The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Obama’s Warp Speed Health Care Reform Rightly Focused

Posted by Alan on February 24, 2009

President Barack Obama’s address to the nation was both a rallying cry and a call to arms. And, if there remained any doubt, President Obama made clear he wants health care reform and he wants it now.

In his speech, President Obama promised the budget he will propose soon “includes an historic commitment to comprehensive health care reform — a down-payment on the principle that we must have quality, affordable health care for every American.” He then pledged to begin meetings among stakeholders to begin working through the contentious issues surrounding the topic next week. Pledging reform at warp speed he proclaimed, “So let there be no doubt: health care reform cannot wait; it must not wait and it will not wait another year.”

Can meaningful and comprehensive reform really be developed, debated and enacted in less than 12 months? Some would argue that it has to, that the political will to pass meaningful change must be seized and seized quickly. There will be great pain for some in the reform, and like pulling off a band aid it’s helpful to pull it quickly. Others will say making massive changes to a system as complex as America’s health care system needs to be done thoughtfully and carefully or else the damage from unintended consequences will swamp the benefits of change.

My take on it is that various aspects of a reform package can be developed in a year, but some elements will take longer. The question will be whether the Administration determines it’s better to pass what it can quickly and continue the legislative process into 2010 or wait for an omnibus package.

In any event, the President has little choice but to call for fast reform. His political capital is high right now. It has a lot more room to fall than to grow. Further, there’s broad consensus that health care reform could greatly aid the nation’s economic recovery — and that is his top priority. The sooner the details of reform are clear, the sooner business can rely on help in managing this cost. Further, there’s no shortage of proposals being discussed in and around Congress. If he doesn’t act on health care reform, someone else will. And he has no intention of ceding leadership on the issue to anyone else. Besides, if he misses his target and only brings about reform in 2010, is anyone going to complain? The only real deadline he has is to pass something before the mid-term election in November of next year. In the meantime, why not call for fast action?

More important than his timetable for reform is his focus for reform. And President Obama has made clear the kind of reform he’s looking for. Although former Senator Tom Daschle will no longer be leading the effort, his book, Critical: What We Can Do About the Health-Care Crisis (co-written with Scott S. Greenberger and Jeanne M. Lambrew, now the Deputy Director of the White House Office of Health Reform) clearly sets forth the Administration’s goals.

As I’ve written before, what’s significant, and encouraging, about this approach to health care reform is its focus on controlling the underlying cost of medical care. And that’s where the focus needs to be. A report by the Department of Health and Human Services projects health care costs in 2009 will exceed $8,000 per person. And this doesn’t include additional costs likely to result from the recent expansion by Congress of coverage for children and the economic stimulus money targeting medical technology. In a story on the report, the Associated Press quotes White House spokesman Reid Cherlin as saying “Health care costs are crushing middle class families and the small business that fuel job growth in this country.”

This doesn’t mean the administration will ignore market reforms or back off from seeking to establish a national purchasing pool (they’ll call it an Exchange) for coverage. But the fixation on costs is both appropriate and needed. Especially if we’re going to take health care reform where no American system has gone before — and at warp speed at that.


7 Responses to “Obama’s Warp Speed Health Care Reform Rightly Focused”

  1. Steve said

    Oh yeah… the lets FIX health care by shifting around some money and computerizing everything. I work for a self described leader with a clear eye on the direction of this health care ‘solution’ (translation- they recognize a ground floor opportunity). As a Provider, I spend 85% of my time in an overly complex computer system (apparently developed by the AMA) documenting whatever data this company needs to prove its worth and receive even more $$$$$$$ from the government. Doesn’t really seem to matter that much of the data is inaccurate, nor that it increases the Provider workload to epic proportions- only that the data is entered into the system ON TIME. The remaining 15% of my schedule is dedicated to managing extremely complex patients via crisis-based medicine without adequate resources or support to do my job. I have to FIGHT for those patients to be allowed even basic care. God forbid they have to go to the hospital; which requires several redundant reports, more data entry, and a tongue lashing by the UM department and office-based Medical Director- both of whom apparently know more about patient care than the actual Providers do. In this future model, Insurers remain in firm control of whether the patient gets ANY care. But, what the hey… it all looks good on computer! In the meantime, Providers are continually pressured to work in unsafe conditions and have triple the workload of those dictating said “care”. The future model assures the clinical frontline will remain stressed to the max with greed as the operational model. Change? HAH! Real change would be to SIMPLIFY. From what I’ve experienced thus far, the future is additional layers of bureaucracy to merely reshuffle available funds. Mr. Obama- try asking those of us who struggle to do this for a living. Because, in my opinion, it is amazing that ANYONE wants to be in medicine except, that is, the insurers, business owners, and their marketers. CHA-CHING!

