The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Archive for March, 2010

Health Care Reform: The Lighter Side

Posted by Alan on March 28, 2010

Don’t get me wrong. Health care reform is a serious issue. But sometimes there are ironies and juxtapositions that just strike me as funny.

Take the Mobius strip that is the individual mandate (lingo for requiring everyone to obtain health care coverage, one of the more controversial elements of the health care reform package President Barack Obama signed into law). Try to follow this one: When then First Lady Hillary Clinton led the charge for health care reform in the 1990s she attempted to force employers to cover all their workers (what’s called an employer mandate). Republicans, marching under the banner of personal responsibility, countered with health care reforms that relied on an individual mandate.

Cut to 2008. Then Senator Barack Obama puts forward a health care reform proposal that includes neither an employer nor an employee mandate (although it did require all children to obtain coverage, which would be what, a kiddie mandate?). Then Senator Hillary Clinton rightly chastises her campaign opponent for being unrealistic. If carriers are to be required to accept all applicants regardless of their pre-existing conditions, then everyone needs to be in the insurance pool. Otherwise the system won’t work. Prices will skyrocket as everyone waits until after they need medical care before they buy health insurance. Nay, nay, says the future President.

Until he becomes President. At which time he makes the individual mandate a central component of his overall health care reform plan. Where do Republicans stand on the individual mandate? Having promoted the idea during the Clinton Administration they now oppose it during the Obama Administration. And the trip around the Mobius strip is complete. (Well almost. With a real Mobius strip you wind up back where you started. If history is any guide, however, it is inevitable that one day the GOP will defend the individual mandate as a true expression of personal responsibility. So it’s only a matter of time until the Mobius journey is complete). Given all this it’s kind of a shame that now Secretary of State Clinton doesn’t get one of the 22 pens used by the President to sign the health care reform bill.

But wait, there’s more. Today’s Republicans are so aghast that yesterday’s Republicans proposal for an individual mandate is now part of President Obama’s health care reform law they’re going to court. Well, not Republicans per se. But 14 states are suing to overturn the new health care reform bill and it just so happens that 13 of the 14 Attorneys General filing the suits are Republicans. (The 14th is a Democrat from Louisiana which. There’s a joke there somewhere, but I’m taking a pass).

As the Christian Science Monitor reports, the suits have two basis. First, that “the new law infringes the liberty of individual state residents to choose for themselves whether to have health insurance. It also says the states themselves are victims of a federal power grab by leaders in Washington” because of changes made to Medicaid.

For now, let’s just focus on the claims about whether the individual mandate is unconstitutional. Because this is where Alice’s looking glass comes returns to center stage. It seems there’s a relatively recent Supreme Court precedent that makes this challenge an uphill climb. The ruling, in which conservative Justices Antonin Scalia and Anthony Kennedy joined the 6-to-3 majority according to the Los Angeles Times held that “Congress could regulate (an item) that was neither bought nor sold on the market ….”

Which puts those two Justices and their colleagues in a bit of pickle. Because in order to rule the health insurance law unconstitutional they will likely need to overturn at least certain aspects of this earlier case, Gonzales vs. Raich. And that is something conservatives would like to avoid as that case was about the legality of growing and selling marijuana for medical purposes, something California law permitted. In ruling that the federal government could prevent a state from regulating transactions that occurred solely within its borders, the Supreme Court found the federal government had broad regulatory powers.

The substance of the case that will determine whether an individual mandate is constitutional is important and will have long-term ramifications for the country. But that’s not amusing. What’s amusing is that the suits put conservative Supreme Court justices between a rock and cloudy place.

Health care reform is a serious issue. But you do have to admit there are times when laughter is a more appropriate reaction than jubilation, anger or fear. Not always, but sometimes.


