The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

More Health Care Reform Proposals Added to the Mix

Posted by Alan on June 18, 2009


So many health care reform proposals are flying around the nation’s capital it’s nearly time to bring in the air traffic controllers. There are draft bills, option papers, proposals, outlines, and about any other kind of document you can name whirling around like jets over O’Hare.

Michael Johnson of Blue Shield of California and I gave a presentation on health care reform Wednesday to a group of health insurance brokers. We were reading up on one of the latest ideas issued a few hours earlier literally minutes before the panel got underway. It’s only going to get worse as some stake out (somewhat extreme) negotiating positions while others offer up potential compromises.

Here’s some of the more recent health care reform proposals to be launched — or about to be:

  1.  The web site The Hill is reporting that moderates in the House of Representatives from both sides of the aisle are meeting in private to fashioning a compromise package. Among those meeting are part of the GOP’s “Tuesday Group,” the New Democratic Coalition and the Democratic Blue Dog Coalition. Fearing retribution from party leaders, neither side is offering the names of participants. The meetings are significant not just because they are likely to produce yet another health care reform package. The negotiations also underscore the reality that while the media tends to portray both Democrats and Republicans as monolithic parties of extreme ideologies, there are a significant number of lawmakers who eschew the hardline ideology of their colleagues and search for pragmatic solutions.
  2. Former Senate majority leaders unveiled a health care reform plan they hope will provide a middle ground in debate. The plan was developed by Republican former Senators Howard Baker and Bob Dole along with Democratic former Senators Tom Daschle and George Michell. (Former Senator Mitchell is credited by the Boston Globe with having contributed to the document, although it is signed by only Senators Baker, Daschle and Dole). It weaves around the middle on a number of issues, although it does lean to the left. For example, while the proposal does not call for a creation of a federal government-run health plan it would permit states to create them. It also calls for taxing the value of health plans an employee receives to the extent it exceeds the cost of coverage provided to members of Congress. According to the Boston Globe this would amount about $5,000 for an individual and $13, 000 for a family.
  3. The House Republican leadership unveiled their health care reform plan on Wednesday, too. Among other features it would allow states, small businesses and other group to come together into “pools” to offer low cost health plans that, at a minimum, is provided in a majoirty of states. It also would offer lower-income Americans refundable tax credits they could use to purchase coverage and would make individual health insurance premiums tax deductible. It does not require consumers to buy coverage, but the GOP plan would encourage states “to create a Universal Access Program by establishing and/or reforming existing programs to guarantee all Americans, regardless of pre-existing conditions or past illnesses … access to affordable coverage.” Development of the GOP plan was led by Representative Roy Blunt.
  4. Last week the Chairs of the three House committees with jurisdiction on health care reform released a framework for reform. The Tri-Committee Health Reform Draft Proposal, put forward by House of Representative Chairs Charles Rangel of the Ways and Means Committee, Henry Waxman of the Energy and Commerce Committee, and George Miller of the Education and Labor Committee outlines the key provisions of a unified Democratic reform package. The framework calls for creation of a government-run health plan to compete with private carriers, requires all Americans to obtain coverage (with exemptions in cases of financial hardship), requires most employers to either provide coverage or pay a fee, and provides subsidies for Americans households with incomes up to 400 percent of the federal poverty level.

There will be many more proposals coming soon. As it is relatively early in the legislative process, most will stake out relatively pure ideological positions. Neither party has an incentive to offer compromise solutions yet. So House Democrats, along with Senator Edward Kennedy and his Health, Education, Labor and Pensions Committee, will anchor the left and the GOP Leadership and conservative Senators will anchor the right. As in most negotiations, the goal is to establish a starting position so far to one extreme or the other that the middle shifts in their direction.  

There will be some pragmatic proposals put forward as well. The most anticipated is that expected to be coming soon from the Senate Finance Committee. It’s Chair, Max Baucus, and its Ranking Member, Charles Grassley, seem to be sincere in their efforts to put forward a bi-partisan solution. In the meantime, President Barack Obama will keep up a drumbeat in support of getting comprehensive health care reform legislation through Congress before the end of the year. Although the White House continues to let Congress take the lead in fashioning the final reform package, the Obama Administration is beginning to get more engaged in the legislative process.

