The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Archive for July, 2009

Pelosi Paints Insurance Carriers as Immoral

Posted by Alan on July 31, 2009

It’s not easy being Speaker of the House. Just look at the Herculean task Speaker Nancy Pelosi has on health care reform. Her job is to herd 256 Democrats toward a consensus – Democrats who come from diverse districts and, as a result, bring to the House diverse perspectives. Her caucus is currently engaged in a harsh and public ideological battle over health care reform, and specifically on the issue of a government-run insurance plan.

It appears that Speaker Pelosi has decided on a strategy for dealing with this division, and it’s a page out of former-Senator John Edwards playbook. Last year when he was still a candidate for President, Senator Edwards displayed his flair for demagoguery by vilifying insurance carriers as unworthy to be part of the health care reform debate. Now Speaker Pelosi is going further.

Glenn Thrush described the Speaker’s outburst at, Speaker Pelosi was asked about liberals objecting to compromise on health care reform. He quotes her response, "’The public option — that’s where the insurance companies are making their attacks — it’s almost immoral what they are doing,’" said Pelosi, addressing reporters outside of her office a few minutes ago.

"’Of course, they’ve been immoral all along,’" she added. "’They are the villains in this, they have been part of the problem in a major way. They are doing everything in their power to stop a public option from happening and the public has to know.. They have had a good thing going for a long time at the expense of the American people and the health of our country.’"

Remember President Barack Obama’s call for for a civil debate in which “we can disagree without being disagreeable?” Speaker Pelosi apparently missed the memo.

Making the insurance industry the immoral villain may be good politics. The American public and their representatives love having a bad guy to boo. Black and white arguments generate a lot more sound bites than do debates painted in nuanced shades of gray. Slotting insurance companies into that role is a no-brainer. The public doesn’t trust insurance companies concerning health care reform and the industry has shown a startling lack of political skill over the years. Let’s face it, insurance carriers have auditioning for the villain role for years. Congratulations, you’ve got the part.

But should they be cast as immoral? Immoral people are unfit to participate in civil society. They are cast out from the community. They are less than the community. Is this what the Speaker of the House means? Is it what she believes? Is this the kind of language she should bring to bear on an opponent over a public policy issue? And is it really smart politics to describe an opponent on an issue as immoral when that opponent, if she were being fair about it, is backing a great deal of the health care reforms put forward by Democrats?

Speaker Pelosi supports a strong public policy option. I believe she sincerely believes it will “keep insurers honest,” increase competition in the market and help reduce health insurance premiums. She could have used her bully pulpit to educate voters on why she believes what she does. She could explain how a public plan paying less than health care providers actual costs strengthens the health care system in the United States. She could have explained why a public plan needs government-bestowed advantages to compete with private carriers.

Instead she chose the low road of a Glenn Beck. Mr. Beck, however, is an entertainer, not a political leader. His job is to create controversy without regard to reality and, shamefully, to inspire the worst in people. Speaker Pelosi’s job is to legislate and educate. Hers is a much higher calling than Mr. Beck’s. She should be held to a higher standard.

Legitimate concerns have been raised concerning the efficacy of a government-run health plan and its ability to create a competitive market without destroying that market. Speaker Pelosi owes it to the American public to address those concerns. In providing that explanation criticism of the health insurance industry will be be warranted, but such criticism cannot be the entire explanation. Nor does the criticism need to be less than civil.

The Bush Administration made an art form out of casting opponents to its policies as immoral and unpatriotic. Speaker Pelosi used to oppose that kind of politics and she was right to do so. She is wrong to embrace it.


Posted in Health Care Reform | 20 Comments »

Progressives Will Face Tough Health Care Reform Choice

Posted by Alan on July 29, 2009

Just looking at the broad facts, liberals should be riding high. President Barack Obama occupies the White House. Democrats hold a 60-40 super-majority in the U.S. Senate and a commanding 256-178 majority in the House (with one more on the way after a special election in California later this year). Republicans are on an electoral losing streak of epic proportions and have yet to find a unified voice. It doesn’t get much better than this.

Except appearances can be deceiving and liberals will soon need to decide whether they are willing to vote for a bill that, in their view, improves America’s health care system but does not go nearly far enough or should they leave the system the way it is.

Note: This post was updated on July 30th to provide more details concerning the House Energy & Commerce Committee compromise and liberals reaction to it. Additions are presented in italics.

The evolution of health care reform legislation as it moves through Congress must frustrate progressives. It started off to their liking. Senator Edward Kennedy’s Health, Education, Labor and Pensions Committee pushed forward a bill that satisfied much of the liberal wish list. Good times continued when the House Ways & Means and the Education & Labor Committees passed equally progressive bills. That the affirmative votes on all three committee came exclusively from Democrats was not of great concern to supporters. Health care reform was coming whether Republicans wanted to join the parade or not.