Posted in Health Care Reform, Healthcare Reform, Politics | Tagged: , , | 10 Comments »

HHS’ Technology Problem Presents a Real Opportunity

Posted by Alan on March 27, 2010

Opportunities sometimes arrive unexpectedly, usually alongside a problem. Health care reform will be no different. A problem facing the Department of Health and Human Services in implementing  a standard database of health plans brings with it an opportunity to eliminate unnecessary spending in the current system and unleash a new wave of sales innovation.

As reported by Tony Romm, writing for The Hill’s technology blog, Hillicon Valley, in less than 60 days HHS must develop a “standardized format” to present health plan information to consumers. Roughly a month later, federal officials are supposed to launch a website providing this information to consumers on a state-by-state basis. In other words, HHS has until July 1st to build what the Hill calls “a central, online health insurance information hub.” The feds will maintain the insurance information site until the states implement their insurance exchanges in 2014.

90 days is not a lot of time to build a new high-tech tool, especially for a bureaucracy like HHS – a heavy-user of technology, but not a dedicated technology organization. But building the quoting engine is the least of their worries. The tough part of the job is be coming up with a way to feed disparate data into a single platform. And when it comes to how insurance companies present their rates and benefits, “disparate” understates the case.

Today health insurance companies are free to develop rate tables in any format they desire. They also have tremendous discretion in how they describe the benefits they offer and to some extent, what benefits they describe.The Babel-esque result is that providing apple-to-apple comparisons among carriers is an extremely labor intensive, subjective task. The idea of creating a standardized information hub is designed to bring some order to this chaos.

And, fortunately, HHS doesn’t have to start from scratch. Quoting systems are a highly-evolved, well-established technology (I’ve been involved in developing more than a few over the past few decades). Several companies have already built effective small group and/or individual quoting systems in use in multiple states. Some of the best known are Connecture, eHealthinsurance, HealthConnect, Norvax, and Quotit. These firms and their competitors already do what HHS is supposed to deliver: provide consumers and their brokers information about available health plans from multiple carriers using a single interface and presenting the carriers’ distinctive information in a common format.

HHS will be hard pressed to meet their tight deadline building a quoting system from scratch. Obtaining one from an established vendor is the only way they’ll deliver what the new health care reform law demands on time.

Enter opportunity. HHS is unlikely to simply lease a third-party quoting system. Instead they will buy a system. Then they will seek to make their purchase the industry standard. One way to do that would be to make the system open source – available for anyone and everyone to build upon.

The biggest operating cost incurred by quoting system providers like those mentioned is not building the quoting technology: it’s inputting and maintaining the rate and benefit information. Each company is required to translate the unique templates and descriptions used by the carriers into a standard format. From an industry point of view this is nonsensical, especially when one realizes the eventual result is pretty much the same: a report displaying carriers’ rates and benefits.

What’s happening with quoting insurance rates is reminiscent of what occurred in the auto industry when the government required them to deploy catalytic converters. Each car company spent many millions of dollars creating a proprietary device. Yet do you know anyone who has purchased a car based on the design of its catalytic converter? Think of how much automobile manufacturers would have saved if they’d come together to create a common device. This would have freed them to compete not on an invisible commodity built into every car, but on design, price, quality and a host of other more meaningful elements.

Similarly, the quoting system vendors are spending considerable sums taking the same information and translating it into their proprietary platforms. The arrival of standard formats and of open source programming will free them to devote their energies on building what truly differentiates them: the myriad products and services they’ve built around their proprietary quoting systems. It is the case management, marketing, HR, client-communication, and other applications with which they’ve surrounded their quoting systems that makes each one unique and adds value.

These are entrepreneurial companies we’re talking about. Dollars currently spent on translating carrier information into their proprietary platforms will be diverted toward creating new ways of helping brokers assist and support their clients. Meanwhile the standards will help carriers reduce their administrative costs. By making the quoting system architecture open source other entrepreneurs could enter the field, bringing their new approaches to the market.

The Department of Health and Human Services cannot duplicate in three months what these enterprises have spent years refining. Nor should they try. Instead, HHS should quickly pick one of the current systems and establish it as the industry standard.

