The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

No One Defends the Status Quo. Nonetheless …

Posted by Alan on June 15, 2009

Health care reform is not for the weak willed. Just ask President Barack Obama. As Congress continues to draft legislation the President is expending his political capital to mobilize supporters of his reform package while at the same time seeking to soften the opposition. As tough as the task lawmakers face, President Obama’s is in many ways the more challenging.

Consider President Obama’s appearance today before the American Medical Association. According to the Associated Press, when he sympathized with the doctors on the need to address malpractice reform he was cheered. When he told them he did not oppose capping malpractice judgements as the way of accomplishing this, some booed. That the President brought up malpractice at all was enough to mobilize trial lawyers. The president of their primary lobbying organization, the American Association for Justice, issued a statement denying that defensive medicine leads to higher health costs, according to the Associated Press.

Then of course there’s the opposition from the insurance industry and others concerning the creation of a government-run health plan to compete with private carriers. Yes, compromises are being put forward to find common ground on this issue. Meanwhile, however,  there’s former-Governor Mitt Romney’s claiming on ABC’s “This Week” Sunday declaring that public plans are “a Trojan horse … a way of getting government into the insurance business so they can take over health care.”

Or take the Republican attack on the Administration for creating a working group to study the effectiveness of various medical treatments. Representative Tom Price, a former surgeon, accused the President of “seeking a government takeover’ of health care.” The committee, he claimed would turn into rationing boards that would instruct doctors what services they could — and could not — provide their patients.

In a similar vein, Senate Minority Leader Mitch McConnell, Senate Minority Whip Jon Kyle and other GOP Senators introduced “The Preserving Access to Targeted, Individualized, and Effective New Treatments and Services (PATIENTS) Act. The legislation’s sponsors claim it is targeted at “comparative effectiveness research” which they claim is “commonly used in ‘socialized health care systems,” according to The Hill’s Blog. To its advocates, comparative effectiveness research holds the promise of eliminating much of the $700 billion in unnecessary medical spending incurred each year. It would also go a long way toward eliminating the disparity in spending profiled by Dr. Atul Gawande in his much discussed New Yorker article. Opponents do not address the difficulty in making politically free determination of what treatment is effective or not. Instead they attack it as empowering the government to determin who lives and who does not, even though current instances of comparative effectiveness programs in the United States are highly regarded by doctors, patients and others.

No one is defending the status quo. Not surprising since most people believe it is seriously broken. President Obama has rightfully framed the health care reform debate as an integral part of his economic recovery efforts. The reality is that American businesses are hamstrung by an often dysfunctional system. It’s equally true that hundreds of billions of dollars are wasted each year on defensive medicine, ineffective treatment and overpriced prescriptions.

The critical political puzzle facing President Obama is whether he can marshal the votes necessary to force through health care reform that causes pain to so many interests while improving on the status quo. He has some advantages other presidents have not shared. There is widespread agreement the status quo is unacceptable. He is extremely popular. His party holds significant majorities in both the House and Senate.

And did I mention the widespread agreement that the status quo is unacceptable? Because it is worth repeating. Opponents to reform have an advantage. They can zero in on one or two items they dislike knowing others will be attacking the package in other weak spots. To prevent the death of reform by a thousand cuts the Administration will need to fend off all of these attacks. Not an easy task. Among other tactics, it will require developing compromises that address opponents’ reasonable concerns without watering down the entire package so much it fails to improve on the current system.

That’s why health care reform is not for the weak willed.


4 Responses to “No One Defends the Status Quo. Nonetheless …”

  1. I agree completely with the theory that our states should be the testing ground for democracy. So my question is why not work with some willing states to implement the proposed Obama plan? I’m certainly not for expansion of government, especially with something like my health care. But I’m certainly open minded enought to look at options. Why isn’t there talk in Congress to implement whatever compromise surfaces with a willing state. Show the public what will or will not work. If anyone is hoping for radical reform, the best way to do it, in my opinion, is to “try before you buy”.


  2. It is also a little bothersome that Obama just glanced over tort reform in this speech. Certainly malpractice insurance and plaintiff’s attorneys are driving up the costs of health care. You simply can’t honestly talk about attacking rising health care costs from all angles and then ignore a major problem because it involves your political backers. It is a little disingenuous at best.