Liberals were on a role, but then their moderate and conservative colleagues began to make their presence felt. And there are more of them than is generally acknowledged. While conservative talk show hosts like to brand the Democrats as a monolithic subsidiary of Mao-spouting communists, the reality is far different (actually, reality is usually different than that described by conservative talk show hosts, but that’s a topic for another day).  A party does not capture 60 percent of the Senate and 59 percent of the House by running cookie cutter candidates all pledged to the same ideology. The country is too diverse. The brilliance of Rahm Emanuel, then head of the Democratic Congressional Campaign Committee and now White House Chief of Staff, was that he discarded virtually the entire Democratic litmus test in his search for candidates. The only significant requirement he demanded of the candidates he recruited was that, once elected, they would vote for a Democrat for Speaker of the House. Meanwhile, the GOP who hewed closely to the beliefs and principles of their base. Moderates were scorned and labeled RINOs (Republicans in Name Only). They succeeded in recruiting ideologues who had no chance of winning outside the reddest of red districts.

Consequently, the Democratic caucus is chock full of moderates and even conservatives.  Which all but guarantees that liberals will be disappointed. There are simply not enough liberals in Congress to pass a bill without support from moderates.

So it should not have been a surprise when problems developed as the progressive juggernaut moved beyond some of the most liberal committees in Congress. The Blue Dog Coalition, a group of moderate Democrats in the House, objected to a host of provisions in the Ways & Means and Education & Labor bills. While they lacked the votes to hold up the legislation in those committees, they did such leverage in the the House Energy & Commerce Committee. The Blue Dog Democrats had an agenda for health care reform that differed in many respects from that of their more liberal colleagues.

Meanwhile, in the Senate, Democrats and Republicans on the Senate Finance Committee were working tirelessly to hash out a health care reform package that could garner bi-partisan support. To get there, Senator Max Baucus, Chair of the committee, was willing to jettison some of the more treasured elements of the liberal health care reform agenda.

Both the Blue Dog Democrats and the moderates on the Senate Finance Committee are making substantial progress. House Energy & Commerce Committee Chair Henry Waxman and Representative Mike Ross, speaking on behalf of the Blue Dogs, announced an agreement that will allow the full committee to begin marking up health care reform legislation. The specific changes to the bill from the versions passed by the Ways & Means and Education & Labor Committees are not yet public. But there are four major elements according to wire stories:

  • Keeping the 10-hear cost below $1 trillion by agreeing to $100 billion in cuts
  • Preventing a public plan from simply imposing Medicaid rates by allowing physiicans and other medical providers to negoiate rates with the government plan
  • Exempting businesses with payrolls below $500,000 (86 percent of all small businesses)  from any government mandates requiring them to provide health insurance to their employees
  • Postponing a full House vote on health care reform until after September 8th

At the same time, Senator Baucus and the ranking minority member of the committee, Senator Chuck Grassley, are making it known they are close to unveiling the Senate Finance Committee’s compromise. Their proposal is unlikely to include a government-run health plan. It may not include all the mandates and subsidies liberals seek. In short, they will reform the health care system, but leave much of what exists in place. Which puts progressives in an uncomfortable position.

Moderates and conservatives seem willing to defeat any health care reform legislation rather than vote for the kind of reforms liberals seek. Will liberals refuse to support legislation that does not go as far as they demand? As of now they are threatening to do just that. The Progressive Caucus is circulating a letter seeking 50 signatures (enough to defeat any bill) pledging to kill any legislation failing to contain a strong public plan.

That’s not yet known. That the compromise proposals will be attacked from both the left and the right is to be expected. And liberals are already expressing outrage at having their wishes denied. For example, the Associated Press quotes Representative Lynn Woolsey  as saying “They can’t possibly be taking us seriously if they’re going to bring this [compromise legislation] forward.”

But will liberals insist on getting their way even if it means letting the status quo stand?

Ideology and pragmatism are often hard to reconcile, but my prediction is that liberals will vote for moderate health care reform. The reason: Senator Kennedy and President Obama will eventually accept a compromise. Throughout his career Senator Kennedy has demonstrated the political wisdom of taking half a loaf now and continuing the fight for the rest another day. And, according to the Associated Press story cited above, the White House is already making clear the Administration is willing to settle for a more moderate bill.

With Senator Kennedy and President Obama’s urging, enough liberals will accept that even modest reform is preferable to the status quo. They won’t be happy with what it contains, or more accurately, what it doesn’t contain, but they will be among those applauding when President Obama signs the bill into law this Fall.

