The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

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.

10 Responses to “Coming Soon: Health Care Reform That Might Pass”

  1. Don said

    I haven’t been able to find out if the bills currently being discussed include:
    1. will we still be able to purchase a supplementary insurance policy over Medicare (or the new public “medicare” like option)
    2. will illegal immigrants be covered? legal immigrants who are not citizens? If yes, would it follow that tourists, visitors, etc who need health care while in the US be also covered?
    Will you address these two subjects?

  2. Cathy Reese said

    I truly have to wonder if how the government has managed the health care of our soldiers returning with battle injuries is reflective of how astute it is and will be about all our health care requirements?

  3. Amir said

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    The ads for all visits go to charity to fight Ulcerative Colitis too!



    Thanks in advance.

  4. Sean said

    Everything that I have seen about this focuses on the symptom and not the cause. Obama wants for the insurance companies to have to pay for more treatment and reduce the limitations. Won’t premiums have to increase, in order for the insurance companies to pay for these? The answer is yes. Where will the costs of the government’s central processing branch come from? The answer is us(taxes).

    Getting back to the actual cause of high healthcare costs. The greatest cause of increased doctor cost is malpractice insurance. Malpractice rates are ridiculously high because there are no limits on punitive damages. These cases are presented to juries, who only think about giving money to a poor plaintiff. What they don’t realize is that those ridiculous awards are what is jacking up the rates for the malpractice carriers. This is passed along to the doctors in their premiums. The doctors then must increase their rates in order to cover those costs.

    This is not very difficult folks. Just think about it. You may wonder why none of the politicians you hear speaking have mentioned this? Because the primary occupation, of almost all of our politicians, is as an attorney. They do not even want to consider limiting the trough by which this nation’s lawyers feed.

    Every malpractice suit involves real damages and punitive damages. There are cases all the time where a plaintiff is awarded $2 million, and then will also be given $10 million in punitive damages. This is absurd. If the plaintiff is given $2 million in real damages, that mean that the courts determined that he was damaged by that amount. If you want to have him win the lottery and given him punitive damages, then limit it to two times the real damages. This would greatly reduce malpractice premiums right there.

    An even better plan would be to have the punitive damages paid to the state, for state healthcare costs. I understand if they want to punish the doctor, but giving the money to the plaintiff doesn’t make sense. The real damages reflect what the injured person lost.

    • Nosedoc said

      The liability issue is significant, but not for the reasons you stated. Even in areas like Texas where caps on non-economic damages have stabilized malpractice premium rates with a net influx of doctors into the state. The practice of Defensive Medicine, however, has not changed in a measurable way–i.e., health care expenditures have not gone down, because the consumption of health care services has not gone down. This, I believe, is because the fear of litigation, which is at the root of the over-utilization of diagnostic studies. The very idea that “I will not miss diagnosis x, no matter how remote the odds are that it could be present, justifies my ordering as many CT scans, MRI studies, or PET scans as it takes for me to stay out of trouble.” That is just how noxious an experience it is to be served papers for a lawsuit–it is to be avoided at ALL COSTS (especially since the costs are with other people’s money). A streamlined system in which liability claims need to be prescreened by an experienced panel followed by an efficient Health Courts system is what is needed to finally do away with the practice of Defensive Medicine.

  5. Nosedoc said

    This is an article from today’s NY Times about bipartisan meetings among 6 key senators to come up with a workable centrist plan. It is worthy of reading since it is reporting without commentary. You will likely need to register: it’s free.

  6. Introducing a public health plan needs to be removed from the current legislative bill. Were in a recession and the government needs to realize they would be spending money on something that will hurt the economy and destroy an industry. There have been too many quick unthought out and irrational decisions made by our government lately and it makes me wonder, do they want our economy to ever recover? There are far more important things this money can be used for and Washington needs slow down and focus on smart healthcare reform and getting it right the first time.
    The insurance industry is already getting hit hard by the recession. Too much to quick will bankrupt the insurance companies and ultimately there will be bigger problems than there is now. The government needs to give insurance companies a chance under the new reform rules and each company should be required to prove themselves while getting used to all the new industry changes. A public option should be a last resort and done only if the health industry doesn’t improve. Give the companies a chance first.
    There also needs to be a sugar, alcohol and an increase in the tobacco tax. Think of how many less people there will be with diabetics, heart disease, rotten teeth, etc. if sugar became less affordable. It’s time for the people to take control of their own lives. It’s not fair for the person who chooses not to smoke, not to drink alcohol or not to drink a two liter of Coke each day to be responsible for paying as much as the person who chooses these unhealthy habits. The government is so quick to change the companies, but what are they doing to regulate what those who choose unhealthy lifestyles and drive up the health cost of health insurance premiums for us all?
    As for the Exchange, it’s not needed. The administrative cost of the Exchange will be more than what agents get paid now. Government employees are more expensive because of all the benefits they receive from the government. Most agents are self employed and responsible 100% for their own benefits and retirement plans. Most people prefer having an agent help them apply and answer questions to eliminate errors. Why change something that already works. Most people prefer and already know what to expect with how things work now. If trying to reach someone at the Exchange is anything like trying to get someone on the phone at the Social Security or Medicare offices, we all can expect to wait on hold for at least 20 minutes before we finally get to speak with a live person. That’s 20 minutes of your or mine that is wasted.
    Finally, the amount the government pays a doctor needs to be the same as what an insurance companies pay for the same service. It needs to be mandated that all companies and the government should all be on the same pay schedule, including Medicare. Let’s be fair.

    • Rick said

      I believe the Exchange is intended to be an additional option available for the public to purchase health insurance from participating companies within the Exchange. Does anyone know if the Exchange is intended to be an additional outlet or the only one for small business?

      The typical small business person does not have time to shop for coverage through the exchange, then explain the coverage to employees. The lost work time and misunderstanding would cost this small business person greatly. Small business will need a health insurance broker and I understand provisions are made for brokers to sell for the Exchange. I hope insurance companies/brokers will also be allowed to sell and provide coverage outside the Exchange. The government would certainly be smart if they allowed this.

      If the Public Health Option is formed as a co-op, how is that different from mutual health insurance companies as these companies are owned by its policyholders? If the government was smart they would pay agents to sell coverage for the co-op.

      • Paul said

        It is ‘billed’ as an alternative.. but the reality, under the current house language, is that any plan sold to individuals outside of the exchange will not be allowed to enroll any new members and no changes to the designs can be made. so those plans will quickly go away (being quickly made uncompetitive as the premiums go up beyond cost inflation due to cost share leveraging), leaving only the exchange with it’s federally based regulations remaining. for small employers, any plan outside of the exchange will be allowed to exist (and enroll new members) but within five years must comply with the exchange rules on cost sharing, minimum benefits, etc… so eventually there won’t be any meaningful difference between an exchange plan and a non-exchange plan.

  7. I am starting to see progress finally. The Senate Finance Committee plan has been getting some press today, and it does sound like something more palatable than what I’ve heard from Obama and the Pelosicrats so far.

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