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Health care reform has become more about arrogance than reform

nospam@example.com (ROBERT LASZEWSKI) — Fri, 12 Mar 2010 13:41:10 -0500

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

Health Care "Reform" Bill is NOT Reform At All!

nospam@example.com (ROBERT LASZEWSKI) — Thu, 11 Mar 2010 16:04:58 -0500

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

The Failure of Health Care Reform: Bribes, Lies & Gridlock

nospam@example.com (ROBERT LASZEWSKI) — Tue, 02 Mar 2010 15:13:14 -0500

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/

Health Care Reform even more of a mess: Reconciliation?

nospam@example.com (ROBERT LASZEWSKI) — Mon, 01 Mar 2010 14:30:52 -0500

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

Republicans win at Health Care Summit

nospam@example.com (ROBERT LASZEWSKI) — Fri, 26 Feb 2010 12:47:22 -0500

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

President Obamas' Health Care Plan- Not a Game Changer

nospam@example.com (ROBERT LASZEWSKI) — Wed, 24 Feb 2010 13:53:24 -0500

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

Anthem Blue Cross raises rates 39% for health insurance in California

nospam@example.com (ROBERT LASZEWSKI) — Thu, 11 Feb 2010 15:05:50 -0500

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

Health Care Summit: What is the Blair House meeting about?

nospam@example.com (ROBERT LASZEWSKI) — Mon, 08 Feb 2010 16:43:45 -0500

By:Robert Laszewski President of Health Policy and Strategy Associates

Getting Democrats and Republicans to constructively engage on health care is the best way to make progress.

To date, the Democrats have blown health care reform once again by being too arrogant in thinking they could just ram their version through.

The Republicans have no health care proposal. Their “black book” list of ideas they handed the President in Baltimore is a collection of second and third tier proposals at best.

So, what is the Blair House meeting about?

Well, I am not optimistic that it will be about real bipartisanship and a good will attempt to change the game.

It will more likely end up being an opportunity for each side to simply continue the petty bickering and once again try to convince a majority of voters their ideas really aren’t so bad.

Obama hopes his health care details will finally appeal to viewers as they realize he holds the only real plan. The problem with that logic is that the Democratic health care reform “well” has already been irretrievably “poisoned”.

The Republicans would like voters to believe their list of ideas will appeal to voters but the reality is that all of the attention they will now get will likely lead to a consensus, particularly among independent observers, that the Republicans, save for their tort reform proposals, aren’t holding any real cards.

I doubt either side will end up winners here.

The Democrats will only reinforce the sense they just don’t get it and Republicans will continue to come across looking like they think voters have forgotten that they were the bums who lost the last two elections.

When the day is done, I will suggest the Republicans are right about this: They all need to start over.

When Baucus and Grassley were in the midst of their Senate Finance negotiations last summer, I said I didn’t see them being able to accomplish anything—not because they couldn’t have. To me, the real problem was that the talks were taking place at the far out edges—left and right. Republicans were being told that bipartisanship was the same thing as capitulation—“Our bill is the only way.”

Republicans, including the Republican members of the “gang of six” in Finance last summer, had and have no plan. But, in Finance, they were quite willing to agree to a far-reaching bill that would have covered tens of millions of those presently uninsured. Things got a lot closer than most people realize. I do think the Democrats can eventually—although not likely in this election year—bring lots of Republicans onboard a new initiative that first takes the current bills off the table.

Real bipartisanship will occur when both sides find common ground in the middle and begin to work their way as far out toward both the left and right as they can and still hold the needed votes. It is about starting in the middle where they agree.

It's my sense that Blair House will be about the same old here’s my plan and if you want to be bipartisan you will come on board with my ideas. It will not be middle-out and it will fail to jumpstart anything for that reason.

Presuming that is the Obama strategy, the best thing the Republicans could do is call for new negotiations with no preconditions and let the Democrats just continue defending the plan that has already been roundly rejected.