Added 9:05 pm July 29, 2009: As noted above, liberals are upset over any compromise that does not include a public health insurance plan. In a post on, Glenn Thrush reports that “Two months ago, most of the 80-plus members of the Congressional Progressive Caucus signed a pledge that they would oppose any health care bill that didn’t contain a bona fide public option that would compete with private insurers. On Wednesday, they seemed willing to stick to their promise.”  He goes on to quote Representative Barney Frank as saying liberals might reject the House leadership’s  request to support a weakened public option. “I don’t think it would pass the House — I wouldn’t vote for it,'” the post quotes Rep. Frank as saying.  No one would cheer louder than Republicans to see health care reform fail because moderate and liberal Democrats fail to come together. Which is, to repeat my prediction from above, why I think liberals will eventually take a deep breath, vote for a moderate bill, and come back in 2010 fighting for more.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics | Tagged: , , , , , , , , , , , , | 4 Comments »

Coming Soon: Health Care Reform That Might Pass

Posted by Alan on July 27, 2009

We’re getting closer to seeing what the health care reform likely to emerge from Congress will actually look like. The Senate Finance Committee is likely to unveil its bi-partisan reform plan in the next few days. While it’s likely to disappoint members of both parties, it also holds out the greatest promise for serving as a framework for meaningful, comprehensive reform.

Some of those who will be disappointed with a more centrist approach to health care reform will be those who have created a cottage industry from highlighting the more egregious elements of the plans already passed by Congressional Committees. These proposals never had much chance of becoming law, but partisans across the spectrum embraced them as either statements of principles (on the left) or evidence of skullduggery (on the right). countless hours of heated argument, outraged accusations, misinformed attacks, and righteous indignation have been heaped on these bills. They also generated, to be fair, serious public policy debates on meaningful issues that shined a light on the complexity and trade-offs inherent in reforming one-sixth of the nation’s economy. They received all this attention in part because they were the only detailed reform plans around.

The Senate Finance Committee is about to change that. And it could be the House Energy and Commerce Committee, whose liberal and moderate Democratic members are seeking to find common ground, may also come forward with a detailed plan soon.

The health care reform proposal likely to emerge from the Senate Finance Committee will disappoint some in the White House. According to the Associated Press, it does not call for creating a government-run health plan as President Barack Obama has proposed to provide competition for private carriers. Instead, such competition would be provided by non-profit health insurance cooperatives. While the federal government would provide seed money for launching these cooperatives, they would have to survive in the market without government subsidy or management. The Senate Finance Committee is also expected to forgo requiring businesses to offer health insurance coverage to their employees, although individuals would be required to obtain such coverage on their own if their employer does not offer it.

There will no doubt be much in the Senate Finance Committee’s proposal to raise the ire of, well, most everyone. If there was a path to health care reform that triggered spontaneous outbursts of Kumbaya in the halls of Congress, it would have been introduced and enacted by now. So we get to look forward to plenty of controversy, sniping, partisan positioning and serious policy debate over the next several weeks.

The good news, however, is that all that energy will be directed to refining a health care reform plan that has the chance of actually being enacted. And that is progress.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics | Tagged: , , , , | 10 Comments »

Health Care Reform Status Quo a Bad Plan

Posted by Alan on July 25, 2009

One thing everyone can agree on: there is no perfect health care reform legislation. Every idea has flaws. Every proposal presents problems. This is the reality, but it should not be an excuse for doing nothing. Because the status quo is flawed and problematic, too. And the longer it takes to address the fundamental problems of the current system, the worse the cure will be.

This is a point President Barack Obama made in his press conference on July 22nd. Calling the status quo a “back-breaking alternative plan” he positioned the situation accurately. What’s being debated in Washington is not just the risks and benefits of change, but the cost of doing nothing.

Steven Pearlstein made the same point in his Washington Post business column. “Among the range of options for health-care reform, there’s one that is sure to raise your taxes, increase your out-of-pocket medical expenses, swell the federal deficit, leave more Americans without insurance and guarantee that wages will remain stagnant,” he writes. “That’s the option of doing nothing ….”

It is becoming increasingly difficult to argue for the status quo, yet that’s what the “no reform” advocates are doing. They ignore the financial reality that, unless changes are made, the current system will increase government deficits and shackle business expansion. Eventually changes will be made. The longer the tough decisions concerning what changes to make are put off, the more onerous the eventual changes are likely to be – single payer anyone?

This is not to say that proposals currently on the table are better than the current system. Some would definitely make matters worse. What it argues for is giving those seeking comprehensive and responsible reform to do their work. As Mr. Pearlstein points out, the broad outlines of reform are swirling around Washington: shifting reimbursement from fee-for-service to quality, requiring carriers to sell and consumers to buy coverage, preventive care, and accelerating the adoption of medical technology. I’d add to the list the likelihood that calls for a public plan will morph into acceptance of health insurance co-operatives, owned by its members. This is the direction in which I hope the health care reform debate will move. But what matters is keeping it moving.

Because the status quo is an alternative that may be reassuring to some now, but is likely to result in far worse reforms i the future.

