The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Health Care Reform Summit May Be Substantive

Posted by Alan on February 24, 2010


Will the February 25th health care reform summit merely be political theater? Or will it serve as an inflection point that leads to passage of health care reform legislation? I haven’t seen any polls on the matter, but a quick search on the topic certainly creates the impression that many believe the summit will be six hours of politics with nothing substantive emerging.

I respectfully disagree.

Yes, the bipartisan health care reform summit President Barack Obama is convening will have more than its fair share of politics. That’s inevitable when that many politicians are in the same room. And given that it is in the electoral interest of Democrats to produce health care reform and in the electoral interest of Republicans to deny Democrats this victory, that politics will pervade the proceedings is to be expected. Nor should the political facets of the summit be criticized or denigrated. America’s legislative system is political. Unlike other country’s in which the ruling party is expected to rule (thus Prime Ministers are the leaders of the legislative majority), in America we set up a system that would inevitably be adversarial.

Of course, one could argue (and I do) that this adversarial relationship has gone too far. Today’s political climate is poisoned by an unwillingness or inability by one side to recognize anything of value put forward by the other. Opponents are not simply wrong, they are evil. It’s as if the prevailing logic has become: “Reasonable people cannot disagree because anyone who was reasonable would agree with me. Ergo, people who disagree with me are unreasonable.” That this is a both foolish and unhealthy, both for the individuals involved and the Republic, doesn’t seem to matter. That radio talk shows and cable news channels (especially during prime time) pour fuel on this fire – usually embellished with misunderstood or downright erroneous facts – only makes the matter worse.

Which is a long way of saying that those who claim the bipartisan health care reform summit will fail to rise above political gamesmanship have the odds in their favor. But at the risk of being naive, I think it will lead to something more substantive. Here’s some reasons why:

  • It’s hard to be political for six hours straight (even with an hour off for lunch). The participants know they’re engaged in a bit of Kabuki theater. But staying in character that long is tough. These folks do have sincerely held beliefs. Even those who stifle those beliefs in favor of scoring political points are likely to let a ray of substance shine through during the course of the day.
  • And each side has an incentive to seize that ray of sunshine (to butcher the metaphor) and ratchet it up a bit.
  • For Democrats, the incentive is to get on record the specific provisions Republicans demand to see in a health care reform bill and identify the ones they can live with. By expanding the Obama health care reform proposal to include as many GOP ideas as possible, the Democrats assume a no-lose situation. If including those provisions gain Republican support for a bill, they win by passing health care reform legislation. If Republicans remain united against a bill that includes ideas they profess to support, the Democrats get to paint the Republicans as obstructionist.
  • For Republicans, they need to re-position themselves as something other than the Party of No. Not that their base wants them to do anything other than oppose whatever bill the Democrats put forward. But Republicans won’t win elections this November just appealing to their base. It’s independent voters who decide elections. In Virginia in 2008 those independent voters helped send a Democrat to the White House. Those same independents last year put a Republican in the Governor’s mansion. By offering substantive proposals Republicans in Congress can demonstrate they’re serious about solving problems. They can then claim to withhold their support for whatever legislation the President puts forward on the grounds that they cannot support rate regulation, or Medicare cuts, or new taxes or something. But they need to show they care about fixing America’s health care system. And that means putting ideas on the table that reduce costs and expand coverage.
  • Which leads me to believe President Obama’s health care reform plan will be modified subsequent to the summit. And because it will likely incorporate ideas from a broader spectrum than participated in the drafting of the current plan, the result is likely to be a better proposal.
  • At the very least, the summit will allow Democrats and Republicans to explain to the American people the “why” behind their positions. Which will liberate Democrats to move forward with legislation regardless of whether Republicans support it or not.
    • If the Republicans have used the summit to seize the high ground, the resulting legislation will be much more moderate than what the President is proposing today.
    • If Republicans fail to put forward meaningful ideas, the proposal will be poorer for it, but will move forward nonetheless.

