The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

A Critical Week for Health Care Reform

Posted by Alan on February 21, 2010

The long strange trip that has been health care reform will take a few new twists and turns this week as President Barack Obama and Congressional Leaders will meet for a televised summit. No matter what actually happens at Blair House the event will be substantial for several reasons. Among them:

  • We finally get to see what ObamaCare really looks like. In the past the Administration has voiced support for various elements of legislation “owned” by Congress. While Senate Majority Leader Harry Reid and Speaker Nancy Pelosi struggle to fashion a unified bill Democrats in both of their caucuses can support, President Obama will unveil his own version of health care reform. While it will no doubt be based on the two bills passed, respectively, by the Senate and the House, it will not be the official Democratic bill: it will be the White House bill.
  • We finally get to see if either party can rise above the politics of health care reform to actually address the policy of health care reform. Senate Republicans bowed to the inevitable and agreed to participate in the summit agreeing to participate “in good faith” according to the Los Angeles Times. While House Republicans have yet to say whether they’ll attend the summit, they would be foolish not to. The GOP is fighting hard to be known as something other than the Party of No. Not attending would set this positioning effort way back. Besides, the summit provides Republicans with the opportunity to clearly lay out their alternatives and to eviscerate the Democratic approach to health care reform. Yes the meeting gives Democrats the same opportunity. The key for each party, however, will be how they balance the two tactics: pushing forward their own policies; and tearing down the other side’s ideas. If they focus on the benefits of their own approach there’s a real opportunity to find common ground. If they choose to turn the Blair House into a political Thunderdome then politics will trump policy.
  • Health care reform will move forward after Thursday’s health care reform summit. But we’ll learn whether what moves forward represents compromise or a Democrats-only version of reform. If Republicans put forward serious ideas (and I assume they will) it will be hard for the Administration to push reforms through the Senate with a simple majority – even though an increasing number of Democrats in the Senate seem willing to use reconciliation to pass a health care reform bill. (Reconciliation allows the Senate to vote on budget related issues without providing the minority the ability to filibuster. A filibuster allows the minority to force the majority to pass legislation with a super-majority of 60 votes in the Senate. Filibusters are not allowed in the House which operates on a simple majority basis). Instead, President Obama would be likely to put forward legislation that incorporates much of what the GOP offers – and then dare Republicans to defeat such a bill. Whether Republicans would – or could – hold out for a bill in which they give up nothing and insist on a pure GOP version of health care reform would be interesting to see.
  • If no common ground emerges – whether because Democrats refuse to listen to Republicans or the GOP refuses to truly negotiate – the majority party is likely to move forward on their own. Whether liberals in the Democratic caucus have learned the lesson of the past year would be interesting to watch. That lesson, that it is Democrats who have a majority in Congress, not liberals and that the two are not the same, is a major reason Democrats are in danger of losing the opportunity to pass health care reform in the first place. If the Administration and Democratic leaders had focused on a moderate bill that could gain the support of their more conservative caucus members from the beginning, they would have passed a bill long before they lost their 60th vote. By hewing to the left, they delayed the inevitable: whatever health care reform bill, if any, emerges from Congress will disappoint true believers among progressives.

The ramp-up to Thursday will be interesting. President Obama will unveil his reform plan. The House GOP leaders will agree to attend the summit. The pundits will pontificate. And on Thursday, we learn the future of health care reform. Stay tuned.

4 Responses to “A Critical Week for Health Care Reform”

  1. Patty, you said (among other things):

    “One group plan
    Everyone would have access to insurance if all insurance companies were required to offer a plan to individuals as though they were all in one large company group plan, with the same rate and no exclusions. There is no cost to taxpayers; premiums are paid by the insured.

    Guaranteed coverage and insurance market reforms
    Few would argue with such provisions. The health insurance industry has been such a Wild West that companies could promise anything and provide nothing. They suffered no bad consequences when they blatantly breached contracts with subscribers. Other than enforcement, there would be no cost to taxpayers.

    Individual responsibility…”

    You have presented a really “Feel Good” proposal that sadly has no substance.