They really do have to scrap it all and start over.

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

Health Care Reform "Plan B" Anti-trust Exemption Repealed

nospam@example.com (ROBERT LASZEWSKI) — Thu, 04 Feb 2010 17:08:12 -0500

By:Robert Laszewski President of Health Policy and Strategy Associates

With word that the House is likely to take up the repeal of the health insurance industry anti-trust exemption it is now clear the Democratic leadership has begun Plan B.

It is also clear that this is much more a part of a political Kabuki dance then any substantive effort at even piecemeal health care reform.

The House probably has the votes to pass the repeal. The Senate does not. I doubt that even all of the 59 Senate Democrats will vote for it if and when it does come up on the floor of the Senate.

The base of the Democratic Party, as well as many “progressive” Dems in the House and Senate, are rabidly mad about not being able to ram their health care bill through. That is why you continue to hear all of the talk about reconciliation options even though there is no chance such a scheme would pass either the House or Senate.

But what to do?

The apparent answer is to bring up a few smaller health care bills the Democratic leadership views as popular back home and expect the Republicans will vote against them. Right now health care is a big negative issue for the Dems given the unpopularity of their effort to date. But if they can be seen trying to pass a few smaller measures “we can all agree on” only to be thwarted by Republican opposition their hope is they can turn the table on this issue to their advantage—well before they get to November.

Interesting politics but no hope for any real progress while these games play out.

**********

When the Democrats say they believe they can still pass a health care bill are they bluffing? That's my opinion.

Here is a first rate story from Politico on their options and the dismal political reality each faces.

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

Health Care May live after Obama & Republicans meet in Baltimore

nospam@example.com (ROBERT LASZEWSKI) — Mon, 01 Feb 2010 17:00:34 -0500

By:Robert Laszewski President of Health Policy and Strategy Associates

Intentionally or unintentionally, my sense is that Obama came out of Baltimore thinking he is now on to something, and I hope the Republicans took the same lesson away.

Constructive good faith political engagement in Washington actually works.

It is just incredible that House Minority Leader John Boehner has had not direct contact with the White House for about a year. A pox on both their houses for that. The party leadership never talks to each other--save being across the table from one another on talk shows. The two sides just level charges and counter charges at each other apparently never caring whether they actually accomplish some good policy for the rest of us.

But a funny thing happened in the midst of Friday's photo-op meeting between the President and the Republican House caucus. Good faith, an airing of ideas, and a mutual respect of each other's views actually resulted in both a political coup for both sides and some very first level progress on important issues--not the least was health care.

Can you believe it? Good manners and good intentions actually have a political value!

I will suggest that the next best step is for the President to take the lead in inviting the Republican and Democratic leadership to the White House on a regular basis in an attempt to broker some real progress on the important issues. If the President wants to turn his job approval ratings around that kind of good faith leadership would take them to the stratosphere.

I am not suggesting that the very thin Republican "play book" has any big ideas for health care reform. But I do believe that many of the Democratic ideas to cover 30 million people could be embraced by lots of Republicans if the two sides could show each other some respect and not just try to jam the majorities' ideological ideas (Republican or Democratic) down the other's throat. It wouldn't also hurt the Democrats to concede some points to the Republicans.

As bad as the left has been recently in thinking they were just going to ram a health care bill their way because of the results of the last election, I saw the right do exactly the same thing when they had control in recent years. (Remember the Republican chairman of the House Ways and Means Committee who tried to get the minority Democrats arrested for boycotting a meeting?) That kind of "take no prisoners" approach to government is what is really at the heart of gridlock while the country just continues to drift downward.

Worst case, if we did see a real effort and it eventually broke down, the side that would lose would be the side that didn't behave themselves. Now that would be a political outcome we could all live with.