What the final health care reform legislation will look like is, as yet, unknown. It may resemble one of the ideas already put forward. Or perhaps something new to the mix will gain momentum. I’m betting that something will pass this year. The process of getting to one bill will be messy, but eventually, a consensus will form.

Not yet, but eventually.

7 Responses to “More Health Care Reform Proposals Added to the Mix”

  1. KenK said

    No, Dave Wood, I don’t have faith in the Congress to get things right, which is why I want the government to stick to reworking Medicare. They are incapable of reducing the costs of health care, even for creating changes that are not all that ethically “sticky”, like requiring all Medicare beneficiaries to fill out a form that they want assistance in creating a san Advanced Directive or Living Will (or choose to do “everything”) which would, by itself, save billions of dollars in unwanted, unnecessary end-of-life care. Authorize the creation of CPT codes that reimburse health professionals to sit down with patients and their families for end-of-life planning would likely save billions more. The problem is, all the President and Congress speak in terms of is “off the top” savings–rob Peter here, pay Paul there, without any attempt to seek input from Peter or Paul on how they think they can save the taxpayers some serious money. I agree that the money will ultimately not be there for the Boomers even if the cap on FICA contributions is lifted.

  2. I think it is hard to compare the US to any European country. It is better to try and compare them to individual states, because based on population and size that is essentially what they are. Americans certainly do value choice and quality then maybe equality – for better or for worse.

  3. KenK said

    Single Payer is not the answer right now. The government has no successful business model to build from, certainly not in an expanded form of Medicare. The best path to take in the short run is to fix Medicare’s over-utilization issues and bring the insurance cartel under the same scrutiny and regulation that any public utility falls under. This includes establishing controls on the premium rates that can be charged relative to overhead and risk, tolerable levels of profitability, and codes of conduct for the insurers in their interactions with beneficiaries and providers. Providers will be required to follow accepted indications when ordering diagnostic studies as utilization would be monitored, and a reformed medical liability system would be in place to put an end to the practice of defensive medicine. Under a single payer in the U.S., providers would likely close their private practices and unionize as employees of the payer, leaving the liability coverage responsibility to the employer. At this point the government’s hand would be forced, and medical tort reform would occur under these circumstances as well.

    • Dave Wood said

      Single payer has many models to choose from. There are 40 nations that run single payer. Most use a regional model, then each region runs its own specifics based on local tastes with Federal guidelines.

      I have read from many different players like ex Bush HHA Secretary, and Mr. Nichols that we should have a more state based system whereby different preferences both politically and demographically, can be addressed.

      Certainly conservative Utah or Alabama agree on virtually nothing with liberal Vermont or Oregon, both politically or demographically. Why pass legislation that is nation wide when we don’t agree on much of anything regarding health care reform.

      If Congress would pass a structure, a outline for a single payer system AND a conservative written more choice and more competition private insuance based system, THEN let the states opt into either voluntarily through a local election, we could have a single payer system in a state like Vermont. Then the American people can see the results and slowly other states or countys could opt into their own self ruled and self taxing single payer system. Likewise we may see conservative Kanas pass a private insurance based more choice and more competition style system.

      The model for the conservative more choice and more competition type system would be Switzerland and Holland, where in fact they have a totally private insurance based system.

      The one stark difference between Europeans and Americans is that Europeans value EQUALITY over CHOICE. We Americans value CHOICE over EQUALITY, this results in Europeans complying with an individual mandate more easily than cowboy Americans.

      In fact I predict that Obama’s individual mandate Massachusettes style reform plan will result in perhaps a half reduction in the uninsured.

      A third of the uninsured can afford insurance but CHOOSE not to buy it. Most of these folks will buy it with subsidys. Another third of the uninsured are currently ELIGIBLE for existing govt. health care coverage, but fail to sign up. Do you believe these folks will NOW sign up? And many of the uninsured are living in poverty, or in the black market economy, are illegal, or are hiding from authority. I dont think Obama’s mandate will sway many of these folks.

      As for KenK and this best practices govt. authority, this is truly a scary thought that this new authority will now encourage Doctors and hospital to behave in a certain way. My wife is a RN and I can tell you with certainty that providers will tell you that each person and his or her treatments is DIFFERENT. Each Doctor is different.