  2. The healthcare system is falling apart, but as a health advocate I am assured a job as medical industries are in high demand always. Many poeple these days are utilizing
    medical call center and telephone triage services to skirt high medical costs. A nurse line combined with certified nurse triage practicioners is a great alternative to going to the ER and being charged those astronimcal fees.

  3. Time for a real doctor!

    Picture this. It’s early February. The city’s courageous Leader, crusader for truth and justice, victor of dozens of battles, during the past two and a half centuries, is rushed to the big city emergency room with fluid around his heart. His pericardium is filled with pus and the tension in this sack is compressing each heartbeat The Leader (of the free world) is dying right before our very eyes. Immediate, meaningful action must be taken now!

    Enter the dapper, slick talking, new emergency room chief. Let’s call him Doctor Obama. Everyone in the emergency room on this dark, gloomy, late afternoon knows that quick, decisive action must be taken, if the Leader is to be saved. But what to do?

    It is for sure that the Leader’s last doctors, Dr. Bush and his trusty, ever-present partner, Dr. Cheney, certainly didn’t know what to do. The multiple procedures that Doctors Bush and Cheney had done to the Leader, over the preceding 8 years had, in every instance, made the Leader worse…much worse!! Nevertheless, Doctors Bush and Cheney and their corrupt, white collar colleagues had made enormous sums of money off the Leader, with all their clever CPT codes and duplicate billings But now the Leader is but a mere shadow of himself…. the Leader is dying!!

    But what to do? Up steps the dysfunctional emergency room charge nurse. Let’s call her Charge Nurse Pelosi. Nurse Pelosi, with that fixed and constant smile, says to Dr. Obama, “let me handle this. Leave everything up to me. I’ll tell you what you need to do to save the Leader.” she says with that dumb looking, inappropriate smile of hers.

    It seems that Nurse Pelosi and Nurse Jane Harman, both ranking members of the hospital’s Executive Committee, had been complicit of flagrant, repeated malpractice for their part in covering up a series of grotesque, unacceptable procedures performed on a number of Arab and Persian patients by Doctors Bush and Cheney. In order to defraud Medicaid and Medicare of enormous sums of money. In stark contradiction to the hospital’s bylaws. Keeping this in mind, Nurse Pelosi’s and Nurse Harman’s recommendations, in the Leaders case, surely could not be considered legitimate.

    Anyway, Nurse Pelosi, with that fixed and constant smile, says to Dr. Obama, “now is the time for health care reform. Doctors Bush and Cheney have totally screwed up our health care system. The system is too expensive. And provides inadequate care”. (As if air head Pelosi would know the difference between quality care and inadequate care.)

    Nurse Pelosi says to Dr. Obama, “here’s what we are going to do! Send down to the ghettos and bring up some of those half way doctors who can barely speak English. Along with their cadres of lawyers and administrators.…And do this STAT! We’ll get these guys in here and let them take care of the Leader’s pericardial tamponade. It will be a lot cheaper. And will give us time to rove around the city giving slick speeches…convincing the people that we are doing everything possible to save the leader, while simultaneously reducing health care costs”.

    Nurse Pelosi rambled on…“Look we’d be saving money…and maybe even getting the Leader through this current crisis. While simultaneously establishing a new health care system in which administrators, health care lawyers, physician assistants and nurse practitioners will flourish. In a new health care system in which they can, finally, become autonomous. Like in Russia and Cuba. You don’t see the Russians and the Cubans wasting all their resources trying to save patients who are (eventually) going to die anyway, do you?” 604 words

    · Pelosi and Harman violated principal of checks and balances by failing to check Bush-Cheney Administrations grab for power

    · Pelosi and Harman complicit re POW torture and 9/11 Commission cover ups.