    *One Group Plan: is the same as a Single Payor System. Choice is eliminated. It only allows for a one size fits all program. It is in philosophy “very UnAmerican” and very Socialist. All premiums are to be borne by the individual, yet there is not language in your plan to require that the individual must purchase coverage and no language spelling out what the consequence will be for failure to do so. If you have been following the news, print, electronic, and all other forms for the past one plus years, then you must be aware that this is one major reason why the public is as angry as they are at the Obama Administration and the Congress for attempting to jam through a Single Payor System, or even a Public Option. Leaving the public with no choice whatever is the antithesis of American Democratic philosophy.

    *Guaranteed Coverage: means “Guaranteed Issue” means nothing if the public doesn’t have to buy it. The “Risk Pool” will continue to be small in comparison to the claims made and the plan will go broke fast. You have incorporated no citizen mandates to “take part”. Canada has a 7% Uninsured rate because there are no mandates requiring that one sign up for a “Taxpayer” funded system, let alone one that must be funded by the individual. The uninsured rate under your “plan” would likely be over 50% (totally arbitrary figure) as nobody has to buy anything.

    *Individual Responsibility: What Individual Responsibility? You have presented no mandates that the public be responsible for anything. Without such mandates, the majority of Americans who relish in their watching “Monday Night Football” with a pizza in one hand and a beer in the other, who prefer to watch mindless animated cartoons, game shows, reality TV, and other such programming rather than watching programs that make them “Think”, will continue to eat foods that aren’t healthy, resist activity that will make them healthy, and will most certainly NOT pay for anything they don’t need to pay for knowing that someone else will still have to pick up their costs.

    *”Money is wasted on mailed Explanation of Benefits forms from insurance companies when this information could be provided for free via a secured web site”: Uh huh; and how will the many millions of elderly who have no experience or ability to negotiate the internet, or spell the word, those who are mildly disabled and would have the same problem, those who work in fields where no internet knowledge is needed (like Construction), those who cannot afford a computer or internet connection, access those EOBs? I imagine that the cost to taxpayers in helping those who cannot meet the just mentioned issues to overcome these obstacles would be, at minimum, in the Mega Billions of dollars.

    Your plan, Patty, doesn’t address our ability to eliminate all of the very expensive Entitlements that we have incorporated into our Society, still leaving us with a Public Mindset that favors “Societal Welfare-ism” instead of “Individual Responsibility”.

    Patty, your post leaves me thinking that you haven’t given this subject the benefit of your performing a lot of needed research, a major problem of the Obama Administration when they first approached Health Care Reform in the beginning of Obama’s Presidency. With respect for the thought that you have given this issue, it seems to me that you would be well advised to research the many and varied components that are inherent in a reform of our very complicated health care delivery, health care funding, good health care assuring, and health care insuring system, instead of simply bashing the health care delivery and insuring companies, which you appear to be doing, with relish.

  2. First of all, awesome post! I’ve got a small question nagging me, I really like the layout of your site and tried to download the same design on my WP website. However, there is some kind of strange coding error in the footer. Do you have any hints, what version are you using? Please PM me on Twitter @FitnessHealthGuide or via e-mail.

  3. CHP said

    Great recap. Excited to see what will come of Thursday’s summit. I hope it’s not just political niceties on TV, and then back to the same old partisan backdoor maneuvering once the cameras are off.

  4. Healthcare reform can start now with no high price tag

    Obama and Congress are taking the entirely wrong approach to healthcare reform. We can be doing so much right now to improve healthcare without suspicious price tags. There is nothing wrong with carrying out reform in two phases: the immediate and low price-tag phase, and the longer-term, let’s-find-the-money-first phase.

    What can be done now, with little public opposition:

    One group plan
    Everyone would have access to insurance if all insurance companies were required to offer a plan to individuals as though they were all in one large company group plan, with the same rate and no exclusions. There is no cost to taxpayers; premiums are paid by the insured.

    Guaranteed coverage and insurance market reforms
    Few would argue with such provisions. The health insurance industry has been such a Wild West that companies could promise anything and provide nothing. They suffered no bad consequences when they blatantly breached contracts with subscribers. Other than enforcement, there would be no cost to taxpayers.

    Essential benefits
    An independent committee would define an “essential benefit package” as a minimum quality standard. It would include preventive services with no co-pays or deductibles, mental health services, and oral health and vision for children. It would cap the amount that consumers have to spend per year, and cost taxpayers nothing. Insurance companies could add features to this basic package. Now they can get away with not paying for basic services because most people do not have a choice of plans, and insurance plans are far too complicated to easily compare.