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

Medicaid and Medicare are the most efficient forms of health care

nospam@example.com (Political Blogger) — Fri, 29 Jan 2010 13:16:03 -0500

By: Brandon Mersman

America has never been a country of baby steps. Franklin D. Roosevelt did not dream in baby steps when he imagined the New Deal. John F. Kennedy did not dream in baby steps when he encouraged NASA to reach for the moon.

Health care reform has ignited passions on both sides. Those that think we are headed towards socialism are afraid they will be stuck with the bill for those that are not covered now. Those on the left want a plan that will efficiently cover all Americans.

President Obama has been pushing this issue with all of his "political capital" after he was elected. Health care has been at the forefront of his political agenda for over a year now causing his own approval ratings to plummet.

In mid-August President Obama signaled that he would be willing to concede ground on the public health care option in his health care reform overhaul. Instead of the public option there would be health insurance co-ops designed to provide low cost health insurance.

The question remains however, how much reform can there really be without a public option?

There are many in the field that contend health insurance co-ops will not be all that successful in lowering health care costs based on factual evidence from existing health insurance co-ops.

In the 1990's there was a push for health insurance co-ops in which a few were successfully formed from that movement. However, the success of these co-ops
has been minimal at best.

The very few insurance co-ops that exist today only provide about a 3 percent discount compared to that of your regular private insurance company. A 3 percent savings is not what the bottom rung of Americas economy is looking for to be able to afford health care.

Medicaid and Medicare are the most efficient forms of health care we have in this country today. Only 2 percent of the cost of these programs goes into administrative costs and the rest goes to providing efficient health care to those that they cover.

In the 1960's when Medicaid and Medicare were passed by President Johnson conservatives claimed that this was socialism and socialized medicine. Today conservatives are claiming the same thing when it comes to this health care reform program.

Your private insurance company spends 30 percent of their fees on administrative costs. The added administration costs over the past few years has gone towards hiring more staff to cover themselves from having to cover their patients when they need treatment. It is as simple as that. The government option, single payer form of health care, is more efficient than the private sector.

Creating a government run public health care option is our best and most efficient option towards lowering health care costs for all. The government has shown since the inception of Medicaid and Medicare that the most efficient and reliable means of providing affordable health care is through government run health care programs.

Creating a government health care program will create the most competitive machine to private insurance companies that will work to reduce the cost of health care for all Americans.

Reducing health care costs is the most fundamental element to stimulating our fragile economy. Businesses spend an exorbitant amount of money on health care for their employees and the potential savings of a public health care option could create billions of dollars reinvested in our economy.

The bottom line is that with no public health care option there will be no real reform in this bill. That's all. President Obama and the conservative Democrats cannot continue to take baby steps towards reform.

47 million Americans live day to day with no health care insurance at all as politicians debate over keeping their elected positions in November. Senator Kennedy spent over 40 years arguing on the Senate floor and across America for those who remain uncovered.

As America continues to lag behind the rest of the modern world in health care politicians on capital hill continue to push for baby steps and push back against any kind of forward progress.

President Obama has only one option as far as I am concerned, push for real reform or face a Democratic challenger in 2012. Without a public health care option I would not hesitate to vote for a Democratic opponent to President Obama.

Now is not the time for baby steps on health care reform. Now is the time for real, meaningful change. The change that we were promised by a young man with inspirational words.

Read more of Brandon at The Mersman Blog

The State of the Union: Obama bipartisan on Health Care Bill

nospam@example.com (ROBERT LASZEWSKI) — Thu, 28 Jan 2010 14:59:00 -0500

By:Robert Laszewski President of Health Policy and Strategy Associates

As Yogi Berra said, "When you come to a fork in the road, take it."

President Obama came to a fork in the road during his State of the Union speech on health care reform. Would he do what many liberals have demanded--push harder to pass the Democratic health care bill? Or, do as many moderate Dems and some Republicans have called for--work to get a smaller but bipartisan health care bill?

Listening to Obama's speech on the State of the Union he seems to be taking both forks.