Will this cost-saving opportunity change the world? No. But when it comes to wringing costs out of the health insurance system, any opportunity is welcome.

Posted in Health Care Reform, Healthcare Reform | Tagged: , , , , , , | 19 Comments »

Civility Required Here

Posted by Alan on March 26, 2010

There are plenty of blogs out there where partisans can throw red meat (or blue meat, as the case may be) to their base; blogs where the more outrageous the statements the more praised the writer will be. This is not one of those blogs.

Health care reform generates a great deal of passion and heat. The issues are personal and critical, moral and political, economic and ideological all at once. People have strong feelings and beliefs about America’s health care system. There is absolutely nothing wrong with that – unless it slips into the kind of ugly behavior we’re seeing across the country where vandalism and name-calling seems to be becoming increasingly acceptable.

Because while there’s nothing wrong with being passionate about one’s beliefs, there is something wrong in viewing the other side as less than human, labeling them as socialists or whiners or idiots or what-have-you. Name calling and stereotyping do nothing to shed light on a complex topic. It may make the writer feel better, but it diminishes the debate and the value of this blog.

I’ve let the arguments and venting run for the past few few weeks. First, because I don’t monitor the comments as closely as perhaps I should. Second, because I felt it reflected the anger, jubilation and passion readers feel about what’s happening with health care reform. And third, because I don’t want to stifle open conversations.  I was willing to let some inappropriate comments remain on the site because I didn’t want to stifle the conversation. I did remove some especially offensive comments, but frankly I should have removed more. The tone of the debate on the site has too often slid into an abyss that is neither appropriate nor welcome.

So, as reluctant as I play the role of censor, I’m going to impose a tighter rein on the discussion. Hopefully I won’t swing too far the other way as I truly enjoy the give-and-take that takes place on this blog. The articulate expression of views and perspectives that most commentators provide this blog most of the time is part of its appeal, at least to me.

I very much appreciate that you all take the time to read my posts and share your comments with the small community we’ve created here around the health care reform issue. And I hope you’ll continue to join in the discussion.  When you just have to vent, there’s plenty of other sites available to you. Knock yourself out. But when you’re writing here, please keep it civil.

Posted in Uncategorized | 13 Comments »

Health Care Reform 2010: Required Reading Part I

Posted by Alan on March 24, 2010

Complex legislation is, well, complex, and the health care reform recently signed into law by President Barack Obama is no exception. Complicating the complexity is that the Senate is still considering clean-up legislation that will modify the existing health care reform law. And the Senate could wind up amending that clean-up bill before passing it (if the Senate does pass it) sending the sidecar legislation back to the House for their approval. and could change some of its provisions. (This circumstance is looking increasingly unlikely. The clean-up bill will go back to the House to correct some technical problems, but it is unlikely to contain substantive changes. But then, nothing is certain when it comes to health care reform).

So to paraphrase Winston Churchill’s famous “”a riddle, wrapped in a mystery, inside an enigma,” what we have here is uncertainty, wrapped in complications, inside complexity. There are many layers to this onion and it will take time to get through them all. Which doesn’t mean we shouldn’t start trying to figure out what’s what. It just means we should recognize understanding what the new world of health care in America will be like is far less certain than the critics and proponents would have us believe.

