By:Robert Laszewski President of Health Policy and Strategy Associates
Away from Washington people I talk to are just amazed at what the Democrats are in the process of doing on health care reform.
What I think the Democratic leadership is missing is that this is no longer about passing a health care bill in the minds of lots of these voters—a majority of voters from what the polls say.
To these people, this is about Democratic arrogance. What the polls don't measure is the anger I hear from people who can't believe what is going on. After the last few recent state elections and all of the polls that overwhelmingly say, “stop” or “start over” they just keep plowing along anyway. To defend themselves, the Dems point to the many times the Republicans have used the legislative tactic of reconciliation before—the Bush tax cuts, Part D, welfare reform.
They are right. But those were popular bills.
The Dems may be scoring debating points but instead what the voters I talk to see is a demonstration of political arrogance—not a health care legislative process.
The Democratic logic is that they have already voted for it so they might as well put a finished product on the table for people to appreciate on Election Day.
But the problem with that logic is that the the bill’s real benefits—eliminating pre-existing conditions and medical underwriting as well as the subsidies to buy insurance—don’t start until 2014.
What voters, particularly the swing independent voters, now see is not a health care bill but political arrogance—and that is really the issue Democrats are going to have to deal with.
What I think this is finally going to come down to is a few House Democrats putting their finger in the air to see which direction the political wind is blowing from. It's pretty clear to me there will be a gale force wind blowing from the direction of "no."
Read more of Robert Laszewski at healthpolicyandmarket.blogspot.com
This blog does not reflect the views of Metro Group Inc, and are solely the opinion of the author
Thursday, March 11. 2010
Health Care "Reform" Bill is NOT Reform At All!
By:Robert Laszewski President of Health Policy and Strategy Associates
Any big health care bill will be full of compromises—political or otherwise. But this bill doesn’t even come close to deserving to be called “health care reform.”
As the Democrats make their final push to pass their health care bill many of them, and most notably the President, are arguing that it should be passed because it is the “right thing to do whatever the polls say.”
Their argument is powerful: We will never get the perfect bill. If this fails who knows how long it will be before we have another big proposal up for a vote. There are millions of uninsured unable to get coverage because of preexisting conditions or the inability to pay the big premiums and this bill would help them.
But as an unavoidable moral imperative, enacting this bill would fall way short:
It is unsustainable. Promises are being made that cannot be kept. As President Obama has said many times, we need fundamental health care system reform or the promises we have already made—the Medicare and Medicaid entitlements, for example—will bankrupt us. What few cost containment elements the Democrats seriously considered are now either gone from their final bill or hopelessly watered down—most notably the “Cadillac” tax on high cost benefits and the Medicare cost containment commission.
It is paying off the people already profiting the most from the status quo. Many of the big special interests, that will have to change their ways if we are really going to improve the system, are simply being paid off for their support. The drug deal, the hospital deal, promises not to cut or change the way physicians are paid, all add up to more guaranteeing the status quo rather than doing anything that will bring about the systemic change everyone knows is needed.
Nothing in these bills will fundamentally change our current fiscal course. As the CBO, and every other expert has said, if this bill becomes law we will continue on the same cost trajectory we are already on. Yes, the CBO says the Democratic plan will reduce costs during the next ten years by about $100 billion—but that only means they would be $100 billion less than the $35 trillion they would have been anyway! That is merely a rounding error on the track we are already on.
There is nothing here that will stop unaffordable health insurance rate increases. Lately supporters have said this bill is the solution to the recent big individual health insurance rate increases we have been reading about in the press. But there is little in this bill that will mitigate or control any such increases because so little would be done to impact underlying health care costs.
We often hear the argument, “Let’s get this entitlement expansion bill passed and it will force us to deal with costs later.” If we don’t now have the political courage to face daunting health care costs in the face of exploding deficits how will we have that courage later?
I will suggest that adding 30 million more people to an unsustainable system expecting it will create an even bigger crisis and thereby force real reform is tantamount to reboarding the Titanic in the hopes it will sink faster. It is also hard to see how doing such a thing is the politically courageous thing to do.
Just where is the moral imperative in ramming a trillion dollar entitlement expansion through knowing full well it will make our long-term deficit nightmare even worse—for those now uninsured and for everyone else?
The Democratic health care bill makes little if any systemic changes to the health care system—certainly not at the level we need.
The Democratic health care bill makes promises we cannot keep.
Proponents of the Democratic health care bill make the claim that it will make health insurance affordable, improve our deficit outlook, and make our health insurance system sustainable. None of those claims are even close to being true and everyone who knows anything about this debate knows that.
Heck of a foundation for doing the “right thing.”