    At the end of the day, I believe both chambers of Congress will vote on a comprehensive health care reform bill – something that has not happened in recent memory despite decades of effort. If Republican Senators filibuster the President’s health care reform bill, Democrats will turn to the reconciliation process (which allows them to pass legislation with a simple majority, not the super-majority overcoming a filibuster requires.) They’ll claim they gave bipartisanship a try and that they are playing by the rules (which permit circumventing filibusters in certain circumstances) and by American principals (what’s more American than “the majority rules?”)

    That’s my educated guess. What’s hazier to me are two additional and critical questions.

    1. Will the legislation voted on by Congress be health insurance reform or will it be real health care reform that tackles the need to control costs?
    2. Will they be able to put forward a single bill capable of obtaining majorities in both the House and Senate?

    But first things first. And first is the summit. Will either size, neither or both engage in a substantive debate? I think so. And even those who are skeptical of this result should hope so.

    6 Responses to “Health Care Reform Summit May Be Substantive”

    1. Barb Tx said

      Health Care Reform – what Congress should be talking about:

      The health care reform debate should include exploring ways to eliminate unnecessary expenses and fraudulent charges, without creating unneeded cuts to programs (such as the massive proposed cuts to Medicare) or sacrifice of the quality of care…and limit the need for the massive taxes that have been proposed for mandated insurance.

      Identify and implement cost-saving steps without simply adding to the deficit and the additional burden of the current health care bills. Identify positive solutions by systematically reviewing unnecessary expenses, rather than simply adding complexity, expense, un-popular restrictions, and tax increases.

      “As many as 60% of all emergency room (ER) visits are for non-urgent problems.”
      gateway.nlm.nih.gov/MeetingAbstracts/102234075.html
      “National statistics put the cost of treating non-urgent conditions in ERs at about $21 billion.” (August 25, 2008)
      http://www.boston.com/business/technology/articles/2008/08/25/the_ers_in_urgent_need_of_a_fix/
      “According to the National Center for Health Statistics, the average emergency room visit costs $1,049, while the average physician’s office visit cost around $153. Emergency room treatment for non-emergency medical conditions is a major contributor to the rising cost of health care.”
      http://www.blueridgehealth.org/in_the_news/health-pages/save-er-for-real-emergencies.html
      Establish more urgent care or walk-in clinics for treatment of non-emergent health problems. A triage nurse in the ER could refer non-emergent cases to a nearby clinic and reserve ER’s for the treatment of life and death situations.

      Identify and eliminate preventable conditions with simple actions that SHOULD already be a standard.
      Consumer Reports reviewed an easily-implemented change that would save approximately $1.39 billion health care dollars for the 33000 lives lost each year (not including the health care costs for those who managed to survive) from Hospital-caused MSRA blood infections introduced by central line catheters to provide nutrition and hydration, etc. Treating these infections costs approximately $42000/patient. A simple 5-step program (such as handwashing by health care providers) was shown to reduce these infections to zero occurrences in hospitals where these measures were implemented. (Consumer Reports Magazine, March 2010). Congress should enact legislation requiring all hospitals to publicly and clearly report this data, and to follow the simple checklist. Medicare does not cover the massive expense of these hospital-introduced infections because they consider them avoidable. Instead, Medicare should list the hospitals it will not support due to this avoidable condition, rather than punishing the patient.

      Provide for appropriate health insurance for the un-insured through the implementation of inexpensive catastrophic policies for young people who are at low risk, higher income people who do not want to pay for comprehensive health insurance, or those unable to afford health insurance. Rather than imposing a fine, identify them and enable them to either get the health care they are eligible for, or purchase inexpensive catastrophic insurance, providing subsidies for catastrophic insurance as needed.

      Medicare is under-funded. Place a cap on Medicare (and Social Security) benefits such that people in the high income bracket are not eligible for these benefits, in order to preserve the benefits for those who do need these programs. Legislatively prevent Congress from raiding Social Security and Medicare, in order to help offset the solvency issues.

