"Our No. 1 issue is to try to cap the rising cost of healthcare," said Joe Hunt, head of the International Assn. of Bridge, Structural, Ornamental and Reinforcing Iron Workers. "Every time we get a raise for our members, it goes into the health insurance."
For businesses, the rising costs have also been devastating, with the employer contribution to an average family premium more than doubling in the same period -- from nearly $4,250 a year to more than $9,300.
Sensitive to public anxiety, Obama rarely begins a discussion about healthcare without insisting that healthcare spending must be controlled, a message he repeated last week even while out of the country.
On Capitol Hill, senior Democrats have pledged to tackle the problem, which has sent the nation's annual healthcare tab beyond $2.5 trillion and threatens to bankrupt Medicare in eight years.
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Promises of action
Mammoth legislation being debated in the House and Senate includes incentives to better coordinate care among hospitals and doctors, to cut costly hospital readmissions, and to evaluate what kinds of care yield the best results. There is also new money for prevention, which many experts say saves money in the long term.
But many of the proposals in the two healthcare bills released by Democrats are limited to pilot programs and research initiatives. (A third bill by the Senate Finance Committee is still being developed.)
House leaders envision new centers to analyze medical data. The Senate health panel has outlined plans for a "national strategy to improve healthcare quality." But these institutions would have no authority to force changes.
Both bills would create a government insurance program that senior Democrats say could pressure providers to lower costs. What is missing, critics contend, are bolder initiatives in the existing Medicare and Medicaid programs to reward doctors and hospitals that become more efficient -- and cut federal payments to those that do not.
"There are enormous opportunities to save money," said Ken Thorpe, an Emory University healthcare economist who has been advising Democratic lawmakers on the legislation. "What has been proposed is much too tepid."
Even the recent agreement between hospitals and the administration to cut federal payments to hospitals by $155 billion over the next decade does little to change the way providers are paid, said Mark McClellan, who headed the Centers for Medicare & Medicaid Services under the Bush administration.