Read more of Robert Laszewski at healthpolicyandmarket.blogspot.com
This blog does not reflect the views of Metro Group Inc, and are solely the opinion of the author
Any big health care bill will be full of compromises—political or otherwise. But this bill doesn’t even come close to deserving to be called “health care reform.”
As the Democrats make their final push to pass their health care bill many of them, and most notably the President, are arguing that it should be passed because it is the “right thing to do whatever the polls say.”
Their argument is powerful: We will never get the perfect bill. If this fails who knows how long it will be before we have another big proposal up for a vote. There are millions of uninsured unable to get coverage because of preexisting conditions or the inability to pay the big premiums and this bill would help them.
But as an unavoidable moral imperative, enacting this bill would fall way short:
It is unsustainable. Promises are being made that cannot be kept. As President Obama has said many times, we need fundamental health care system reform or the promises we have already made—the Medicare and Medicaid entitlements, for example—will bankrupt us. What few cost containment elements the Democrats seriously considered are now either gone from their final bill or hopelessly watered down—most notably the “Cadillac” tax on high cost benefits and the Medicare cost containment commission.
It is paying off the people already profiting the most from the status quo. Many of the big special interests, that will have to change their ways if we are really going to improve the system, are simply being paid off for their support. The drug deal, the hospital deal, promises not to cut or change the way physicians are paid, all add up to more guaranteeing the status quo rather than doing anything that will bring about the systemic change everyone knows is needed.
Nothing in these bills will fundamentally change our current fiscal course. As the CBO, and every other expert has said, if this bill becomes law we will continue on the same cost trajectory we are already on. Yes, the CBO says the Democratic plan will reduce costs during the next ten years by about $100 billion—but that only means they would be $100 billion less than the $35 trillion they would have been anyway! That is merely a rounding error on the track we are already on.
There is nothing here that will stop unaffordable health insurance rate increases. Lately supporters have said this bill is the solution to the recent big individual health insurance rate increases we have been reading about in the press. But there is little in this bill that will mitigate or control any such increases because so little would be done to impact underlying health care costs.
We often hear the argument, “Let’s get this entitlement expansion bill passed and it will force us to deal with costs later.” If we don’t now have the political courage to face daunting health care costs in the face of exploding deficits how will we have that courage later?
I will suggest that adding 30 million more people to an unsustainable system expecting it will create an even bigger crisis and thereby force real reform is tantamount to reboarding the Titanic in the hopes it will sink faster. It is also hard to see how doing such a thing is the politically courageous thing to do.
Just where is the moral imperative in ramming a trillion dollar entitlement expansion through knowing full well it will make our long-term deficit nightmare even worse—for those now uninsured and for everyone else?
The Democratic health care bill makes little if any systemic changes to the health care system—certainly not at the level we need.
The Democratic health care bill makes promises we cannot keep.
Proponents of the Democratic health care bill make the claim that it will make health insurance affordable, improve our deficit outlook, and make our health insurance system sustainable. None of those claims are even close to being true and everyone who knows anything about this debate knows that.
Heck of a foundation for doing the “right thing.”
Read more of Robert Laszewski at healthpolicyandmarket.blogspot.com
This blog does not reflect the views of Metro Group Inc, and are solely the opinion of the author
Tuesday, March 2. 2010
The Failure of Health Care Reform: Bribes, Lies & Gridlock
By: Brian Klepper and David C. Kibbe
The stalemate in the bi-partisan health care summit was cast the moment it was announced. Republicans demanded that the reform process start anew, and Mr. Obama insisted on the Senate bill as the framework going forward. The President may now offer a more modest reform bill that can demonstrate some progress on the health care crisis, but that remains to be seen.
We hoped the White House would seize the opportunity presented by Massachusetts’ election of Scott Brown to begin again, huddling away from the lobbyists to develop a new set of provisions that would include reasonable Republican elements, like medical liability reform, as well as other meaningful cost reduction provisions excluded from the first round of bills: pricing/quality transparency, a move away from fee-for-service reimbursement, and the re-empowerment of primary care.
They took a different path. As Ezra Klein speculated in the Washington Post, Mr. Obama and his advisers may believe that, with the 2010 elections bearing down on Congress, there is too little time to begin again.
But this is a questionable political calculation. The reform process soured the American people and American business on the health care bills. A January 27 Towers Watson/National Business Group on Health (NBGH) survey found that 71% of employers believe the bills "will increase the overall cost of health care services in the United States." A February 11 Rasmussen survey found that 61% of voters think the bills should have been scrapped and the process started over.
And no wonder. Over the past year, the legalized bribery that is special interest lobbying was fully on display, with members of both parties (but led by the Democrats) taking contributors' money with a gusto unprecedented since the Republican feeding frenzy set off by Newt Gingrich's K-Street Project. A new report from the Center for Public Integrity shows that "more than 1,750 companies and organizations hired about 4,525 lobbyists — eight for each member of Congress — to influence health reform bills in 2009." Together, they spent $1.2 billion on health care, more than one-third of the $3.47 billion spent by special interests in 2009 to buy influence over policy.