      Many individuals and self-employed Americans do not purchase health care because individual insurance is disproportionately expensive when compared to group insurance (which averages the risk). A path for the individuals and self-employed (sole-proprietors) to have access to group health insurance would lower their cost-basis and encourage them to purchase health insurance.

      Health care costs escalated when patients began to expect to only be responsible for a co-pay (with a majority of health care expenses covered by insurance). Provide incentives for insurance companies to provide traditional coverage policies for those who prefer to pay for office visits out of pocket, with health insurance covering the remaining medical expenses.

      Add guarantees that health care reform would include effective regulations, fair options and quality care, by requiring the House and Senate to have the same health care system that they pass for the American people.

      Health care represents a substantial sector of our economy. Address the needs without adding to the problems. Legislators should to listen to the people, health care providers, insurance companies, and those who sell insurance so health care reform includes their ideas and needs and respond to the concerns and problems encountered.

      The majority of people do not want this rushed through without their voices or concerns being heard. We do not want our taxes to increase from the legislators not taking reasonable steps to identify and eliminate unnecessary expenses without sacrificing the quality of care in this country.

      Obama’s proposal adds to the tax burden of people earning under $200k: “raise the floor on the itemized deduction for major medical expenses to 10 percent of AGI for the non-elderly and non-disabled; ” (It is currently 7.5%)…this will increase taxes on many regardless of income…
      http://www.whitehouse.gov/health-care-meeting/proposal/titleix/additional-health-savings

      It also uses modified adjusted gross income instead of adjusted gross income for many calculations…meaning it adds back in many deductions, such as any deduction for student loan interest or qualified tuition and related expenses…so the net result is that it uses a larger number when computing taxes than the IRS does in federal income taxes.

      The stated reason for health care reform is skyrocketing health care expenses. These bills should provide savings, not an enormous expansion of the deficit.

    2. Kevin said

      Here’s hoping you’re right. If either side engages in political theater without bringing substantive ideas to the table, they’ll be hurting their support base. The public has been inundated with health care reform news and is eager for something bipartisan to finally happen.

    3. Scott said

      I think if the Dems really thought they could pass healthcare through reconcilliation, they would have done it already. I think they are trying anything they can to see if they can catch the right breeze to change the sails in their direction.

    4. west ham said

      Health care has to be important for society, findrxonline indicate that health care in America is depressing, is this lack of interest from the government?

      • I do not believe West Ham is a person. I believe it is some form of robotic program trying to drive hits to the cited web site.

        I have also noticed that some of the replies in this forum are canned responses, sometimes reposted several times to different blogs Alan has written.

        Barb Tx, for instance, are you a woman or a PR company working for the Republican Party or perhaps a lobbying organization’s white paper masquerading as a woman?

        • Jim,

          With all due respect, I haven’t read of others questioning your “existence” or validity. Isn’t is rather presumptuous to question others validity simply because they don’t agree with your perspectives?

          Alan doesn’t want to see personal attacks on this site, and I agree with his boundaries. That said, when you consistently question others posts, and their “existence”, simply because their POV, (“Point of View”) is different than yours, isn’t that really a truly strong personal attack against those with whom you may disagree?

          I do not expect others to agree with me, and many on this blog do not, rather vehemently, sometimes with a fair portion of sarcasm thrown in for flavor, but I am not going to question their right to have their own opinions, whether or not they agree with mine.

          This blog can only be considered to be a fair and unbiased, balanced blog if all those posting accept that “Respect for others opinions” and “Civility” be the rules that govern posting here.

          Too much time is spent responding to these personal attacks, IMO. Perhaps, Alan, it is time to post some “Rules of Engagement” on this site, if others find it so difficult to behave as they themselves would like to be treated. The occasional “Let’s play fair” doesn’t seem to be working.

          This is your “Sandbox”, Alan. I am only proposing a thought…

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