What follows then are links to articles, sites and the like you may find useful as you begin your marathon onion peeling process:

  1. Health care reform implementation will arrive slowly at first growing to a torrent by 2018. Keeping track of what happens when can be tricky. Enter the National Association of Health Underwriters and their excellent health care reform timeline.  A superb starting point for understanding what’s ahead.
  2. Legislative intent and legislative language often conflict. For example, Democrats in Congress and the Administration want health insurance carriers to accept children applying for coverage regardless of their pre-existing conditions. They intended to have this requirement implemented within 90-days of enacting health care reform. But the language in the bill apparently does something slightly different. According to the Associated Press, while carriers cannot exclude a child’s pre-existing condition once that child is enrolled, insurers are not required to guarantee acceptance of children applying for coverage who have pre-existing conditions. The Administration will try to rectify this situation through regulation, but it’s not yet clear what they can do.
  3. Professional brokers do much more than simply sell health insurance policies. They educate and counsel their clients over the long-term. Those clients are already calling brokers asking for a quick summary of what health care reform means to them. NAHU comes to the rescue again with their “How the Health Care Reform Legislation Will Impact Your Employer Clients” document. Don’t leave the office without one. (Note: If you’re a professional broker and not a member of NAHU, you need to sign up right away. NAHU has fought vigorously on your behalf. They provide terrific material — such as this document and the timeline, above — on a host of topics. They deserve your support.)
  4. Regular reader Alison sent me a link to an excellent review of the health care reform legislation from the Wall Street Journal.
  5. The Senate is debating HR 4872, the so-called sidecar legislation aimed at improving the legislation signed into law by President Obama. Want to know what it does? Go to the source, which in this case is the House Committee on Rules web site. Here you’ll find the text and summaries of this clean-up health care reform bill.
  6. People’s feelings about the importance of polls tend to wax and wane with whether the poll results coincide with their own opinions. Democrats in Congress who once urged the previous Administration to listen to the polls concerning the war in Iraq are now enamored with the concept of being true to one’s convictions. Republicans who stood firm against public opinion on the issue are now condemning Democrats for ignoring the will of the people. Polls,in other words, are of limited value. But if we’re going to read them, let’s read good ones. The Kaiser Family Foundation has done a series of health care reform related polls over the years. The Foundation’s tracking survey on health , conducted before the current bill passed, reveals some interesting trends concerning the public’s feelings about health care reform.
  7. I’m one of those who believe health care reform will do less than supporters promise and is not nearly as dangerous as critics claim. One reason is that, well, this is always the case with legislation. People have a tendency to assume the best or worst. Reality has a way of settling in somewhere in between. The other reason is that participants in the debate often overstated or misstated facts. A reality check is useful now and then. The Associated Press recently offered a fact check that advocates on both sides of the debate should read.

I’ll publish more required reading material in the days ahead. Meanwhile, if you’ve come across a useful article or site on the subject of health care reform, please send me the link. If it sheds light on the subject (as opposed to merely more heat) I’ll try to include it.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Insurance Agents | Tagged: , , , , | 55 Comments »

Health Care Reform Leaves Plenty of Time to Prepare for Change

Posted by Alan on March 22, 2010

We all know the clichés surrounding change. Change is hard. Change is another word for opportunity. Change is inevitable. Change hurts. Change is for the best. Etc., etc. Put simply: change, whether for good or bad, is uncomfortable. And under the legislation passed by the House of Representatives yesterday, change is coming to the health care industry. In fact, when one-sixth of the economy is involved, change is coming to our society.

The anxiety this change is causing is not surprising. Health care is personal and critical. The legislative process and political context in which this health care reform bill passed has done little to inspire confidence. For many readers of this blog, whose career and livelihood is inextricably tied to the health insurance industry, the changes coming are especially unsettling.

So a certain amount of hyperventilating is to be expected, both in the comments section of this blog and beyond. Over the next several days I’ll be posting information about some of the details of the reform package and offer my observations on how this will impact the industry and, more specifically, professional health insurance brokers. But for now, my advice is, to take a deep breath and try to maintain a sense of perspective.

Keep in mind, nothing is going to change tomorrow. Or next week. Or next month. Most, although not all, of the reforms take effect months and years from now. There will be plenty of time to digest the meaning of the health care reform package and to prepare for its impact.