Posted in Health Care Reform | 12 Comments »

Who Americans Trust on Health Care Reform

Posted by Alan on July 24, 2009

Ouch! That’s one word that comes to mind after reading the results of a Gallup Poll asking Americans which of several groups they have confidence in when it comes to health care reform. The results are clear: if you deliver health care or are an objective authority on health care policy, the public trusts you. If you’re a politician, not so much. And if you’re an insurance company, the only group less trusted are Republicans in Congress. That’s got to hurt. Can you imagine being a Republican Senator and heading off to work each day realizing that the public trusts insurance carriers to do a better job on health care reform than you? Ouch!

The Gallup study was taken in June, so the numbers have no doubt changed. For example, a July 21st Gallup survey show a majority of Americans “disapprove of the way Barack Obama is handling healthcare policy.”  Even so, the poll is still interesting in what it reveals about the standing of certain groups in the eyes of the public (my thanks to reader Meg McComb for bringing it to my attention). The question Gallup asked was, “… please say whether you are confident or not confident in each [group or individual named] to recommend the right thing for reforming the U.S. healthcare system.”

The percent of respondents expressing confidence:

  • Doctors:     73%
  • Healthcare professors/researchers:     62%
  • Hospitals:   61%
  • President Barack Obama:     58%
  • Democratic leaders in Congress:     42%
  • Pharmaceutical companies:     40%
  • Health insurance companies:     35%
  • Republican leaders in Congress:     34%

What the poll found is that doctor, hospitals and researchers are viewed positively across the political spectrum whereas the support for the others is more partisan. So, for example:

  • Hospitals had the confidence of 60% of Democrats, 57% of Independents and 68% of Republicans to recommend the right health care reform.
  • President Obama had the confidence of 85% of Democrats, 53% of Independents and 28% of Republicans
  • Health insurance companies had the confidence of 33% of Democrats, 32% of Independents and 42% of Republicans.

Partisans, not surprisingly, were sticking with their home team. The Democratic leadership had the confidence of 70% of Democrats, 36% of Independents and only 15% of Republicans. The Republican leadership had the confidence of 65% of Republicans, 27% of independents, and just 19% of Democrats.

One interesting finding: while 35% of Democrats and Independents have confidence in the pharmaceutical companies concerning health care reform, an impressive 52% of Republicans do. Which makes one wonder, what medication are they on?

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics | Tagged: | 4 Comments »

Health Care Reform 2009 and the Danger of News Cycles

Posted by Alan on July 23, 2009

The campaign for health care reform is making a lot of people nervous. Every day the media is reporting on a crippling blow President Barack Obama’s reform effort has suffered or on the inevitability of passage. It’s like watching an episode of 24 or Lost every episode (or news cycle, as the case may be) a new cliff hanger. The television shows are obviously fictional. The drama of the health care reform debate is, at times, equally manufactured. And even when the situation is real, the situation is neither definitive nor long lasting.

However you get your news, the situation is pretty much the same. Every news cycle there’s some make-or-break event that requires breathless analysis. The reality is not every meeting, vote or comment is of momentous importance. It may be interesting. It may be informative. But it momentous events are few and far between. Which poses a problem for the media because they live or die on excitement.

The reason is that the need of the media to capture attention of a large audience outweighs its sincere desire to educate and/or influence that audience. The news media is a business. Like all businesses (even non-profits) it must generate revenue. For the media this means selling advertisements.  Most reporters and pundits have a want to educate and inform. Some seek merely to entertain or inflame. All of them, however, have a need to bring an audience to their advertisers. This means the stories they put forward need to excite their audiences enough so they can be exposed to the advertising that creates the revenue the media owners expect. (In this admittedly cynical view, the reporters and pundits are the equivalent of the brokers – it all begins with a sale).

In-depth stories examining the subtleties of a complicated issue like health care reform are not very exciting to a broad audience. Further, most reporters and pundits lack the expertise to examine the subtleties of health care reform. That’s not a put down as it’s not their fault. They need to be generalists and understanding health care requires specialized knowledge. Even those who truly understand the intricacies of the issue face a serious problem, especially on television: the need to break for commercials every few minutes. It’s tough to maintain a narrative when your presentation is constantly being interrupted to sell cars, prescription drugs or cleansers.

What does excite people is conflict. Which is why the media loves a good fight. Conflict requires good guys and bad guys, winners and losers. So instead of exploring the nuances of how a health insurance exchange might work (or what challenges it may face) or how the governments Medicare and Medicaid reimbursement policies increases the cost of private health insurance, the press focuses on the political maneuvering of the day. Broad statements by lawmakers go unchallenged because there’s simply not enough time (or expertise ) to challenge them. Instead, the best sound bites of the day are played and discussed in an echo chamber designed to amplify any conflict – or to create conflict where none exists.

