During the past 10 days, Congress and the Obama administration have been working on various versions of a healthcare reform bill. Virtually all agree that some reform and better efficiency in the health care system is needed. But nobody has all the answers for an optimal solution —especially during a recession. At least there is consensus on the significant issues to be addressed and resolved, so here are the major questions:

How to slow the growth of health care costs for Americans? How to eliminate waste so that health insurance really does make Americans healthier? How can the federal system learn from the several very cost effective health care systems in certain states? How to pay for any reform plan without increasing the deficit? Is there a way to make health care reform pay for itself (with less waste, etc.)? For example, an increasing number of drug manufacturers are offering discount and rebate coupons to reduce the out-of-pocket costs of selected prescription drugs. See online.wsj.com/article/SB125339394529025429.html?mod=djemHL for more information.

Other questions are: How to find the right balance among the (often) competing interests of the medical profession, the drug and medical device industries, insurance companies and the needs of consumers and patients — and the policymakers? How to reconcile and compromise between House and Senate versions of the bills on such a volatile issue? (Note: As of Sept. 21, there were 564 amendments offered by the Senate Finance Committee alone.) What effect the Blue Dog Democrats and the moderate Republicans will have on the final bill?

How to provide insurance coverage for those who lack it? Should it be made illegal to deny insurance to those with pre-existing conditions? (This is probably one of the most controversial issues.) Should it be made illegal to cancel or reduce coverage during a major illness?

How to provide more stability, continuity and security for those who already have health insurance? Should insurance companies be required to cover — with zero or a minimal co-pay — routine tests such as mammograms. What concessions or exemptions should small businesses have? Is there any win-win-win solution?

How to build in choice and competition — to lower costs for consumers — into such a complex bill? Should the “public option” be one of the choices — and can it be administered by the United States (such as Medicaid and Medicare), or is there too much distrust of government? Is this option worth so much controversial debate when, according to the White House, it will affect only 5 percent of Americans?

Of interest to the natural products industry is whether dietary supplements can in some circumstances be reimbursable under a new healthcare system. In this context, it is notable that in early May, when Obama was asked a question about Asian medicine and its place in health care by an acupuncturist and massage therapist, he commented that alternative, complementary medicine remedies and solutions, if they are effective, should not be overlooked. He said, “we should do what works. I will let the science guide me.” See town hall speech (p. 12) at: whitehouse.gov/the_press_office/Remarks-by-the-President-at-Arnold-Missouri-Town-Hall/.

Finally, as the 15th anniversary of DSHEA approaches, it is instructive to re-read Section 2 of that legislation, Congressional Findings, on the importance of vitamins, minerals, and other dietary supplements for health benefits and the public health generally.

The next Brief will cover the major regulatory issues of new products introduced and new claims surfacing at Expo East in Boston this week.

Compiled by Susan D. Brienza, Esq. (Patton Boggs LLP). For questions, comments, or further information, please write [email protected].

See Patton Boggs' Webinar on Health Care Reform: http://www.pattonboggs.com/events/detail.aspx?firmEvent=437