Not only will there be plenty of time to digest and prepare for the coming changes, there is plenty of time to influence what those changes are. Congress is still considering the clean-up legislation. And once these laws are signed, there’s still much to be done. Judges, judges, regulators and state lawmakers will refine, define and mold the provisions of the bills. This is an evolving process. Organizations like the National Association of Health Underwriters are well prepared to promote the viewpoints of its members.

One final bit of reassurance for those overstressing about health care reform. It takes the form of two interconnected truths: 1) things are never as bad as they seem to be; and 2) America is strong enough to muddle through challenges, mistakes and worse.

America survived Senator Joe McCarthy and his witch hunts in the 50’s. We survived the anti-war demonstrations and the campus riots of the 60’s. We survived President Richard Nixon and Watergate in the 70’s. We survived mullets in the 80’s. America survived the scandals of the 90’s. We survived unfunded, deficit-busting tax cuts for the wealthy in the ‘00s. (Two of them, actually). The reason? None of these events were as cataclysmic as they seemed to be at the time. And America is strong enough to survive such problems.

To claim that health care reform marks the end of America’s greatness is illogical and, based on history, wrong. Opponents called Medicare and Social Security socialistic, yet the country is sound and those programs are an established part of what’s considered the norm. Critics claimed President Franklin Roosevelt’s New Deal was going to result in the destruction of American values. Didn’t happen.

At least once per generation some economic swing is described as dooming the financial wellbeing of that generation’s children and grandchildren to an inner circle of financial hell. Well take a look around. We are the grandchildren of those economic policies. And we’re still the strongest economy on the planet.

The unknown is a scary place because, well, it’s unknown. And as human beings we have a tendency to extrapolate from where we’ve been through where we are to where we’re going in a straight line. The Glenn Becks of the world love to play this game, tying reasonable regulation to the advent of socialism, Nazism and communism. But the Glenn Becks of the world are more interested in selling soap (or gold, as the case may be) than in presenting sound and reasoned arguments. To fully understand the silliness of this simplistic, irrational thinking, I strongly urge you to spend 15 minutes watching Jon Stewart’s skewing of Glenn Beck on The Daily Show that aired on March 18th. Not only is it hilarious, but it superbly outlines the danger of Mr. Beck’s sloppy illogic. (There’s a couple of annoying commercials you have to get through before the show starts, and it’s somewhat risqué, but thedelay before he gets to the chalk board is well worth it. This may be the best quarter-hour of political satire I’ve every seen).

America is a resilient country. We are creative, hard working, and dedicated. We work things through. The health care reform package President Obama will sign into law tomorrow (even as improved by the side-car legislation that will likely arrive on his desk in the next few weeks) creates problems galore. It does some good things, too. For those taking notes, the status quo presents problems aplenty, too. And it also does some things well.

Problems are never solved, they’re just replaced with new problems. And as those new problems emerge we’ll address them.

The same holds true for health insurance professionals. We’ve faced change before – and not all of it for the better. But we continued to provide meaningful services to our clients, demonstrated our value and expertise, and we’ve succeeded. And we will again.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics | Tagged: , , , | 31 Comments »

Health Care Reform Passage is Historic, But Only the Beginning

Posted by Alan on March 21, 2010

Health care reform was passed by Congress today. It’s as simple as that. And as complicated. The legislation will do far less than either its proponents or opponents claim. But the legislation will change the insurance industry. It will begin to address some of the drivers of skyrocketing medical costs. It will aggregate more power and influence in government while it is far from a government takeover.

The political impact of health care reform legislation will have far reaching political ramifications for years to come. The Senate health care reform package and the associated clean-up legislation were passed exclusively with Democratic votes. Which means if, over time, the program is deemed by voters as successful the electoral benefits of the program will accrue almost exclusively to Democrats. And if the program is rejected by voters it will be Democrats who are punished.

The vote in the House of Representatives – 219-to-212 to pass the Senate health care reform bill and 220-to-211 in favor of the clean-up legislation – is historic by any definition of the term. Many Presidents of both parties had tried to pass health care reform. Many Congresses had considered such legislation. To President Barack Obama and the 111th United States Congress goes the credit (or blame) for actually taking action.