And then there was the brazen political deal making. Mary Landrieu brought $300 million in federal aid home to Louisiana for voting with the Democratic Leadership, which the GOP promptly dubbed "the Louisiana Purchase." Ben Nelson got the Feds to pay for most of Nebraska's Medicaid expansion...in perpetuity. And, on the eve of the Massachusetts Senatorial election, the White House cut a deal that exempted unions from the tax on "Cadillac health plans" until 2018.
The resulting reform provisions - a cynical combination of expert advice, uncompromising ideology and donor quid pro quos - would have extended entitlements while rescuing the industry at the top of a financial bubble, exacerbating the cost growth problem during a recession by replacing dwindling private funding with public dollars. At the same time, the bills specifically avoided committing to approaches that could wring excessive cost from the system.
In truth, either passing or blocking such poor bills would have had little impact on the increasingly threatening crisis. Short of starting over, American health care will continue to face some very harsh realities. More individual and corporate purchasers, particularly small employers, will be priced out of coverage as health care costs explode. This erosion in mainstream coverage is translating to a reduction in total health plan premium - the engine of the health care economy - and to escalating uncompensated care cost loads throughout the system. A plummeting number of insured patients will find it harder and harder to pay for a rapidly growing number of uninsureds and under-insureds.
These are recipes for instability and disaster. And as health care - the nation's largest economic sector, representing one dollar in six and one job in eleven - becomes increasingly unstable, so does the larger US economy.
Americans are increasingly aware that a government in which both parties are compromised by political ideologies and special interests will likely leave them to their own devices in dealing with health care. American business had, to a great extent, put health care benefits decisions on hold until reform was complete. Now it is resigned to continuing to cope with that burden, but with a renewed commitment to innovation. A February 22nd Towers Watson/NBGH survey found that "83% of companies have already revamped or expect to revamp their health care strategy within the next two years, up from 59% in 2009," a clear sign that businesses now think they need to act on their own behalves. (Of course, most individual Americans don't have that latitude.)
One thing is clear. Without reform as it was constituted and the subsidies it promised, the industry faces an onslaught of actions from the marketplace that will focus on its excesses, drive down reimbursement, and hold it more accountable. A long list of innovations - re-empowered primary care; data collaboratives that identify and then create incentives for making the best choices; new technologies like minimally invasive surgeries, point-of-care testing, and clinical decision support tools; medical tourism; clinical groupware; check lists; Health 2.0 business-to-business ventures that streamline health care processes - are now proving they can improve the quality of care while reducing cost.
The result is inescapable. No system this far out of balance can remain unchanged indefinitely. So long as it was influencing the policy process, the health care industry would never course correct in ways that are in our national interest. But as the environment continues to intensify, the market will be driven to embrace and integrate these solutions. One way or another, the health industry is in for real change over the next few years.
Meanwhile, until America meaningfully addresses cost and access through policy, proper health care will continue to be out of reach to many and will threaten many more with personal financial ruin. It will continue to sap the nation's economic strength, and compromise our efforts to lead and compete internationally.
Which is why the President should begin again, and make achieving serious health care policy reform a dedicated goal. In the process, he could challenge special interest influence over policy, and work to refocus the political process on the common interest. We believe the American people can see how the current paradigm is corroding our nation, and would rally behind this approach. More to the point, this was the premise of Mr. Obama's election. The American mainstream is waiting for him to assert his leadership in this way.
Health care reform has stalled and possibly failed for the moment. But the stakes are so great for America that failure cannot be an option.
Brian Klepper and David C. Kibbe write together on health care reform, market dynamics, innovation and technologies. Vist them at http://www.brianklepper.info/
The stalemate in the bi-partisan health care summit was cast the moment it was announced. Republicans demanded that the reform process start anew, and Mr. Obama insisted on the Senate bill as the framework going forward. The President may now offer a more modest reform bill that can demonstrate some progress on the health care crisis, but that remains to be seen.
We hoped the White House would seize the opportunity presented by Massachusetts’ election of Scott Brown to begin again, huddling away from the lobbyists to develop a new set of provisions that would include reasonable Republican elements, like medical liability reform, as well as other meaningful cost reduction provisions excluded from the first round of bills: pricing/quality transparency, a move away from fee-for-service reimbursement, and the re-empowerment of primary care.
They took a different path. As Ezra Klein speculated in the Washington Post, Mr. Obama and his advisers may believe that, with the 2010 elections bearing down on Congress, there is too little time to begin again.