    · Enablers of war crimes Ranking Members House Intelligence Committee : Jane Harman and Nancy Pelosi

    · Gang of four includes Pelosi and Harman

    · Pelosi and Harman would have, themselves, been subject to impeachment for POW torture, as well That’s why Pelosi said “impeachment is off the table”

    · Medicaid and Medicare fraud cases with multimillion dollar settlements: CVS, Merck, Health South, Walgreen’s, Seven NY hospitals, Smith Kline, Damon Labs, Tenet Health, Hewlett Packard, Pfizer, Tenet Health, Tap Pharmaceuticals, HCA, National Health Labs, Quorum Health, Corning Met Pharmaceuticals, etc, etc….talk about make work for hoards of administrators and

  4. John Pack said

    Executing a quality healthcare program is an extremely difficult proposition, as two factions, one political and the other capitalistic, will have to join hands to make this work. I have been in the business for five years as a broker who focuses on health insurance in both the individual and small business markets. This is plenty long for me to conclude that the current system is badly broken and needs a fix. In my humble opinion, the major culprit is GREED, that same five letter word that is highly responsible for our great country being in the shape that it is in today. The pursuit of the almighty dollar has led to out of control healthcare costs and, in my opinion, a deterioration of ethical behavior. The insurance companies are capitalists and pursuit of profit is THE major objective regardless of what they wnat you to believe.

    However, the other alternative of socialized medicine is an even scarier proposition. Government control is the last thing we need to make this all work. A compromise position which includes universal coverage, uniformity of standards, some governmental control such as possible free clinics for the lower income earners, and incentives for small businesses to offer coverage needs to be well thought out and combine both the private and public sector. Only when all the ulterior motives and egos are pushed aside will this quest become meaningful and lead to a significant improvement over what we have today.

  5. Meg McComb said

    According to the Washington Post today, “President Obama intends to release a budget tomorrow that creates a 10-year, $634 billion “reserve fund” to partially pay for a vast expansion of the U.S. health care system, an overhaul that many experts project will cost as much as $1 trillion over the next decade.

    Obama would pay for the expansion by trimming tax breaks for the wealthy and tightening payments to insurers, hospitals and physicians, according to a senior administration official”.

    This sounds alot like socialized medicine to me. Does anyone else take a different spin on this?

    • Bill Robinson said

      Meg McComb said: “This sounds a lot like socialized medicine to me. Does anyone else take a different spin on this?”

      Well, I think it is far too soon to say that. First, I do not think the President or the majority of Congress want to replace America’s private healthcare system with an all government run single payer system (aka: socialized medicine).

      Second our current healthcare system IS to some degree “broken”, especially due to endlessly soaring health care costs! And it is reassuring to read that some of the key leaders in Congress and President Obama have finally acknowledged that if we do not get health care COSTS under control, no amount of other healthcare reforms will make any improvement in the end result.

      Sen Max Baucus’ 90 page white paper (11/08) on his vision for federal healthcare reform spends 4 pages discussing the need to control health care provider costs, including changing how providers are paid – base payments on the condition being treated, and in outcomes, not on a literal gee-for-service mode where the more things done (effective or not) all get paid to the providers.

      As for their passion to include a government-run “Exchange” (connector) for individuals to use to buy health insurance (and “save big” on premiums, so they think), we will have to fight hard to try and kill the idea with facts and reasons, not with just negativity….and if we fail, by being at the discussion table we at least have a good chance to make such an Exchange still work “OK” for, and to include use of, agents in the equation.

      So everyone…”Hang on…it’s going to be a bumpy ride!”

      • CuriousDoc said

        I have some concerns on reimbursing doctors on “base payments on the condition being treated, and in outcomes”.

        A crucial factor in a patient’s outcome is a patient’s comorbidities. Doctors will be basically incentivized to take care of healthier patients at the expence of more complex cases. They will be incentivized to refer out to another MD at the first sign of a complication. They will be asked to take on the risk of the patient’s medical outcome which is not always under their control (i.e patient non-compliance), and they will play it totally safe abandoning risky – but potentially very beneficial – interventions.

        I think the better system is fee for service with random audits to make sure MDs continue to practice within generally accepted guidelines.

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