If the health care overhaul effort should fall apart in the coming months, it seems likely that this week will be seen as a high point.

Members of Congress, the Obama administration and advocacy groups all lauded the promise Monday by six key industry groups representing hospitals, doctors, insurers, health care workers, drug companies and medical-device companies to cut $2 trillion from the growth of health care costs over the next decade.

President Obama called it “an historic day.” Sen. John D. Rockefeller IV, D-W.Va., called the groups’ pledge an “unprecedented commitment.” Sen. Edward M. Kennedy, D-Mass., called it “an extraordinary moment of opportunity.”

But there is much to be done to turn the pledge into reduced spending. In the next three weeks, the groups will offer Obama detailed suggestions of how they will achieve the goal of reducing the growth of health care costs by 1.5 percent per year over 10 years.

But on Monday, the details were few.

Up to now, the groups said in a letter to Obama, they have been “developing consensus proposals,” such as simplifying and standardizing administrative procedures, reorganizing payment systems to encourage quality care and lower costs, putting in place better preventive care and chronic care, and implementing electronic health records.

“The only way these steps will have an enduring effort is if they are part of a broader effort,” Obama said Monday after meeting with the groups. “What they’re doing is complementary to and is going to be completely compatible with a strong, aggressive effort to move health care reform through here in Washington with an ultimate result of saving health care costs for families, businesses and the government.”

The groups making the proposal were the Advanced Medical Technology Association, representing the medical-device industry; America’s Health Insurance Plans, which represents private insurers; the American Hospital Association; the American Medical Association; the Pharmaceutical Research and Manufacturers of America; and the Service Employees International Union (SEIU), the country’s largest union of health care workers.

Secret Coalition Formed Weeks Ago

Led by SEIU, the industry effort came together only in recent weeks, according to participants. “For quite a long time, we’ve been discussing what it would take to support the president and the Congress in health reform,” said Jay Gellert, president and CEO of insurer HealthNet.

Dennis Rivera, the chairman of SEIU’s health care initiative, said that real conversations on the deal began last month, then picked up steam. As agreement began to coalesce around what the groups could support, Rivera said, he contacted the White House “about three weeks ago” to let the administration know the groups were planning something.

A week later, administration officials met with group members to hear an outline. “We had kind of a slide show presentation introducing how we could accomplish the goals,” Rivera said.

The presentation, apparently a success, came around the time a handful of influential lawmakers, such as Sen. Christopher J. Dodd, D-Conn., were asking the White House to take a more forceful role.

“We asked if they thought this was an endeavour they would welcome,” Rivera said, and the response was positive.

After that signal from the White House, the group met frequently. The sessions were kept quiet — only a few people knew they were going on, and many other powerful health care advocates and lobbyists had no idea about the meetings.

“The activity heightened over the last two or three weeks, as we came to see we could play a significant role in addressing the cost issue, which was becoming a critical issue in terms of successfully achieving this,” Gellert said.

By the weekend of May 9, the groups were ready to hand their proposal to the White House, and on May 10, administration officials called a hurried press briefing. On Monday, the groups met with Obama, who announced the proposal. But the initial lack of detail has left some outside the groups skeptical.

“You need some way of tracking this so they can be held accountable,” said John Rother, a lobbyist with AARP, the country’s largest advocacy group for older Americans, which did not participate in the meetings.

Other experts say that proving the savings will be not be easy. “From an analytical perspective, it’s very difficult,” said John Sheils, vice president with the Lewin Group, a health policy firm. “Let’s say it’s 2019 and we’re looking back: How would we actually prove we saved any money?”

The coming weeks will reveal how serious the groups really are. “For it to be credible, they’re going to have to have a lot of details,” Sheils said.

Rother agreed. “The goal is the right goal. If they can actually deliver, it makes a huge difference.”

The groups are mindful of that fact, HealthNet’s Gellert said: “We don’t want, and it’s clear the administration doesn’t want, airy numbers.”

But House Republicans criticized the groups and Obama for the lack of detail.

“I am concerned these developments are more about protecting business interests and currying favor in Washington, D.C., than they are about protecting the relationship between a patient and his or her doctor,” said Rep. Michael C. Burgess of Texas, the head of the Congressional Health Care Caucus, a group of GOP lawmakers.

“These industry groups . . . have made concessions to Washington politicians without asking anything in exchange for the patients they serve,” Burgess said.


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