I don’t blame the press. They have a job to do and, as I mentioned, most have a sincere desire to inform their audience as much as is possible given the restraints of their business. I do feel sorry for their audience. They can’t help but perceive the health care reform debate as a pitched battle between the forces of Light and Darkness with ultimate victory or defeat at risk each day. In short, they are exposed on a regular basis to a heightened version of reality intended to cause enough fear, relief, frustration, and elation to keep them paying attention through the commercials.

So, for example, President Barack Obama wanted each chamber of Congress to pass a bill so the two versions of reforms could be reconciled into a single bill and voted upon in the Fall. The Senate will not meet this deadline (the House probably won’t either, but they may). For the media this is great. Everyone understands due dates. Congress missed theirs so health care reform is in deep trouble and the President lost a major political battle.

Well, not quite. There’s still plenty of time to complete health care reform this year. And while the President may have missed a deadline, at the end of the day he will be judged by whether the status quo endures or not. It’s like owning stock. The price of the stock you own may change every day, but the only thing that matters is the price on the day you sell it. But the media can’t let this be known so every day’s stock price is of paramount importance..

Another example: three Congressional Committees have moved health care reform bills forward (an important milestone). Two Congressional Committees are still refining their proposals. Which ones are the most important? Given the hyperbole and attention showered on the versions that have already made it through a committee you’d be forgiven for assuming it’s the former. The odds are, however, that what emerges from the Senate Finance Committee and the House Energy and Commerce Committee are going to more closely reflect the final legislative package than anything already voted upon. The reason is that these committees are seeking to gain the support of moderates (both Democrats and Republicans) and those moderates are critical for passage.

Consider: Democrats have 60 votes in the Senate, but 18 of those are moderates. Without the support of at least eight of those moderates nothing passes in the Senate. (And this assumes only 50 votes will be needed. If 60 votes are required to move health care reform legislation through the Senate, which is more likely, then every one of those moderates needs to be brought on board).

In the House, Democrats will soon hold a 257-178 member majority (there’s one vacancy, so there are only 256 Democrats in the House today). It takes 218 votes to pass anything through the House. Without Republican support, the House Leadership can only afford to lose 39 members of their caucus. The moderate Blue Dog Coalition has at least 52 members. Do the math.

What all this means is that we have yet to see the two most meaningful health care reform bills yet. Which makes much of what’s being reported lately exciting, but ultimately, not as important as the media would have us believe. The day-to-day tumult is not what matters. Health care reform will be determined by the forces and dynamics that are not easy to explain. And they certainly don’t fit within commercials.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics | Tagged: , , , | 4 Comments »

Health Care Reform Outline Becoming Clearer as Deadline is Missed

Posted by Alan on July 22, 2009

The reality is that Congress will miss President Barack Obama’s August deadline for health care reform. The Administration had wanted each Chamber to pass a bill before Congress recesses in early-August. Members of a Conference Committee would then spend the recess working through differences between the bills and Congress would be in a position to send legislation to the President’s desk in October. That was the plan.

Now there is a strong likelihood Congress will be unable to pass out a bill before the summer recess. Part of the reason is that moderate and conservative Democrats are balking at the price tag for reform and some of the provisions being pushed by their more liberal colleagues. At the same time, the Senate Finance Committee and its Chair, Senator Max Baucus, has not given up on fashioning a bi-partisan bill, no mean feat on legislation as complicated as health care reform.

What this means is that lawmakers will return home in August with numerous questions concerning health care reform unanswered. They will hold town hall meetings, listen to constituents, and return in September to make the final effort to reform America’s health care system. While this will push the work of the Conference Committee back by a few weeks, it does not mean the President’s real deadline — signing a bill into law this year — will be missed. It just means the Conference Committee will have a bit less time to do their work.  (A short civics lesson: a Conference Committee is an ad hoc working group comprised of both Senators and Representatives from both parties whose job it is to reconcile bills on the same topic passed by the Senate and House. Their compromise bill, if approved by both Chambers, is then sent to the President for his signature or veto).

The summer recess will hardly be relaxing for most members of Congress. While home they will be confronted on a daily basis passionate advocates on all sides of all the many issues tied to health care reform. Cost containment, universal coverage, preventive care, taxes, mandates and more will be part of their daily diet. Whether the cumulative effect of this stew of meetings, confrontations and discussions will be to encourage a more progressive or a more moderate approach to reform is an open question. Certainly millions of dollars will be spent by interest groups of all political persuasions, especially in the districts and states of moderate Democrats. The 24-hour cable news networks will be so inundated with health care reform advertising next month they may have no room for their regular fare of prescription drug, debt relief and Vonage commercials.