Continue pushing the Democratic plans: "As temperatures cool, I want everyone to take another look at the plan we’ve proposed. There’s a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo."

Looking for a bipartisan approach: "But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. Here’s what I ask of Congress, though: Do not walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people."

President Obama came to that fork in the road during the State of the Union and instead of giving the Congress a clear sense of where he was willing to put his remaining political capital he just took it.

Is he willing to put his Congressional majorities on the line in an election year to keep pushing for the now unpopular health care bills? Or, is he willing to put his political capital on the line in an effort to pull the far left in his own party to the center and call the Republicans out on their offer of bipartisanship in order to produce a modest bill?

In the wake of the President's State of the Union Address, we have no better idea just where he wants to lead his party, the entire Congress, or the country on health care reform.

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

Health Care Bill Plan B? Is There One?

nospam@example.com (ROBERT LASZEWSKI) — Wed, 27 Jan 2010 16:44:11 -0500

By:Robert Laszewski President of Health Policy and Strategy Associates

As the State of the Union approaches Democrats are considering their health care policy options. There are lots of reports about “Plan B”—pushing through the Senate bill with a parallel corrections bill that could be passed in the Senate using reconciliation rules.

That’s as dead as the original House and Senate health care bills. Moderate Democrats have no stomach for such a legislative stunt in the face of Massachusetts and bad health care polls. Many liberals even question that strategy.

Everyone is awaiting this week’s State of the Union speech. Will President Obama:

1. Embrace the call by many on the left to Democrat-up and just ram the health care bill through?
2. Call for a scaled back bill built around modest and popular first steps that could attract bipartisan support?
3. Just jabber in a way no one can figure out which course he really supports?

My bet is on number three.

As I have said before, I think getting even a modest bill is a long shot in this election year but it is not impossible.

I like the idea of focusing on tax credits for small business as a first priority more than trying to help the individual market. The small group market is guarantee issue and government tax credits have the impact of encouraging matching funds—government money would encourage employer contributions making coverage even more affordable for the uninsured.

Add to that a modest Medicaid expansion, the albeit tepid cost containment parts of the current bills such as the pilot programs and giving CMS more authority to implement them, modest insurance reforms like ending rescission and funding for high risk pools, proving good faith with Republicans by including tort reform, and we have a bipartisan down payment on health reform.

Democrats need to erase the bad taste voters so far have for their dead health care efforts. They could do that with this kind of modest first step health care bill. Republicans also have something to prove on health care—the Democratic problems shouldn’t be confused with any sense on the part of voters that Republicans have yet to make any constructive contribution to this debate.

In my mind, the smart political move for Democrats is to call the Republicans out on their offers to be bipartisan by putting a deal on the table Republicans couldn’t refuse.

If the Republicans take the offer, the Democrats can get beyond the health care political mess they are in. If the Republicans don’t, the Dems have the leverage they need to turn the tables on the Republicans before the November elections.

They could also, coincidentally, actually help out a few million people.

Lots of folks think there is no chance anything positive can now come out of this poisoned political environment.

I am not so cynical.

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

A Smaller Bipartisan Health Care Bill & What It Could Look Like

nospam@example.com (ROBERT LASZEWSKI) — Thu, 21 Jan 2010 11:25:43 -0500

Kentucky Senator Republican Mitch McConnell Source: Wikipedia

By:Robert Laszewski President of Health Policy and Strategy Associates

In the wake of the Massachusetts vote, Democrats are scrambling to find a way out of the health care political mess they are in.

Right now they are in a daze standing by waiting to see if any of the "trial balloons" they have launched gain any traction. So far, ideas to ram though the now toxic Senate bill in the House in one parliamentary form or another are falling flat.

Last night, the President formally launched one of his own trial balloons--doing some kind of a scaled back bipartisan health Care bill.

The problem with bipartisanship now is that the Republican base is not about to let any of their own Senators do anything to take the Dems off the political meat hook they are now dangling from.