  3. John Pack said

    I have been a health insurance broker in the state of California for the past five years and have experienced the good, the bad and the ugly regarding our healthcare system. As with many reform efforts, many times the powers that be cannot see the forest for the trees. It is my humble opinion that the healthcare system in this country can be fixed in a more simplistic fashion than implementing more spending and debt at a time when fiscal responsibility needs to be the order of the day.

    I am not in favor of a government controlled healthcare system or increased governmental intervention in our lives. There is no question that our current healthcare system needs a major overhaul, but the $64K question is “how do we accomplish this.”

    My own opinion of a workable healthcare system would include the following:

    • Government funded and operated clinics geared to lower income individuals that focus on basic and preventive services.
    • Government subsidies for those with declinable pre-existing conditions who would purchase a select pool of private health plans that are guaranteed issue.
    • Federally legislated private plans instead of state legislated. Full portability of coverage amongst states.
    • Universal underwriting standards. There is far too much inconsistency in medical underwriting by insurance companies.
    • Universal disclosure legislation which would eliminate certain insurance companies from misleading consumers and force the insurers to eliminate many of the asterisks in plan disclosures.
    • Continuation of tax benefits for businesses that offer group health plans.

    In short, I do not feel that this administration should be allowed to force a plan upon the American public that will not be financially feasible. It appears to me that many are more concerned with fulfilling a campaign promise than debating one of the most important issues of our lifetime. Only through debate and sharing of ideas and philosophies can a workable healthcare plan be achieved in these times of economic chaos.

  4. Dave Wood said

    Health care reform is not for the weak willed? Is this the reason that Obama wants to tinker around the edges of a dysfuntional, inefficient, and unfair so called system?

    The thing that scares me most is not the details of Obama’s Massachusetts style reform slate, but the fact that the Congress, in their infinite wisdom, will run it.

    Imagine, each time the cardiologists scream to Congress that we need to raise the rates they get for an office visit, Congress must convene hearings, then draft legislation, then hear from all the various interest groups, then decide whats politically feasable, then debate, then critque the opposition, then vote, then change all the forms and billing systems, then the cardiologists get their raise. Imagine that for each and every detail of health care……………ARE WE INSANE?

    Doesn’t the Congress have enough on their plate, without debating what a proctologist in Gullivers Hole Mississippi gets for an office visit?

    As for this debate on best practices, the main point of this idea is that some regions over use treatments and drugs, others don’t. Some regions may be happy to pay for a Doctor who is conservative in his medical practice and therefore wants to over use, others regions may not.

    Health care is the ULTIMATE local issue, and should be ran from a locally elected board that will administer policy based on local tastes and whims.

    Does anybody believe that Alabamans are willing to pay for a government ran system? Or that Vermonters are willing to have a totally private insurance based more choice and more competition type system? So why the need for national health care policy?

    If our main problem in American health care is cost, and the two main drivers of high cost are: 1. the inefficient system itself 2. the poor health status of the American people, then why on gods green earth is Obama going to spend a hundred billion to give a card to 30 million Americans? FOR WHAT?

    Will the card get little Johnny to put down the fries? To get dad to walk a few miles each week, to get mom to stop eating at the drive thru.

    If you think health care is expensive now, YOU AINT SEEN NOTHIN BABY!!!! My wife is a nurse and the studys conclude we are in for a hurricane of expensive ailments. Obesity, depression, insomnia, back problems, poor sex lives which leads to poor marriages and high anxiety, diabetes, and on and on…….. BUT WAIT…Obama wants to give me a CARD, so I can see the Doctor, who will advise me that, surprise surprise, I need to lose the weight. Slow down on the red wine, stop smoking, eat right, and skip the drive thru.

    Only a locally elected, limited, and accountable authority can hire professional weight loss experts to slow down this obesity epidemic, one on one. The entire family must be in on this effort. It won’t be easy, but the alternative is higher and higher health care bills. And an eventual bias towards obese people, even a rebellion from thin people who have to pay for the obese.

    I pray that all Americans look carefully at the Obama plan and understand that there is no turning back. Once this hundred dollar gravy train gets rollin, there will be no stopping it. The powerful interests will NEVER let go of this cash. We will have squandered our real chance for logical, reasonable health care reform advocated by conservatives like Newt Gingrich, and liberals like Sen. Feingold and John Conyers. We can have it all. The TWO BILL SOLUTION is the answer.

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