While the deadline is being missed, what elements are likely to be included in the reform package is becoming clearer. It is all but certain, for example, that an exchange will be created with the intention of helping consumers shop for health insurance will be created (although the nature of this exchange is still to be determined). There is also, surprisingly, a growing consensus on requiring every American to have health insurance. As reported by the Washington Post, the idea of an individual mandate “Is one of the few common threads running through all three bills being considered in Congress, greatly increasing the likelihood it will survive the legislative process.” Given that another virtual certainty is that carriers will be obliged to accept all applications for coverage without regard to pre-existing conditions, this is a good thing. States in which there is a mandate to sell coverage, but not one to buy it, premiums sky rocket. In New York and New Jersey, where this imbalance exists, average premiums for individual coverage are more than twice as high as they are in California which has neither mandate.

Not everyone supports a balanced approach to guaranteed issue. Many Republicans oppose the concept of requiring individuals to buy health insurance. One Republican proposal, The Patients’ Choice Act, introduced by two Senators and two Representatives, all self-proclaimed conservatives, emulates the New York and New Jersey model. Meanwhile some Democrats are concerned subsidies to help low income Americans afford the premiums they’d be required to pay will be inadequate. Nonetheless, as the Washington Post article explains, support for the concept is widespread.

Even President Obama, who opposed the mandate to purchase idea during the campaign has come around as long as there are exemptions for those who simply cannot afford the premiums: “I was opposed to this idea because my general attitude was, the reason people don’t have health insurance is not because they don’t want it, but because they can’t afford it. And if you make it affordable, then they will come,” he said in a recent interview with CBS. “I’ve been persuaded that there are enough young, uninsured people who are cheap to cover, but are opting out. To make sure that those folks are part of the overall pool is the best way to make sure that all of our premiums go down.”

So yes, Congress will miss the August deadline for passing health care reform. At the same time, critical elements of what will eventually emerge in the reforms are becoming increasingly clear. The only deadline that really matters is passing legislation before the silly season of mid-term elections arrives. And that’s a target date Congress is likely to meet.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics | Tagged: , , | 13 Comments »

Health Care Reform: It’s Not About Obama

Posted by Alan on July 21, 2009

Health care in America is complicated, pervasive and critical. There’s a lot that works well in the current system. There is much that needs to be fixed. Getting health care reform right will take patience, determination and constructive debate. That’s why it makes sense to worry less about deadlines and more about getting reform right.

Moderate Democrats and others have been driving this point home and President Barack Obama statement’s were beginning to recognize Congress was unlikely to meet his August deadline for passing health care reform legislation. (He continued to push for enactment this year, but seemed more open to a vote in the Fall).

Enter South Carolina Senator Jim DeMint. Speaking on a conference call organized by Conservatives for Patients Rights, Ben Smith on reports Senator DeMint as saying if Republicans can “hold [health care reform] back until we go home for a month’s break in August … Senators and Congressman will come back in September afraid to vote against the American people.” This may or may not be true, but it’s certainly a reasonable political analysis. However, the Senator then went on to say,  “If we’re able to stop Obama on this it will be his Waterloo. It will break him.”

And thus Senator DeMint undermines the efforts of responsible lawmakers to pass thoughtful health care reform legislation. Senator DeMint did not offer public policy differences with President Obama. He cast the issue as purely political. It was the essence of the “just say no” “I hope Obama fails” foolishness that Republicans spout from time-to-time. It’s the my ideology right or wrong philosophy that has made the GOP party a distinct minority in Congress. It makes the health care reform issue all about President Obama.

Regardless of whether you agree with Senator DeMint’s opposition to President Obama or not, this is inept politics. It undermines substantive reasons for taking more time to refine the health care reform package. Worse, it gives the Administration an opportunity for changing the topic and potent ammunition for calling for fast passage. Which is exactly what’s happened. Newsweek describes the scene: President Obama is speaking at a Children’s hospital. After quoting Senator DeMint’s remarks, he proclaims, “Think about that. This isn’t about me. this isn’t about politics. This is about a health care system that is breaking America’s families, breaking America’s businesses and breaking America’s economy. And we can’t afford the politics of delay and defeat when it comes to health care, not this time, not now.” In other words, on “their” side is the party of “no,” on your side, my fellow Americans, is me.

The Administration wants nothing more than to cast his health care reform effort as a battle against obstructionist conservatives. You may have noted that conservatives got pounded in the last election. They make ideal targets. Making Senator DeMint the face of the GOP anti-health care reform efforts is a gift to the White House. Even Senator DeMint realizes this. “Let’s be clear, there is no one in this debate advocating that we do nothing despite the president’s constant straw man arguments,” the Senator said yesterday. And he’s right, the Administration is using his remarks to create a straw man, an easy target to knock down. The reality is what Senator DeMint says to a group of conservatives who already agrees with him doesn’t really mean much. He was preaching to the choir. But when his language was given a wider audience, it was easily exploited.

Senator DeMint said today that “Republican have offered comprehensive health care reform solutions ….” Technically that’s true, but what the GOP has put forward is as misguided in their own way as any element of the Democrat’s proposals.