But this is a questionable political calculation. The reform process soured the American people and American business on the health care bills. A January 27 Towers Watson/National Business Group on Health (NBGH) survey found that 71% of employers believe the bills "will increase the overall cost of health care services in the United States." A February 11 Rasmussen survey found that 61% of voters think the bills should have been scrapped and the process started over.
And no wonder. Over the past year, the legalized bribery that is special interest lobbying was fully on display, with members of both parties (but led by the Democrats) taking contributors' money with a gusto unprecedented since the Republican feeding frenzy set off by Newt Gingrich's K-Street Project. A new report from the Center for Public Integrity shows that "more than 1,750 companies and organizations hired about 4,525 lobbyists — eight for each member of Congress — to influence health reform bills in 2009." Together, they spent $1.2 billion on health care, more than one-third of the $3.47 billion spent by special interests in 2009 to buy influence over policy.
And then there was the brazen political deal making. Mary Landrieu brought $300 million in federal aid home to Louisiana for voting with the Democratic Leadership, which the GOP promptly dubbed "the Louisiana Purchase." Ben Nelson got the Feds to pay for most of Nebraska's Medicaid expansion...in perpetuity. And, on the eve of the Massachusetts Senatorial election, the White House cut a deal that exempted unions from the tax on "Cadillac health plans" until 2018.
The resulting reform provisions - a cynical combination of expert advice, uncompromising ideology and donor quid pro quos - would have extended entitlements while rescuing the industry at the top of a financial bubble, exacerbating the cost growth problem during a recession by replacing dwindling private funding with public dollars. At the same time, the bills specifically avoided committing to approaches that could wring excessive cost from the system.
In truth, either passing or blocking such poor bills would have had little impact on the increasingly threatening crisis. Short of starting over, American health care will continue to face some very harsh realities. More individual and corporate purchasers, particularly small employers, will be priced out of coverage as health care costs explode. This erosion in mainstream coverage is translating to a reduction in total health plan premium - the engine of the health care economy - and to escalating uncompensated care cost loads throughout the system. A plummeting number of insured patients will find it harder and harder to pay for a rapidly growing number of uninsureds and under-insureds.
These are recipes for instability and disaster. And as health care - the nation's largest economic sector, representing one dollar in six and one job in eleven - becomes increasingly unstable, so does the larger US economy.
Americans are increasingly aware that a government in which both parties are compromised by political ideologies and special interests will likely leave them to their own devices in dealing with health care. American business had, to a great extent, put health care benefits decisions on hold until reform was complete. Now it is resigned to continuing to cope with that burden, but with a renewed commitment to innovation. A February 22nd Towers Watson/NBGH survey found that "83% of companies have already revamped or expect to revamp their health care strategy within the next two years, up from 59% in 2009," a clear sign that businesses now think they need to act on their own behalves. (Of course, most individual Americans don't have that latitude.)
One thing is clear. Without reform as it was constituted and the subsidies it promised, the industry faces an onslaught of actions from the marketplace that will focus on its excesses, drive down reimbursement, and hold it more accountable. A long list of innovations - re-empowered primary care; data collaboratives that identify and then create incentives for making the best choices; new technologies like minimally invasive surgeries, point-of-care testing, and clinical decision support tools; medical tourism; clinical groupware; check lists; Health 2.0 business-to-business ventures that streamline health care processes - are now proving they can improve the quality of care while reducing cost.
The result is inescapable. No system this far out of balance can remain unchanged indefinitely. So long as it was influencing the policy process, the health care industry would never course correct in ways that are in our national interest. But as the environment continues to intensify, the market will be driven to embrace and integrate these solutions. One way or another, the health industry is in for real change over the next few years.
Meanwhile, until America meaningfully addresses cost and access through policy, proper health care will continue to be out of reach to many and will threaten many more with personal financial ruin. It will continue to sap the nation's economic strength, and compromise our efforts to lead and compete internationally.
Which is why the President should begin again, and make achieving serious health care policy reform a dedicated goal. In the process, he could challenge special interest influence over policy, and work to refocus the political process on the common interest. We believe the American people can see how the current paradigm is corroding our nation, and would rally behind this approach. More to the point, this was the premise of Mr. Obama's election. The American mainstream is waiting for him to assert his leadership in this way.
Health care reform has stalled and possibly failed for the moment. But the stakes are so great for America that failure cannot be an option.
Brian Klepper and David C. Kibbe write together on health care reform, market dynamics, innovation and technologies. Vist them at http://www.brianklepper.info/
Monday, March 1. 2010
Health Care Reform even more of a mess: Reconciliation?
By:Robert Laszewski President of Health Policy and Strategy Associates
Everyone agrees our health care system is unsustainable and too often unfair. At the White House health care summit, that was the only common ground between Democrats and Republicans.
Many Americans are either left-brain liberals or right-brain conservatives, with the remainder somewhere in the middle. These left- and right-brain types look at the same facts but come to different conclusions—no matter what.
