The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Obama Administration Prepares to Shape Health Care Reform

Posted by Alan on June 6, 2009

President Barack Obama and his administration are preparing to take a stronger hand in shaping comprehensive health care reform in an effort to assure a satisfactory bill can be enacted before the end of the year. The effort got underway this weekend as the the White House took to the air waves, the Internet and mobilized their supporters around the country.

President Obama used his weekly Saturday morning web and radio address to link the need for healthcare reform with his efforts to revive the economy. At the same time, his political organization convened thousands of neighborhood meetings to discuss the issue and begin pressuring Congress to take action.

In his remarks, President Obama made clear he and his Administration would be fully engaged with Congress on fashioning comprehensive health care reform. At the same time, he placed effort in both a historical and economic context. Most significantly, he made clear the time to act is now.  “It’s time to deliver,” he said. “And I am absolutely convinced that if we keep working together and living up to our mutual responsibilities; if we place the American people’s interests above the special interests; we will seize this historic opportunity to finally fix what ails our broken health care system, and strengthen our economy and our country now and for decades to come.”

Organizing for America, the political organization that grew out of President Obama’s 2008 campaign claimed “tens of thousands of supporters participated in thousands of events for health care overhaul” according to the Associated Press. While the grass roots meetings were scheduled weeks ago, their timing meshed nicely with the Obama Administration’s need to take firmer control of the health care reform process. While the President had been content to lay out broad principles and let congress fill in the details, that strategy seems to be changing. A member of the “Obama’s team is described by the Associated Press as saying “if the president wants health care overhaul, the White House needs to control what’s being said …” The implication is they also need to control what’s being done.

President Obama made clear in his radio address that, while he welcomes input from both parties and all stakeholders, his is not willing to settle for mere incremental change. He is after substantial reform. “I know that when you bring together disparate groups with differing views, there will be lively debate.  And that’s a debate I welcome.  But what we can’t welcome is reform that just invests more money in the status quo – reform that throws good money after bad habits.”

Significantly, the President focused most of his prescription for reform on the need to control medical costs. “We must attack the root causes of skyrocketing health care costs.  Some of these costs are the result of unwarranted profiteering that has no place in our health care system, and in too many communities, folks are paying higher costs without receiving better care in return.” Citing the examples of institutions “that offer some of the highest quality of care in the nation at some of the lowest costs in the nation” he declared “We should learn from their successes and promote the best practices, not the most expensive ones.  That’s how we’ll achieve reform that fixes what doesn’t work, and builds on what does.”

This isn’t to say he didn’t address market reforms, but his emphasis on cutting costs and making reform budget neutral over time are indicative of well placed priorities.

President Obama has some very specific ideas concerning health care reform. Some are sound. Some raise serious concerns. While the President will work hard to prevent his vision from being watered down to blandness, compromises will be required. As I posted on Friday, the Democratic majority is broad and diverse. That’s healthy (you’ll pardon the pun). It also makes negotiations over key provisions of the health care reform plan inevitable.

The need to bring together diverse perspectives won’t make the legislative process easier, even with the Administration’s direct involvement. It may, however, make the final product better.


6 Responses to “Obama Administration Prepares to Shape Health Care Reform”

  1. Don said

    Simply put our medical care costs are out of control. According to our Congressional Budget Office, today $1 out of every $6 spent in the USA is spent on health care. By 2050 it will be $1 out of $2.
    When will we get it through our thick heads that we cannot sustain this any longer. I am an American who first experienced life in the UK in 1964. Of all the friends and family who live there I know of no one who is displeased with their health care providers or their treatment. When they come here though they’ve heard about our system and are worried in case they may get stuck with massive bills.
    Without a doubt we need to address this 800 pound gorilla now.

  2. TDC said

    When a cheaper alternative with lower quality is made available, employers will opt to purchase those less costly insurance plans, forcing employees to accept this cheaper alternative which may or may not allow them to keep their current doctors. Employees may also be invited to purchase their own healthcare if they have their heart set on keeping their own physician after years of establishing a trusting doctor-patient relationship. This is the part you’re not told, that ultimately, it will be a luxury to keep your existing physician and your existing health plan.

