The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

An Opportunity for Health Care Reform Leadership

Posted by Alan on January 25, 2010

The more things change the more things stay the same. Especially when it comes to health care reform.

As the Los Angeles Times reports, the White House, through senior advisor David Axelrod, is pledging to move forward with health care reform. Meanwhile Senate Minority Leader Mitch McConnel is urging President Barack Obama to start the whole reform process over. Both sentiments are driven by political needs as much as anything else. Mr. Axelrod knows that President Obama and Congress has invested too much political capital in the issue to just walk away from the effort now. At the same time Senator McConnell knows that starting over means little if any meaningful reform is likely to pass this year, giving the GOP the gift of a shiny hammer during the upcoming mid-term elections.

Mr. Axelrod, speaking on ABC’s “This Week” described the election results in Massachusetts (in which voters rejected the assumed victor, Attorney General Martha Coakley for Republican state Senator Scott Brown) as a rejection of health care reform. According to a recent poll, 68 percent of voters, he noted in the interview, supported Massachusetts’ comprehensive health care reform program. What he didn’t say, but I take as the implication, is that Massachusetts voters support health care reform, just not the White House’s health care reform plan.

Senate Majority Leader Harry Reid, Speaker Nancy Pelosi and their top lieutenants are still considering how to proceed. I continue to expect that Democrats will move forward with scaled back version of their existing reform package rather than starting over. They’ll meet with Republicans. Perhaps even include some provisions that are high on the GOP wish list. And then Democrats will move forward with a legislative package that addresses modest cost containment, insurance reforms, and increasing access to existing government programs like Medicaid.

President Obama can do more than just streamline the existing health care reform legislation – he can implement meaningful changes on his own. That’s the suggestion offered by columnist David Ignatius in the Washington Post (his full column is online and can be viewed, for free, after registering with What Mr. Ignatius proposes is that the President use his executive authority to launch pilot projects in the Medicare and Medicaid programs that have the promise of restraining costs. As he notes, “this approach would have the benefit of beginning to reduce the costs of delivering care before comprehensive legislation makes the system universal.”

Mr. Ignatius points out that the process leading to the current House and Senate has been “an abomination. The voters sent Obama to Washington to lead, not to engage in endless horse-trading.” By using his presidential authority to push existing public programs to pay for value, as opposed to simply activity, President Obama can demonstrate the leadership voters expect of him.

The cost containment projects suggested by Mr. Ignatius were developed by Dr. Delos Cosgrove, CEO of the Cleveland Clinic and Dr. Denis Cortese, a former CEO of the Mayo Clinic. They identified two areas in which the President could have an immediate impact. “First, Medicare should adopt a ‘value index’ that would “reward those who provide safe, high-quality care with excellent service at a reasonable cost.” Second, “Medicare should start bundling payments to hospitals, physicians, nursing homes and others so that providers are paid for outcomes, rather than individual procedures.”

Mr. Ignatius recognizes that implementing these reforms across all of Medicare would require Congressional approval, but he also notes that they could begin immediately as pilot projects.  It’s an interesting idea. The failure to adequately address cost containment has been one of the most widespread criticisms of the current health care reform proposal. By looking at alternatives to the current fee-for-service medical reimbursement model, President Obama can make a meaningful contribution to improving America’s health care system. Demonstrating leadership and improving the system: not a bad outcome for an embattled president.


3 Responses to “An Opportunity for Health Care Reform Leadership”

  1. CHP said

    What he didn’t say, but I take as the implication, is that Massachusetts voters support health care reform, just not the White House’s health care reform plan.

    I think this is key. Most Americans support reform, just not the reform that was being pushed through Congress so haphazardly.

  2. Linda Rose Koehler said

    Why have we not seen anything that addresses the ‘costs’ of health care not health insurance premiums? Missing from all of this is the tort reform ~ trial lawyers, malpractice costs that are out of control, and free medical that encourages the “I will sue” attitude. Physicians forced to give and order tests that are not necessary, but ‘requested’ from patients, prescriptions demanded by an uninformed but media ‘educated’ public. Reform, yes, not from politicians; we need reform designed by insurance industry professionals ~ brokers, agents, HR agents, and carrier representatives for true reform that will work. NAHU addresses the Brokers’ value and concerns.

  3. Rick Kolstad said

    I’d like to see the president use his “bully pulpit” to promote some solution to the pre-existing condition dilemma; perhaps a national open enrollment period or something that would give everyone a one-time shot at gaining coverage. If one chose to gamble then they have a certain waiting period (perhaps 6 months) before the condition is covered. I think that would satisfy much of the public; then address prescription drugs, one of the major cost factors (now that no deal exists with big pharma, perhaps threaten to, or actually negotiate rates; why should Canadians get discounts)followed by tort reform (similar to California perhaps), and finally how about coming up with a single communications protocol and enable all providers and carriers to communicate electronically (a big order, but not compared with the out of control monster that emerged from both houses.

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