    Individual responsibility
    It is time for the government to be honest about the lifestyle factors that cause many of our healthcare problems. According to an article at that is based on research reported in The New England Journal of Medicine, “preventable illness makes up approximately 80% of the burden of illness and 90% of all healthcare costs,” and “preventable illnesses account for eight of the nine leading categories of death.” This is the single most important factor in lowering healthcare costs and making people healthier. But in most ways it is not a role for government. It is up to individuals to change their habits. However, the federal government certainly shouldn’t be making the situation worse. That means telling the truth about the fast food and prepared food industries. And it means requiring that government agencies and contractors use part-time and telecommuting work arrangements so people have time to exercise and prepare food at home. A national campaign aimed at employers, encouraging them to use flexible schedules for workers, such as part-time and telecommuting, could do a lot of good, with the government itself taking the lead. Cost to taxpayers: nothing. In fact, there are potentially huge savings in lowered healthcare costs.

    Pushing for results
    It is time for ratings. Netflix movies are rated. EBay sellers are rated. This is established technology. It is time for a central web site that shows us ratings for healthcare providers. Some sites do this now, but there are too many with too few ratings and it is chaotic. An insurance company doing ratings of its providers is not an unbiased source. How good is that doctor / hospital / radiology lab anyhow? How effective? How organized? How long a wait? How polite? How accurate a bill? This costs little and offers so much in savings and making healthcare very effective quickly. No more money is wasted on ineffective providers. People get well much sooner. Providers change their methods to get better ratings. Cost to taxpayers: very little. Such a site would also reveal the really bad eggs . . . moving on to . . .

    Making sure healthcare providers really do their job
    States are supposed to enforce this now, but often don’t. According to a press release from Public Citizen’s Sidney Wolfe, MD, “Most state medical boards are doing a dangerously lax job in enforcing their state medical practice acts and adequately disciplining physicians.” In another article, Dr. Wolfe said that from 1990 to 2002, just five percent of U.S. physicians caused 54 percent of the nation’s malpractice lawsuit payments, basing his numbers on information from the National Practitioner Data Bank. A constant stream of reports show that hospitals are covering up mistakes. If states were doing their job, there would be little or no malpractice lawsuits. This is far more important than tort reform. With ratings, state regulators, properly funded and monitored, could spot and check on providers who are doing a poor job before they do something really really wrong. Such a practice would eliminate payments to incompetent providers and lower malpractice cost. Cost to taxpayers: very little.

    Emphasizing primary care
    Healthcare reform needs to enhance the partnership between patient and primary care doctor. The primary care doctor is the one who needs to be on top of what is happening with a patient, with whatever record-keeping system works best for him or her (usually a hybrid of paper and database. All-electronic record-keeping is not reliable yet). Primary care doctors need to be paid as much or more than specialists and be paid for phone call and record-keeping time instead of just doctor visit time. Many doctors are forced to use a more expensive visit when a phone call will do because they don’t get paid for phone time. Cost to taxpayers: nothing

    Looking close at hospitals
    Hospitals need to be very closely audited. Not only are there often bogus charges on bills, but the charges are far far beyond costs. No one really checks this, so they keep doing it. Employees wander around hospitals that don’t seem to be doing anything. Hospitals charge for unnecessary tests, with no one making sure that tests are based on research. Anyone who complains is ignored. Medical institutions are roach motels for our hard-earned dollars. Dollars check in but they don’t check out. Cost to taxpayers: very little.

    A simple little thing
    Refrigerator magnets can save millions. Yes, you read that right. A magnet can list the phone numbers, hours, and locations of urgent care centers that can be used during weekends and evenings instead of much more expensive emergency rooms. We now waste millions on non-emergency problems being treated in emergency rooms simply because people don’t know where else to go. Cost to taxpayers: very little.

    Another simple little thing
    Money is wasted on mailed Explanation of Benefits forms from insurance companies when this information could be provided for free via a secured web site. Cost to taxpayers: nothing.

    These no- or low-cost changes would greatly improve care and save millions. They are the first step. There is no reason to delay them in order to get a “comprehensive” healthcare reform. No reform can possibly work without them in place first.

    Patty Zevallos
    media producer – web, video, print

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