This past election, something unique occurred. The independents were so frustrated with the Republicans about the Iraq war, the financial meltdown and the spendthrift ways of Congress that they swept liberals into power and apparently gave them a mandate to pass health care reform.
The liberals set about doing just that. No false advertising was involved—they crafted health care bills consistent with their campaign promises. But when conservatives erupted over the legislation last summer, they reminded many of those independent voters about their more-moderate political instincts.
It turns out that liberals needed the backing of a handful of moderate Republicans -- not because they needed their votes, but because they needed their endorsements.
By August, when the raucous town meetings occurred, it became clear that liberals had overplayed their hand on health care. After election defeats in Virginia, New Jersey and, most notably, Massachusetts, as well as months of months of sagging opinion polls, Democrats tried to adjust.
There was one problem: The more that the Democratic leadership pulled the health plan toward the center, the worse it looked to everyone—liberals, conservatives and independents.
That was the backdrop as Democrats and Republicans arrived at Blair House Thursday for the health care summit – a meeting that was not so much an attempt at bipartisanship as an effort to create political cover for wavering Democratic moderates in the House and Senate.
The thinking was that if the president and the Democratic leadership managed to show that their plan was better than the comparatively thin Republican approach – and as a result win points in the public opinion polls -- the moderates would perhaps feel free to vote for the big Democratic bill.
But the White House summit ended in a draw.
The Democrats talked about the substance of the bill, but the Republicans knew that the latest polls favored “starting over” and aggressively repeated that message all day. They played to the anxiety of swing voters about a huge entitlement expansion in the face of the Great Recession, as well as skepticism about the Democrats’ trillion-dollar numbers.
Now, with the session behind them, Democratic leaders and the president apparently believe they can't go backward and that tearing up their health care bill would be admitting they can't govern with huge majorities. Also off the table is support from moderate Republicans.
The Democrats have two options.
The first is to ignore the recent state elections and the polls and ram their bill through Congress using controversial reconciliation rules. The problem: There are as many as 90 House Democrats who are vulnerable in the November elections, and at least half are moderate Democrats who weren’t ever enamored with health care proposals written by their more liberal leadership.
The second is “Plan B,” a scaled-down bill costing about a third of the big bill and far more modest in giving the government authority over the health care system. It could likely attract some Republican votes and give Democrats, particularly moderates, a legitimate claim that they listened to voters and acted in a more measured way. It also would give the president and the Democratic congressional leadership something positive to show at election time.
The Democrats will use the coming weeks to see if they can talk members of their own party into taking the Great Health Care Leap of 2010.
My sense is that they better have a Plan B ready to go.
After watching this debate, as well as the Clinton health care battle 15 years ago, my conclusion is that arrogant partisanship on big, consequential policy issues is a prescription for failure.
What a mess.
Read more of Robert Laszewski at healthpolicyandmarket.blogspot.com
This blog does not reflect the views of Metro Group Inc, and are solely the opinion of the author
Everyone agrees our health care system is unsustainable and too often unfair. At the White House health care summit, that was the only common ground between Democrats and Republicans.
Many Americans are either left-brain liberals or right-brain conservatives, with the remainder somewhere in the middle. These left- and right-brain types look at the same facts but come to different conclusions—no matter what.
This past election, something unique occurred. The independents were so frustrated with the Republicans about the Iraq war, the financial meltdown and the spendthrift ways of Congress that they swept liberals into power and apparently gave them a mandate to pass health care reform.
The liberals set about doing just that. No false advertising was involved—they crafted health care bills consistent with their campaign promises. But when conservatives erupted over the legislation last summer, they reminded many of those independent voters about their more-moderate political instincts.
It turns out that liberals needed the backing of a handful of moderate Republicans -- not because they needed their votes, but because they needed their endorsements.
By August, when the raucous town meetings occurred, it became clear that liberals had overplayed their hand on health care. After election defeats in Virginia, New Jersey and, most notably, Massachusetts, as well as months of months of sagging opinion polls, Democrats tried to adjust.
There was one problem: The more that the Democratic leadership pulled the health plan toward the center, the worse it looked to everyone—liberals, conservatives and independents.
That was the backdrop as Democrats and Republicans arrived at Blair House Thursday for the health care summit – a meeting that was not so much an attempt at bipartisanship as an effort to create political cover for wavering Democratic moderates in the House and Senate.
The thinking was that if the president and the Democratic leadership managed to show that their plan was better than the comparatively thin Republican approach – and as a result win points in the public opinion polls -- the moderates would perhaps feel free to vote for the big Democratic bill.
But the White House summit ended in a draw.