Democrats could well try to create a very popular stripped down health bill with a win-win objective--if it passes they are off the hook and have something to take to the November elections and if Republicans block it they have themselves an issue on which they can try to neutralize the Republicans.

But that sounds great in principle--health care details are always problematic.

What follows is a post that I did the day after Barack Obama was elected President. In it I suggested a modest bipartisan Health Care bill was the only thing I could see passing in 2009--or 2010 for that matter.

You will note that suggestion #1 has already been accomplished--as well as some positive health IT steps.

From Wednesday, November 5, 2008:

There is Now a Real Bipartisan Opportunity in Health Care

President-Elect Obama, and about every candidate for Congress, has said he wants to change the partisan tone in Washington. Obama, the Democratic Congressional leadership, and the Republicans have a terrific opportunity to do just that on health care when they all come to Washington early next year.

As I posted earlier, I do not believe there is any chance we can see the enactment of the comprehensive Obama health plan in the near term.

But there are a number of important steps that can be taken next year and each of them have enjoyed strong bipartisan support during the past year:

Nevada Senator Democrat Harry Reid
Source: Wikipedia

1. Reauthorizing the State Children's Health Insurance Plan (SCHIP) and increasing the number of kids covered from six million to ten million. The Congress passed exactly that kind of reauthorization twice by strong bipartisan margins only to come a few votes short of being able to override two Bush vetoes of the bill. Those attempts met pay-as-you-go requirements by boosting the cigarette tax to pay for it.
2. Rearranging Medicare spending by equalizing the payments private Medicare plans get with the payments the traditional Medicare plan receives for the same seniors. The Medicare physicians face a 21% fee cut on January 1, 2010 and there are other serious cost issues for Medicare. In July, the Congress took the first step toward payment equalization with a veto proof margin of 70-26 in the Senate and 383-41 in the House. The really hard part here is crafting a new Medicare physician payment system that is desperately needed but the first step, where to get the money, has strong bipartisan support.
3. John McCain and Barack Obama had a number of similar and relatively non-controversial cost containment ideas in their health plans which would cost the federal government little or nothing. These similar proposals included the expansion of health information technology and a patient medical record; improving transparency about health care quality and costs including prices, errors, staffing ratios, infection rates, and disparities in care and costs; wellness initiatives including an emphasis on healthy lifestyles; development of best practice standards, requirements for disease management programs; requiring effectiveness reviews for procedures, devices, and drugs; and requiring providers to collect and report data to ensure standards for health quality are followed.
4. There is bipartisan support for assisting small business in providing and paying for health insurance. In 1999, 56% of employers with 3-9 workers provided health insurance to their workers. By 2007, that had dropped to 45%. By contrast, employers with more than 200 workers provide health insurance 99% of the time. The one place employer-provided health insurance is melting away is in the small employer area. A modest bill to assist the small employer enjoys support among both Republicans and Democrats.

A big $100 billion [per year] comprehensive health care reform plan like the Obama health plan is not realistic in these times of financial crisis.

But, there is already bipartisan support for a children's health insurance (SCHIP) extension and the means to pay for it, reform of Medicare provider payments and the means to pay for that, a list of commonly agreed to cost containment initiatives that would cost the government little or nothing, and bipartisan support for help to the small employer to offer health insurance.

To be sure these steps would only make a dent in the number of those uninsured and these bipartisan cost containment items will only help our cost problem around the edges.

But all of these bipartisan steps would be progress, are doable, and are affordable.

President-Elect Obama and the Democratic leadership can do what the last two Presidents did--promise bipartisanship and then quickly employ the same old partisanship out of the mistaken belief they had the majorities in Congress that would enable them to steamroll the opposition. That mistake led to the 1994 Republican takeover of the Congress in the first case and two straight election defeats, in 2006 and 2008, in the second.

