The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Big Impact from Small Health Care Reform Initiatives?

Posted by Alan on February 1, 2010


Whether Congress will pass comprehensive health care reform is, shall we say, an “iffy” proposition at this stage. Members of Congress continue to meet, seeking to find a way to pass meaningful reforms through a House increasingly reluctant to support anything expensive and a Senate incapable of shutting off a filibuster. Not surprisingly, observers are looking for clues as to what Plan B … or C, D, E and F … might look like.

According to the Associated Press “President Barack Obama’s modest health care budget may be harbinger of what’s ahead if his overhaul plan dies in Congress.” “Modest” is the correct word. Among the items:

  1. Emergency funds for state Medicaid programs ($25.5 billion) to help handle the influx of program participants as a result of the recession.
  2. $290 million to community health centers, providers to much of the uninsured.
  3. Funds for Medicare to experiment with ways of treating chronic health problems.
  4. Increased funding for comparative effectiveness research to help identify the treatments most effective at addressing costly conditions
  5. A boost to existing efforts to speed adoption of computerized medical records.
  6. increasing anti-fraud personnel and programs within Medicare and Medicaid.

Any and all of these may be useful and necessary. None individually or all of them collectively can be called “comprehensive.” As Secretary of Health and Human Services, Kathleen Sebelius describes them, the budget is “a platform.” And that is how it should be looked at. If comprehensive health care reform legislation dies in Congress, the game will shift to “small ball” in Washington, D.C. The goal will be to accumulate minor gains through the budget, to advance health care reform through executive orders, and to use existing programs to experiment with ways of improving medical care and reducing health care costs.

Comprehensive health care reform coming out of Washington is still possible, albeit far more unlikely now than just two weeks ago. As a result states are far more likely to move forward with more robust reform legislation than were considered in the past year or so. And Washington will continue to try to improve on the status quo through small efforts aimed at having a substantial cumulative effect. Significantly, because these more restrained proposals are less controversial, there’s a high likelihood at least some of these ideas will become law.

4 Responses to “Big Impact from Small Health Care Reform Initiatives?”

  1. CHP said

    Because these more restrained proposals are less controversial, there’s a high likelihood at least some of these ideas will become law.

    There’s also a decent likelihood that the pubic and Congress alike will actually understand some of these reforms. The 2,000 page, reform-everything-at-once health care bill was never accepted by the public, because no politician or pundit could ever articulate the nuances of the bill. Or how we were realistically going to pay for it.

    The piece meal approach at least allows for better comprehension by all parties.

  2. Spencer Lehmann said

    Scott, I don’t mean to make it sound easy. Certainly it will not be easy, though a heck of a lot easier than attempting the gargantuan and costly program envision by President Obama.

    Your response, sarcasm notwithstanding, appears to be simplistically cavalier. Nothing I’ve suggested could sensibly lead to the statement “let’s just have “someone” pay for everyones health insurance and then we can cove everyone (sic).” On the contrary, it is made clear that purchasing coverage would be incumbent on those insured. However:

    You also say: “You can’t do what you said with “insurance reform” without all the other things to make up for all the additional claims that will need to be paid.” Assuming that more user friendly underwriting and other such rules mandated by regulation will increase the risk pool and increase the reserves base for claims adjudication should resolve that specific concern. Let’s not leave this up to assumptions, and while this is hardly the place to fully flesh out an “Insurance Reform” Bill, let’s be certain that the risk pool does reach proper percentages, and assure that a far greater percentage of those uninsured become insured, and Mandate that everyone, all Americans, must purchase coverage, and those that cannot afford to purchase adequate coverage must sign up for Medicaid, or a High Risk Pool, or a Basic Health Plan, whatever venue works for them based on means tested income.

    Nothing we do will be easy, Scott, but it should be understandable in Plain English, be devoid of as much “legalese” as possible so that the 60% of the House and 40% of the Senate who are not lawyers can understand it, and so that the majority of literate Americans can understand it (we, after all, are the ones who will pay for whatever Congress passes and the President signs into law), and do our best to create good law without putting America another One to Two Trillion Dollars in debt (which would make it even far more difficult for our children and grandchildren to have a decent future). Further, let’s require that every single member of Congress who is allowed to vote on any legislation be able to prove, via some accepted system, that they have READ the proposed legislation, and then let’s require that whatever Congress passes out of Congress, they, and the Administration, and the Judiciary, must live under the very law that they make. Any and all who live in America must be subject to and abide by the laws and rules of this government established “Of, By, and For the People”.

  3. Spencer Lehmann said

    President Obama’s plan, shoved off to Congress to “flesh out”, was far too grandiose in wanting to “take over the world of health care” as Americans knew it, far too expensive in costing well over $1Trillion, and far too difficult for the most technically oriented to understand, let alone 100 Senators and 435 Representatives.

    That said, it would be nice if America could end up 2010 with something to show for the Billions upon Billions of taxpayer dollars that have been spent thus far, for naught.

    How about some simple, fairly low cost “Insurance Reform”, needed, and not too difficult to do. Heck, even a politician or two could understand what might take up a few hundred pages.

    We need policies that are: Non-can, Guaranteed Renewable, no Declinations (though serious pre-existing conditions must have a pre-X period, I.e. Cancer, Pregnancy…we all know about the woman who bought Blue Cross AFTER she became pregnant, then canceled it after delivery telling BC of WA that she would buy it again as soon as she got pregnant, right? The story was printed in several of the nations papers including the WSJ…this was shortly after WA adopted Hillary-Care and put ground glass in it); No Cancellations due to claims history whether group or individual …a few others…not tough. Had this been done from the start of Obama’s Administration, he and Congress could have turned their attention to Jobs; the Economy; Unemployment; Military Defense; Terrorism, and the War On, which so many in this Congress and Administration refused for so long to acknowledge…and what is this nonsense about having Enemy Combatants who want to kill all Americans tried in our court system after being read their Miranda Rights? They became citizens of the USA, when?

    As it now stands, the same number of uninsureds in the US is the same as it was at this time last year. Nothing has been accomplished, or gained. Perhaps in 2010 we can shorten the list of those who are uninsured.

    You write well, Alan. And you present a pretty good and objectively stated case, for the most part. It is my perspective, however, that we have been forced to waste one very important year, have far more unemployed now than at the beginning of Obama’s term (in fact, three times more…from 5 million to 15 million), are far more deeply in debt, and need to get to the business of business, and getting Americans employed and out of debt, not to mention our mother country. Health Care Reform should now take up the end of the line. It has been given far too much attention while too many of that 15 million Americans don’t know how they will make their mortgage payment or buy their next meal.

    • Scott said

      You can’t do what you said with “insurance reform” without all the other things to make up for all the additional claims that will need to be paid. If we are going to make thing sound easy, let’s just have “someone” pay for everyones health insurance and then we can cove everyone. Problem solved.

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