The Democrats talked about the substance of the bill, but the Republicans knew that the latest polls favored “starting over” and aggressively repeated that message all day. They played to the anxiety of swing voters about a huge entitlement expansion in the face of the Great Recession, as well as skepticism about the Democrats’ trillion-dollar numbers.
Now, with the session behind them, Democratic leaders and the president apparently believe they can't go backward and that tearing up their health care bill would be admitting they can't govern with huge majorities. Also off the table is support from moderate Republicans.
The Democrats have two options.
The first is to ignore the recent state elections and the polls and ram their bill through Congress using controversial reconciliation rules. The problem: There are as many as 90 House Democrats who are vulnerable in the November elections, and at least half are moderate Democrats who weren’t ever enamored with health care proposals written by their more liberal leadership.
The second is “Plan B,” a scaled-down bill costing about a third of the big bill and far more modest in giving the government authority over the health care system. It could likely attract some Republican votes and give Democrats, particularly moderates, a legitimate claim that they listened to voters and acted in a more measured way. It also would give the president and the Democratic congressional leadership something positive to show at election time.
The Democrats will use the coming weeks to see if they can talk members of their own party into taking the Great Health Care Leap of 2010.
My sense is that they better have a Plan B ready to go.
After watching this debate, as well as the Clinton health care battle 15 years ago, my conclusion is that arrogant partisanship on big, consequential policy issues is a prescription for failure.
What a mess.
Read more of Robert Laszewski at healthpolicyandmarket.blogspot.com
This blog does not reflect the views of Metro Group Inc, and are solely the opinion of the author
Friday, February 26. 2010
Republicans win at Health Care Summit
By:Robert Laszewski President of Health Policy and Strategy Associates
There is politics and there is policy.
On the policy front what we saw today during the Health Care Summit was the same exchange of the old talking points we have watched for a longtime. No progress was made toward any kind of health care bill. That is no surprise--this was never going to be the place to fashion any kind of compromise.
At the end of the summit President Obama asked the Republicans if it was worth it to spend another month or six weeks trying to come to some agreement. I am glad he did that. I am not optimistic but a "yes" from the Republicans would be the right answer for the country.
On the political front this was a win for Republicans because it was a draw. Granted, they have a very thin health care agenda but all they had to do was hold their own over the course of the day. Politically, if not on policy, they did that. No minds were changed in the room and likely none out in the country. The left will still say get on with passing this, those on right will say kill it, and the majority of critical swing voters will still be concerned that the Democratic bills are going too far too fast in the face of the Great Recession. This is the biggest reason I don't hold out a lot of hope there will be a lot of Republican willingness to come to the table--at least before the November elections.
Ironically, this "bipartisan summit" may have just increased the political cynicism in the country because it went off so predictably.
Most importantly, I don't see the President and the Democratic leadership having accomplished their real goal: To "stiffen the spines" of the moderate Democratic votes they need to ram their health care agenda through using reconciliation rules.
A week from now, I expect the polls will still show only about the same 40% approval rating for the Democratic health care agenda and the moderate Democrats won't have the political cover they need to vote for a reconciliation strategy.
Unless the President gets a positive response from the Republicans on his offer to spend a few weeks trying for a bipartisan bill, it will be on to "Plan B" for the Democrats.
Read more of Robert Laszewski at healthpolicyandmarket.blogspot.com
This blog does not reflect the views of Metro Group Inc, and are solely the opinion of the author
There is politics and there is policy.
On the policy front what we saw today during the Health Care Summit was the same exchange of the old talking points we have watched for a longtime. No progress was made toward any kind of health care bill. That is no surprise--this was never going to be the place to fashion any kind of compromise.
At the end of the summit President Obama asked the Republicans if it was worth it to spend another month or six weeks trying to come to some agreement. I am glad he did that. I am not optimistic but a "yes" from the Republicans would be the right answer for the country.
On the political front this was a win for Republicans because it was a draw. Granted, they have a very thin health care agenda but all they had to do was hold their own over the course of the day. Politically, if not on policy, they did that. No minds were changed in the room and likely none out in the country. The left will still say get on with passing this, those on right will say kill it, and the majority of critical swing voters will still be concerned that the Democratic bills are going too far too fast in the face of the Great Recession. This is the biggest reason I don't hold out a lot of hope there will be a lot of Republican willingness to come to the table--at least before the November elections.
Ironically, this "bipartisan summit" may have just increased the political cynicism in the country because it went off so predictably.
Most importantly, I don't see the President and the Democratic leadership having accomplished their real goal: To "stiffen the spines" of the moderate Democratic votes they need to ram their health care agenda through using reconciliation rules.
A week from now, I expect the polls will still show only about the same 40% approval rating for the Democratic health care agenda and the moderate Democrats won't have the political cover they need to vote for a reconciliation strategy.
Unless the President gets a positive response from the Republicans on his offer to spend a few weeks trying for a bipartisan bill, it will be on to "Plan B" for the Democrats.