What’s needed, but won’t happen, is for everyone to take a deep breath and calm down. It will take 60 votes in the Senate to pass health care reform – President Obama knows this, the Congressional Leadership knows this and so do the pundits. There are not 60 liberals in the U.S. Senate. Nor are there 40 conservatives. The political reality is the reforms that emerge will reflect the views of the moderates that can provide the necessary votes. This doesn’t mean the reforms will be wise, but it probably means they will be less than extreme.

The Senate Finance Committee’s proposal will come the closest to reflecting this moderate approach to reform. They need more time to get their bill together and we should give it to them. In the meantime, let’s recognize that health care reform is too important an issue to play with solely to embarrass a political opponent. Doing so only makes the job harder.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics | Tagged: , | 5 Comments »

Obama: Don’t Bet Against Health Care Reform This Year

Posted by Alan on July 17, 2009

A few hours ago I wrote about how President Barack Obama was ratcheting up the heat and pressure on Congress to pass comprehensive health care reform in August. Today he turned down the heat a bit, but kept the pressure on. In a skillful speech he laid out to the American people the benefits they will gain from health care reform, described the substantial areas of agreement already achieved by negotiators, reinforced his reasons for seeking reform, and pledged that reform will be enacted this year.

Some highlights from his speech.

Existing common ground: “We’re now at a point where most everyone agrees we need that we need to invest in preventive and wellness programs that save us money and help [us] lead healthier lives.We have an agreement on the need to simplify the insurance forms and paperwork that patients have to fill out every time they go to a hospital or see a doctor. We have an agreement on the need to reform our health insurance system so that if you lose your job, change your job or start a small business. you can still get affordable health insurance. We have an agreement on the need to prevent insurance companies from denying coverage to Americans with pre-existing medical conditions. And we have agreement on the need for a health insurance exchange, a marketplace where people can compare prices and quality and choose the health care plan that best suits their needs.”

On the benefits reform: “This is what health insurance reform will mean for the average American. It will mean lower costs, more choices and coverage you can count on. It will save you and your family money. You won’t have to worry about being priced out of the market. You won’t have to worry about one illness leading to your family going into financial ruin. Americans will have coverage that finally has stability and security. And Americans who don’t have health insurance will finally have affordable quality options.”

Impact on the deficit: “Health insurance reform cannot add to our deficit over the next decade. And I mean it.”

On cost containment: “Our proposal would change incentives so that providers will give patients the best care, not just the most expensive care, which will mean big savings over time. This is what we mean when we say that we need ‘delivery system reform.’ I’ve proposed to Congress .. that an independent group of doctors and medical experts will oversee long term cost saving measures. Every year there’s a new report that details how much waste and inefficiency there is in Medicare, how best practices are not always used, and how many billions of dollars could be saved. Unfortunately, this report ends up sitting on a shelf. And what we want to do is force Congress to make sure that they are acting on these recommendations to bend the cost curve each and every year.”

What’s at stake and the timing of reform: “Now is not the time to slow down. And now is certainly not the time to lose heart. Make no mistake, if we step back from this challenge at this moment we are consigning our children to a future of skyrocketing premiums and crushing deficits. There is no argument about that. If we don’t achieve health care reform we cannot control the costs of Medicare and Medicaid and we can not control our long term debt and our long term deficits … If we don’t get health care reform done now then no one’s health insurance is going to be secure because you’re going to continue to see premiums going up at astronomical rates,  out-of-pocket costs going up at astronomical rates and people who lose their job or have a pre-existing medical condition or changing their jobs finding themselves in a situation where they cannot get health care. And that is not a future that I accept for the United States of America. And that’s why those who are betting against this happening this year are badly mistaken. We are going to get this done. We will reform health care. It will happen this year.”

A few observations:

The President referred to his effort as “health insurance reform” on more than one occasion. Every drama needs a bad guy. With hospitals and doctors supporting key elements of reform, prepare for a lot of the rhetoric to turn against the insurance and pharmaceutical industries.

President Obama did not mention the month of August even once. As I wrote earlier today, he had been hammering at Congress to pass legislation next month. If the House and Senate were each to pass legislation that quickly it would still need to go to a conference committee, which means final passage would still be in the Fall. By emphasizing when the bill will get to his desk (“this year”) as opposed to when milestones are achieved in Congress, he shifts attention away from the inside baseball of the legislative schedule and returns it to the benefits of reform (“It will save you and your family money.”). That’s smart politics – it focuses on the benefits, not the features, and avoids appearing like he’s jamming reform through an unwilling Congress.

In his list of areas of agreement, the President included Exchanges, but did not mention a government-run health plan. Exchanges, as noted in a previous post, Exchanges can be a force for good or for not so good. Watching what kind of exchange emerges from the debate will be important. One should not read too much into his failure to mention public plans. He was simply being accurate – there’s no consensus on them. This doesn’t mean he’s giving up on the idea, just that the issue is still open.