      This new authority is a good idea, and should be set up, but I have zero faith that Congress will run it efficiently or effectively. It will become a political animal. When Republicans take back power, it will change.

      The state based systems are more likely to run this new best practices authority effectively because chances are the new state based single payer leadership will know on a personal basis the executives of the large hospitals, the prominent Doctors, and the political winds of their area. Would you trust Congress more than a locally elected authority to determine which treatments are paid for or not?

      This is my big idea on health care refom, I call it the TWO BILL SOLUTION. Help me spread the word. We can have it all, a private insurance more choice plan, AND a single payer plan based on states.

      • KenK said

        Let me clarify. First, I am a physician in private practice and I am keenly aware of differences in practice style that all fall within accepted standards of care. What I was referring to when it came to “government authority” was a less draconian version of the kind of utilization review that the private insurers have in place (and Medicare does not) to keep the health care providers from gaming the system for profit in the manner described in “The Cost Conundrum” by Atul Gawande. The goal here is to save MEDICARE from going insolvent by 2017, which is what it is currently on schedule to do. I did not express a belief that single payer is not right for the U.S., merely a lack of confidence in the Congress to adopt a plan in the ultra-near future with a business model that will both provide sustainable universal health care to all Americans without bringing the country to its knees financially. Again, I’m not saying the successful business models aren’t out there, I just don’t believe we’re going to get one of them if this process is rushed through as if we were all going to spontaneously combust if we don’t have the plan signed, sealed and delivered by the Fall.

        • Dave Wood said

          Well Hello there Dr. Kenny, great to hear from you.

          I understand your position and agree with you. However, if our goal is to SAVE medicare by 2017, and the two main drivers of high costs for medicare are; 1. our so called “system” and 2. the status of the health of the American people, how on gods green earth does Obama care solve either of these two drivers of high cost.

          Obama only makes the system more complex, more rules and regulations, more government intervention, more layers of boards and payers and bureaucracy. Obama makes the horribly fragmented system MORE fragmented.

          Obama does some noble common sense things like forces insurers to accept all applicants. But this will not lower costs.

          Obama sets up this new best practices board, but does anyone believe our great and noble Congress will run it effectively and efficiently?

          Remember these are the same folks who encouraged fannie may and freddy mac to buy MORE sub prime loans back in 04 and o5. Democrats wanted to aid the lower classes and enable them to buy more houses. Republicans wanted Fanny and Freddy to make more money. Hearings were held as to whether Freddy and Fanny should be reined in. We now have the results. The bubble was mostly created with the aid of the Congress and freddy and fannie and the Fed.

          Remember that the Congress voted FOR going to war on faulty evidence. They didnt bother to check the facts. Here we are, 5000 of Americas finest dead, thousands maimed for life, hundreds of thousands of innocent Iraqis dead, and a TRILLION bucks flushed down a rat hole, FOR WHAT?

          Our Federal govt. has failed to protect us from the 9-11 terrorists. The CIA knew who they were and even told the FBI to watch them as they entered San Diego. But what happened.

          How about Katrina, the unfunded Medicare presciption benefits, our failure to have ANY energy policy, and on and on.

          I have no faith in the Congress to get this right. Or to run it well. DO YOU?

          As for the status of the health of the American people. Ask any provider, they will tell you a tidal wave of diabetes is on its way. Obesity and associated heart disease, inflammatory diseases like arthritis and asthma, insomnia, depression, lack of a healthy sex life, are all on the increase. IF YOU THINK HEALTH CARE IS EXPENSIVE NOW, YOU AINT SEEN NOTHIN BABY!!!!

          Wait til the fat and happy baby boomers hit 65 and demand their Medicare. Alzheimers alone will bankrupt the system.

          Will Congress vote to raise taxes, or cut benefits? Will this new utilization process work? Best practices may work, who knows.

  4. Wendy Fry said

    Hi! I thought your readers might be interested in this fresh perspective:

    http://www.sdnn.com/sandiego/2009-06-04/news/health-fitness/arthur-salm-we-need-national-health-care

    http://www.sdnn.com/sandiego/2009-06-08/news/health-fitness/arthur-salm-european-vs-american-health-care

    http://www.sdnn.com/sandiego/2009-06-11/news/arthur-salm-american-vs-euro-health-care-pt-ii

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