Read more of Robert Laszewski at healthpolicyandmarket.blogspot.com
This blog does not reflect the views of Metro Group Inc, and are solely the opinion of the author
Wednesday, February 24. 2010
President Obamas' Health Care Plan- Not a Game Changer
By:Robert Laszewski President of Health Policy and Strategy Associates
It is hard to see how the health care plan President Obama released this morning changes anything.
There is nothing new in it save a health insurance rate regulatory board that is an awkward political proposal at best. What powers would it really have and how would it operate in conjunction with the states already charged with insurance company oversight are just two of the first questions it does not answer.
Fundamentally, what good would insurance rate regulation do if the President’s plan has only tepid cost containment built into it in the first place?
There are not the votes in the House right now to pass this new proposal—or the Senate bill. There are not likely even the votes in the Senate under a 51-vote rule for the President's new plan.
That could change if the President scores a game changer on Thursday at Blair House that finally moves the polls from the 40% approval rating Democrats have had on health care to something over 50%.
But there is nothing in the White House health care proposal that was released this morning that will do that.
If the President thinks he can do it alone on the back of his “communication skills” then all the adulation on the part of his supporters, like his Nobel Peace Prize, has gone to his head.
If Obama wants to score a real game changer on Thursday, when the Republicans call for starting over on health care, I will suggest, the President ought to say, “Deal.” Then call on the Republicans to join he and the Democratic leadership in 60 days of intensive negotiations to get a bipartisan deal. That would really put the Republicans on the spot—and Democrats as well.
If what both sides want is bipartisan health care reform then what they should be agreeing to do is achieve that in a time certain with no preconditions on the table.
Then let’s see who comes to the table in good faith.
The outcome of that exercise, successful or not, would give us a real health care issue to take to the polls in November.
Read more of Robert Laszewski at healthpolicyandmarket.blogspot.com
This blog does not reflect the views of Metro Group Inc, and are solely the opinion of the author
It is hard to see how the health care plan President Obama released this morning changes anything.
There is nothing new in it save a health insurance rate regulatory board that is an awkward political proposal at best. What powers would it really have and how would it operate in conjunction with the states already charged with insurance company oversight are just two of the first questions it does not answer.
Fundamentally, what good would insurance rate regulation do if the President’s plan has only tepid cost containment built into it in the first place?
There are not the votes in the House right now to pass this new proposal—or the Senate bill. There are not likely even the votes in the Senate under a 51-vote rule for the President's new plan.
That could change if the President scores a game changer on Thursday at Blair House that finally moves the polls from the 40% approval rating Democrats have had on health care to something over 50%.
But there is nothing in the White House health care proposal that was released this morning that will do that.
If the President thinks he can do it alone on the back of his “communication skills” then all the adulation on the part of his supporters, like his Nobel Peace Prize, has gone to his head.
If Obama wants to score a real game changer on Thursday, when the Republicans call for starting over on health care, I will suggest, the President ought to say, “Deal.” Then call on the Republicans to join he and the Democratic leadership in 60 days of intensive negotiations to get a bipartisan deal. That would really put the Republicans on the spot—and Democrats as well.
If what both sides want is bipartisan health care reform then what they should be agreeing to do is achieve that in a time certain with no preconditions on the table.
Then let’s see who comes to the table in good faith.
The outcome of that exercise, successful or not, would give us a real health care issue to take to the polls in November.
Read more of Robert Laszewski at healthpolicyandmarket.blogspot.com
This blog does not reflect the views of Metro Group Inc, and are solely the opinion of the author
Thursday, February 11. 2010
Anthem Blue Cross raises rates 39% for health insurance in California
By:Robert Laszewski President of Health Policy and Strategy Associates
Anthem Blue Cross, a subsidiary of Wellpoint Inc, is getting killed in the press over a “39%” rate increase for their individual health insurance block in California.
HHS Secretary Sebelius has pointed to the Wellpoint individual rate increases demanding an explanation. The President even brought it up in his interview on Sunday. At a time Democrats are fond of calling insurance executives “villains” this story just adds more fuel to the fire.
No less than five reporters have called me in the last day asking me to explain it all.
Falling back on my industry experience it is probable:
The “39%” headline is anecdotally the biggest increase the press has found—the average is probably less albeit in the high 20% range.
This is likely driven by a combination of increasing medical cost trend, a bad economy, and anti-selection as healthier people disproportionately drop their coverage leaving a sicker group in the pool.
* The rate increase is probably “defensible,” at least actuarially, based upon the actual experience in that block.
When the day is done this probably says more about why systemic health care reform is so critical than about any one company’s behavior. Last week we heard national health care spending skyrocketed to 17.3% of the economy. This is a real life example of what that macroeconomic statistic really means.