President Obama also did not use his statement to threaten Republicans with an expedited process that would prevent them from filibustering on health care reform. This public restraint contrasts with the comments of his top aides. Coupled with his recent meetings with Senate moderates it indicates the Administration has not completely given up on the finding common ground critical for a bi-partisan solution.

The Obama Administration is deep into campaign mode on the health care reform issue. As he proved over the past two-plus years, it’s risky to bet against Barack Obama in a campaign. As the man said, “We are going to get this done. We will reform health care. It will happen this year.” If there’s any way to deliver on this promise, President Obama will find it.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics | Tagged: , , | 15 Comments »

Obama Should Focus on Getting Health Care Reform Right, Not Fast

Posted by Alan on July 17, 2009

President Barack Obama, as expected, has launched a full-court press on health care reform. For the fourth day in a row he spoke out on the issue, his tone becoming increasingly impatient. He consistent message is for Congress to pass comprehensive health care reform passed in August, which is a shame. His passion should be focused on what reform Congress passes, not when.

President Obama’s passion for health care reform is sincere and clear. Fixing America’s health care system was central to his campaign. Reform is critical to his economic recovery strategy. As moderates and others question the cost and approach to reform, the President’s tolerance is wearing thin. Here’s how CBS News reported on a speech he gave in New Jersey yesterday: “We have finally reached a point when inaction is no longer an option," Obama said, his hoarse voice rising in volume and anger. "I will not defend the status quo." Obama brushed off his opponents as naysayers who expect a different outcome with the same-old approaches to a decades-old challenge. "It’s a path where our health care costs keep rising. … That’s not a future I accept," Obama told the friendly audience.

The ramp-up in rhetoric is tied to an increase in concern about the legislative proposals moving through Congress. Take the preliminary analysis of the health care reform package being considered in the House of Representatives by the Congressional Budget Office. (The analysis does an excellent job of summarizing that bill as well). In his blog, CBO Director Douglas Elmendorf described the findings: “enacting those provisions by themselves would result in a net increase in federal budget deficits of $1,042 billion over the 2010–2019 period. “ His office also estimates that it would reduce the number of uninsured in the country “by about 37 million, leaving about 17 million nonelderly residents uninsured (nearly half of whom would be unauthorized immigrants).” That would increase the number of Americans under the age of 65 with coverage to an impressive 97 percent. But that trillion dollar plus price tag is causing sticker shock in Washington, causing widespread hyperventilation among lawmakers and pundits. (It is important to emphasize that the CBO analysis was preliminary and did not take into account all of the provisions of the bill).

Then there were the meetings President Obama held with moderate Senators Republican Olympia Snowe and Democrat Ben Nelson – both of whom urged him to slow down the process and let negotiations take their course. Add to the mix a letter to Congressional Leaders signed by Senators Snowe and Nelson, along with Senators Susan Collins, Joe Lieberman, Mary Landriu, and Ron Wyden (two Republicans and four Democrats) asking for additional time to find a compromise on health care reform, and you can see why the White House is pushing hard to keep the August deadline alive.

But that’s the wrong focus. The President’s need for speed is a political one. The longer the debate goes on  the greater the possibility outside events or internal political fighting will derail the effort. Passing legislation as complicated and controversial as comprehensive health care reform requires momentum and a sense of urgency. The August deadline, especially in the context of legislation passed by Congressional Committees so far, create both.

Legislation as complicated and controversial as comprehensive health care reform also requires careful consideration and broad support. The careful consideration minimizes the unintended consequences that will surely result from changes of this nature. The broad support assures increases the odds of the new law being enacted smoothly and with a minimum of interference by a future Congress.

By calling those who want to delay passage of health care reform obstructionists implies that the President supports the versions currently before Congress. Yet when asked about specifics the President and his spokespeople note that the details need to be worked out by lawmakers and everything is still on the table. In other words, President Obama wants Congress to hurry up and pass something. He’s outlined what he’d like in it (a public plan, exchanges, a host of cost control measures) and what he doesn’t like (taxing high-end benefits), but he’s not pushing for any specific bill. He’s just pushing.

The problem with this approach is that the President is putting his political capital and prestige into play for a timeline, not a policy. If Congress fails to enact a bill by August the President will be seen as having lost, even if they return from their summer recess and pass a sound bill. Worse, from his point of view, he’s giving opponents another argument for voting against reform if it’s brought to a vote next month: that the process was rushed.

The President would be far better served politically to have the Senate Finance Committee continue to work toward bi-partisan health care reform even if it means pushing back passage of a bill by a couple of months. The nation would be far better off with this outcome, too. The resulting legislation would be more likely to make America’s health care system better, more efficient, more fair and more broadly accepted.

Arm twisting lawmakers into enacting health care reform by an arbitrary date is politics as usual. President Obama promised something different. He should keep that promise and focus on getting health care reform right, not just fast.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics | Tagged: , , , , , | 5 Comments »