President-Elect Obama, the Democratic leadership, and the Republicans have the road map at hand to truly show a bipartisan commitment to health care change and progress. They could actually break the gridlock on health care and make some modest progress.

Will they take the road less traveled or just give us more of the same?

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

Health Care Bill Dead Due To Republican Victory In Massachusetts

nospam@example.com (ROBERT LASZEWSKI) — Wed, 20 Jan 2010 15:23:24 -0500

By:Robert Laszewski President of Health Policy and Strategy Associates

Tuesday’s Republican victory by Scott Brown in Massachusetts means the current Democratic health care bills will not be on the President’s desk in 2010.

Forget the crazy talk of ramming something through—including just having the House pass the pending Senate bill.

I’ve talked to lots of people in the past few months that didn’t like the Democratic effort but conceded that the Dems won the 2008 election on a platform to do health care their way. They would say, “elections matter” and could, albeit begrudgingly, understand Democratic attempts to pass their brand of health care.

But losing Ted Kennedy’s former seat in Massachusetts with the singular issue being health care?

The game has changed. Democrats just can’t any longer spin the polls that for months have been so negative on the Democratic health care efforts.

The conclusion is now crystal clear—the people don’t want this. For goodness sakes—they rejected it in Massachusetts! On the political shocker scale this rivals “Dewey Defeats Truman” and the '94 elections.

When Bill Clinton lost the '94 elections, he went before the press the next day and took responsibility for what happened and then spent the next two years successfully rebuilding his presidency.

Obama and the Democratic leadership really only have that course in front of them now.

Defying the American people at this point with these foolish hypotheticals about how they could still thwart the obvious will of the people and pass their bill would only result in their digging themselves into an exponentially deeper political hole.

I am not sure Harry Reid, Nancy Pelosi, and Rahm Emanuel understand this—they have proven to be incredibly politically tone deaf all winter.

But I will tell you something you can take to the bank—a lot of their House and Senate moderate Democrats do understand what this means and you can expect them to begin moving off these bills in the next 24 to 72 hours. A trickle will lead to a stampede and that will be it.

There will be no interest in staying aboard the kamikaze flight Reid and Pelosi are now piloting straight into the 2010 elections.

In the end, this was 1994 all over again. The Democrats thought they could unilaterally do health care their way and blew it just the way they did 15 years ago--out of pure political arrogance.

Photo by: Pete Souza, The Obama-Biden Transition Project

Let me repeat something I must have said on this blog a hundred times—health care is too big an issue to be done in any way other than a bipartisan fashion. One side simply can’t move something this big, complex, and controversial without lots of political cover from the other side. This bunch, to their peril, never understood the lesson that both Social Security and Medicare were passed by comfortable bipartisan margins.

There is no doubt in my mind that there were at least 10 Republican Senators that were ready to deal in good faith on this issue—the “gang of six” plus the Republicans who had signed on to the Wyden-Bennett bill, for example.

But when Max Baucus was given the opportunity to try for a bipartisan solution, his hands were tied—bipartisanship was defined as Republicans having to sign-on to the Democratic bills their leadership and the left wing of the party were overly confident they could pass on their own.

Health care is an easy issue to demagogue. The opposition will always do it. Republicans, including these ten Senators, did a lot of it the past few weeks. That is why the opposition needed to be neutralized in the first place with real bipartisan support.

As readers of this blog know, I have been pessimistic about this effort for more than a year. But, today I also believe there is a way to pass a substantial bipartisan health care bill that would cover at least 30 million people, reform the insurance markets very much like the Democratic bills would have, and begin a process of real systemic change. I also believe that can happen in the next couple of years. It could all be in place by the same 2014 date the Democrats had in their bill.

But for now, the overly confident and unwilling to compromise Democrats blew it again.

With their solid majorities and popular new President, whom else do they have to blame?

The only way for them to make this election-year mess worse would be to ram their bill through. There are lots of Republicans in this town secretly hoping they will at least try!

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