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Obama's health principles, translated By: Carrie Budoff Brown March 10, 2009 04:07 AM EST

When it comes to health care reform, details are key, but it seems that President Barack Obama plans to avoid the minutiae and let eight vague principles speak for him. As written into the budget delivered to Congress last month, these delicately worded principles were crafted to appeal to the broadest possible audience, but behind each lies hints about Obama’s intentions — and the polarizing debates over taxes, mandates and government-run insurance plans on the horizon. Here’s a translation of the principles, first detailed in his budget: 1. Protect families’ financial health. The plan must reduce the growing premiums and other costs American citizens and businesses pay for health care. People must be protected from bankruptcy due to catastrophic illness. Translation: The health care debate isn’t just about the 47 million uninsured Americans. In fact, Obama more often cites the frequency with which medical bills force underinsured families into bankruptcy. So look for a host of policy prescriptions designed to make health care costs more predictable and affordable, including limiting what Americans pay for health insurance to no more than 10 percent of their annual income and providing subsidies to small businesses and individuals to pay for coverage.   2. Make health coverage affordable. The plan must reduce high administrative costs, unnecessary tests and services, waste and other inefficiencies that consume money with no added health benefits. Translation: The insurance industry needs to shape up. Look to California, where Republican Gov. Arnold Schwarzenegger pushed legislation requiring insurers to spend at least 85 percent of their premium dollars on health care rather than spending them on overhead or converting them to profits. From a political standpoint, many lawmakers will want to crack down on the insurance industry, the most unpopular link in the health care debate. Industry insiders say they aren’t opposing a tough review, but the details matter, and they want other industries to be subject to similar treatment.    3. Aim for universality. The plan must put the United States on a clear path to cover all Americans. Translation: Don’t expect universal health coverage all at once. Health insurance for all is the goal, but how to reach “universality” is the question that most threatens the negotiations. Driven by their distrust of insurance companies, labor unions and progressive Democrats want a government-sponsored plan to compete with private options. Fearful that government will drive them out of the market, the insurance industry is adamantly opposed. During the campaign, Obama pushed for a public plan option, but he has not indicated whether he is wedded to it. The insurance industry also favors individual mandates, such as a legal requirement that every American obtain insurance. Obama did not endorse such a mandate for adults, saying they would buy insurance on their own if costs were reduced. Libertarians say mandates will eventually mean a nationalized system.    4. Provide portability of coverage. People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of pre-existing conditions. Translation: Obama wants a government-organized marketplace, known as an exchange, where Americans can compare and purchase plans of their choice. This is where the controversial question of a public option comes into play: Should a government insurance plan compete with private insurers? Obama and Senate Finance Committee Chairman Max Baucus (D-Mont.) have both said yes. Insurers in the exchange would be prohibited from denying coverage based on pre-existing conditions. The industry says it can’t be expected to pick up the costs from expensive new customers if young — and cheaper-to-insure — customers aren’t directed into the system through a mandate. 5. Guarantee choice. The plan should provide Americans a choice of health plans and physicians. They should have the option of keeping their employer-based health plan. Translation: Don’t get scared — Obama doesn’t want to pick your doctor. This is a deliberate message switch from 1993-94, when interest groups funded the famous “Harry and Louise” ads that cast the Clinton plan as an effort to remove choice from the equation. And no socialized medicine, either. As Baucus says, they are looking for a “uniquely American” solution, which means maintaining the employer-based health plan. 6. Invest in prevention and wellness. The plan must invest in public health measures proven to reduce cost drivers in our system — such as obesity, sedentary lifestyles and smoking — as well as guarantee access to proven preventive treatments. Translation: Get in shape — and get used to hearing a lot more about “individual responsibility.” Quit smoking. Exercise. Eat better. And, to encourage a healthier diet, perhaps a fast food tax? Well, maybe not. Americans value their personal choice and wallets too much. Look for Democrats and Republicans to talk a lot about preventing chronic diseases. 7. Improve patient safety and quality care. The plan must ensure the implementation of proven patient safety measures and provide incentives for changes in the delivery system to reduce unnecessary variability in patient care. It must support the widespread use of health information technology and the development of data on the effectiveness of medical interventions to improve the quality of care delivered. Translation: The payment system is backward. Physicians receive money based on the amount of care they provide — the more tests and visits, the more they make. Obama and others want to shift to a quality-based payment system that rewards good care. And there’s also a movement to expand a concept known as medical home, which encourages practitioners to develop a comprehensive care management service to ensure that patients are filling their prescriptions, going to rehab and shopping for the right food. 8. Maintain long-term fiscal sustainability. The plan must pay for itself by reducing the level of cost growth, improving productivity and dedicating additional sources of revenue. Translation: Read his lips: Taxes are needed, but they won’t do it all. The system needs a complete overhaul to create more efficiencies. Otherwise, costs will keep rising and more taxes will be needed — which is why Obama’s pushing principles 1 through 7.