  3. Mark Goodman said

    In this morning’s NY Times there was an article about the President’s recent meeting with the healthcare “cabinet”. The President has made Dr. Gawande’s article in the New Yorker mandatory reading for this group. This is significant since it moves the discussion to where it needs to be which is on cost of services.

    Last night I saw Dr. Howard Dean rail about the cost from private carriers such as the Blues increase much faster than Medicare costs. My wife asked me if that was true. While I don’t have the facts at my finger tips I don’t doubt his statement. What he left out was Medicare reimburses at rates that aren’t sustainable for providers and facilities and the additional cost is passed along to the insurance carriers. Dr. Dean’s omission is a sad case of telling the public what they want to hear instead of what they need to know.

  4. At least some Senators from the right are banding together on this and pointing out the costs to the administration. Even Sen. Hatch mentioned that we need to get Social Security and Medicare in order before we try to take on another single payer entitlement program.

  5. Alan, helpful post. I find it very interesting that President Obama is now focusing on the cost of providing health care. Could this be that he read Dr. Gawande’s article in the New Yorker ? You recently referred to this article in a previous post and I wrote a blog post about it: It seems that this article is much discussed and is shifting the focus of the reform efforts away from insurance market changes and onto the root cause of ever-rising costs.

    Some of the market reform measures, in my opinion, are needed: guarantee issue in the individual market with an individual mandate. Others, such as the “national exchange” and the “public plan” are ridiculus and will do more harm than good. If Obama, Reid and Pelosi can rein in the cost of care we will all win.

  6. Dave Wood said

    Another excellent post Alan

    Obama now emphasizes the obvious, that cost is indeed our main probelm in American health care, not the uninsured, not the nursing shortage, not the future of Medicare, not the rascally private insurers. ITS ALL ABOUT COST.

    The problem is that Obama’s presciption for cost is not going to work well. More specifically he wants to spend billions to subsidize health medical records equipment to doctors and hospitals. Turns out that the savings generated from a health records system will flow to the provider, not Medicare, not you or me. The private insurers may see some of those savings if they manage to squeeze providers on reimbursement rates.

    If a doctors office saves on record keeping by way of this new equipment Obama has delivered, wont they just pocket those dollars? Same for a struggling hospital.

    Who really believes the providers will pass on their savings to us the ratepayers?

    As for this new best practices gig, I believe that it all boils down to how its managed, and by whom, that will determine if this best practices model will produce results.

    Remember my wife is a RN at the ICU of a local non profit, I believe that it is true that some Doctors and Hospitals do more testing and give more expensive treatment than do others. But who is to say which is truly the proper course? And will the providers actually follow the new best practices guidelines handed down by the Federal Govt.?

    Some providers are prescribing more treatments and tests to profit, some believe it the prudent course of treatment. Some are conservative, some are not. This is a very slippery slope to follow regarding the way providers are able to do their work. It takes health care into the political realm.

    The main problem with Obama’s presciption is that it will be ran by this dysfuntional groups of lackys we call the CONGRESS. I am certainly no right wing anti government bashing dude, but I know from experience that the Congress is not capable of managing a new agency that will determine what and at what price my medical treatments are given.

    IT IS A FLAWED STRUCTURE from the start. Congress is already expected to handle tax policy, foreing policy, the environment, energy policy, trade policy, and now we want this group to over see a new agency that will determine the BEST PRACTICES for our health care providers! YOU GOTTA BE INSANE!

    The entire structure of our health care system is flawed, inefficient, wasteful and unfair. Why add more layers of rules and regulations, more decisions by more federal agencys, more inept management.

    In other countries health care is usually based on some smaller groups. In Germany they have whats called krankenkasse, or funds, that handle their members. In Canada its the provinces which deliver on local provincial political winds and needs. Obama wants more giant federal action and agencys that have no accountability. Will anyone blame congress if this new best practices authrority screws up? What happens when the republicans take control of congress? The reason I bring up the smaller groups in other countries is because that is the route we should take. We should have state based authoritys who will be elected and held accountable through the ballot box. A local authority can make decisions and policy based on local tastes. Health care policy would and should be different in a illegal immigrant state like Arizona compared to a lilly white rural Maine. This notion that we can have NATIONAL health care policy is insane. Conservative Utah does not want Obama care at all. Liberal Vermont wants single payer Canadian health care now.

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