the process of identifying and proposing health care reform solutions. He certainly didn’t endorse all of the policy prescriptions including the mandate and the benefits commission laid out by their final plan, as it was only one part of a large review process," the statement read.
Campaign spokesperson Tim Miller sent along a statement of his own on Huntsman’s health care reform record: “He should be judged based on the plan he supported, endorsed, and signed which has become the model for a comprehensive free-market, consumer driven reform that was not government-centric and did not include a mandate.”