But I am not about to defend Wellpoint having been burned once. A few years ago Lisa Girion of the Los Angeles Times called me to say Wellpoint was retroactively rescinding health insurance policies for inadvertent and immaterial mistakes people had made on their health insurance applications. Falling back on my years of industry experience, I said that couldn’t be true—only the sleazy insurers pulled that sort of thing, Blue Cross of California would never do that.
Of course, Lisa was right and it was the beginning of the California rescission controversy. Not what I would call the best example of public relations at a time the country was debating the industry’s future.
So, what Wellpoint needs to do, and do yesterday, about these increases is to be transparent. Put all of the facts on the table.
Is this another symptom of a health care system run amuck or the actions of a “villainous” insurance company?
Just what is it that Wellpoint is waiting for?
****
Update
Perhaps this is what they were waiting for. Here's what happens when you stand there like a deer in the headlights and let events take over:
From the LA Times today:
Congress opened an investigation Tuesday into Anthem Blue Cross' rate increases in California as President Obama cited the company's premium hikes -- some as high as 39% -- in his bid to pass national healthcare legislation.
The House Committee on Energy and Commerce and its Subcommittee on Oversight and Investigations announced they are examining the increases, which are set to take effect March 1. Anthem is the state's largest for-profit insurer and a unit of Indianapolis health insurance giant Wellpoint Inc.
Committee Chairman Rep. Henry Waxman (D-Beverly Hills) and subcommittee Chairman Rep. Bart Stupak (D-Mich) asked WellPoint's chief executive, Angela F. Braly, to appear at a Feb. 24 hearing of the subcommittee in Washington. They requested that she provide a detailed explanation of the reasons for the rate increases, which have enraged policyholders.
Read more of Robert Laszewski at healthpolicyandmarket.blogspot.com
This blog does not reflect the views of Metro Group Inc, and are solely the opinion of the author
Anthem Blue Cross, a subsidiary of Wellpoint Inc, is getting killed in the press over a “39%” rate increase for their individual health insurance block in California.
HHS Secretary Sebelius has pointed to the Wellpoint individual rate increases demanding an explanation. The President even brought it up in his interview on Sunday. At a time Democrats are fond of calling insurance executives “villains” this story just adds more fuel to the fire.
No less than five reporters have called me in the last day asking me to explain it all.
Falling back on my industry experience it is probable:
The “39%” headline is anecdotally the biggest increase the press has found—the average is probably less albeit in the high 20% range.
This is likely driven by a combination of increasing medical cost trend, a bad economy, and anti-selection as healthier people disproportionately drop their coverage leaving a sicker group in the pool.
* The rate increase is probably “defensible,” at least actuarially, based upon the actual experience in that block.
When the day is done this probably says more about why systemic health care reform is so critical than about any one company’s behavior. Last week we heard national health care spending skyrocketed to 17.3% of the economy. This is a real life example of what that macroeconomic statistic really means.
But I am not about to defend Wellpoint having been burned once. A few years ago Lisa Girion of the Los Angeles Times called me to say Wellpoint was retroactively rescinding health insurance policies for inadvertent and immaterial mistakes people had made on their health insurance applications. Falling back on my years of industry experience, I said that couldn’t be true—only the sleazy insurers pulled that sort of thing, Blue Cross of California would never do that.
Of course, Lisa was right and it was the beginning of the California rescission controversy. Not what I would call the best example of public relations at a time the country was debating the industry’s future.
So, what Wellpoint needs to do, and do yesterday, about these increases is to be transparent. Put all of the facts on the table.
Is this another symptom of a health care system run amuck or the actions of a “villainous” insurance company?
Just what is it that Wellpoint is waiting for?
****
Update
Perhaps this is what they were waiting for. Here's what happens when you stand there like a deer in the headlights and let events take over:
From the LA Times today:
Congress opened an investigation Tuesday into Anthem Blue Cross' rate increases in California as President Obama cited the company's premium hikes -- some as high as 39% -- in his bid to pass national healthcare legislation.
The House Committee on Energy and Commerce and its Subcommittee on Oversight and Investigations announced they are examining the increases, which are set to take effect March 1. Anthem is the state's largest for-profit insurer and a unit of Indianapolis health insurance giant Wellpoint Inc.
Committee Chairman Rep. Henry Waxman (D-Beverly Hills) and subcommittee Chairman Rep. Bart Stupak (D-Mich) asked WellPoint's chief executive, Angela F. Braly, to appear at a Feb. 24 hearing of the subcommittee in Washington. They requested that she provide a detailed explanation of the reasons for the rate increases, which have enraged policyholders.
Read more of Robert Laszewski at healthpolicyandmarket.blogspot.com
This blog does not reflect the views of Metro Group Inc, and are solely the opinion of the author