Their bill is more moderate than some that had been proposed (the proposals of both Presidents Bill Clinton and Richard Nixon were in many ways more far reaching) and far more liberal than others. Yet the politics, policy and process has polarized the nation in ways few issues have before. (I find it ironic that many of those marching against today’s health care reform today were doing much the same against the Viet Nam War in the 60s and early 70s – or condemning those who did).

The House vote today means that, once signed, the Senate health care reform bill, HR 3590, becomes the law of the land. However, virtually no one in Congress or the Administration likes that bill as written. Consequently, the House passed a companion bill, HR 4872, that makes several significant changes to the HR 3590. Most significantly, the companion bill can be considered by the Senate under established parliamentary rules that bypass the filibuster process. This means the clean-up bill can be passed by a simple majority of the Senate – 51 votes. Senate Majority Leader Harry Reid has assured House Speaker Nancy Pelosi he has rounded up the necessary votes. However, success is neither automatic nor guaranteed. Republicans have the ability to delay passage of the clean-up legislation and might be able to have key elements of it removed.

This means there will be two signing ceremonies concerning health care reform: in the first President Obama will sign into law the Senate health care reform bill that no one likes. In the second, President Obama will sign into law a measure that virtually everyone agrees makes the first bill better. American politics being what it is today, however, we will first witness the spectacle of Republicans trying to defeat legislation that contains provisions they would likely admit improve the law that they failed to defeat today. No wonder Alice in Wonderland is the most popular movie in the land today. The body politic has fallen through the looking glass.

As a result of tonight’s action, Congress has addressed the easiest part of health care reform: changing how insurance companies act and are regulated. These “market reforms” are meaningful. Some, although not all, were necessary. But in a real sense the measures enacted represent low hanging fruit. Because the reality is that insurance companies don’t determine insurance premiums in a vacuum. Congress has taken on the easy villains in this drama: the greedy insurance companies. But everyone knows (and a few will admit) that health costs will continue to increase at an unacceptable rate. This means lawmakers will soon be forced to address the real driver of increasing health insurance premiums: medical costs that increase at twice the rate of general inflation. Doing so will be more difficult than beating up on insurance carriers, but eventually there’s no escaping the need to address root causes.

Then there’s the inevitable law suits. State legislators are already passing laws to exempt their citizens from elements of the health care reform package (specifically the requirement imposed on virtually all Americans to obtain health care coverage). And any legislation of this magnitude is a boon for lawyers in both the private and public sectors.

Should agents and brokers (the primary audience for this blog) consider passage of health care reform the death knell of their profession? No. Change will be required (something that has been required with some regularity every few years for the past three decades). But thanks to the efforts of the National Association of Health Underwriters and the hundreds of brokers who have engaged in the health care reform debate, change does not mean elimination for today’s professional brokers. And the reality is, even if Congress failed to pass health care reform brokers faced substantial changes to their profession in the next few years. The status quo was going to change by legislative fiat or as the result of internal stresses. At least now we have a better sense of what the new world will look like.

The health care reform bills passed by the House of Representatives today draw the outlines of this new world. It will be up to judges and regulators and future Congresses and state legislatures to fill in the details. As mentioned previously, neither the health care reform process or debate is over yet.

So yes, the House of Representatives made history tonight. And it’s only the beginning.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics | Tagged: , , , , , , | 26 Comments »

The CMA, California’s 5th Assembly District and the Future of Health Care Reform

Posted by Alan on March 20, 2010

[Full Disclosure: This post is about the 5th Assembly District. The leading Democrat in the race, Larry Miles, is a Trustee on the San Juan School Board, an attorney, mediator and my close friend for over 35 years. I’m actively supporting his campaign.]

Regardless of whether health care reform passes the House of Representatives this weekend, a great deal of how health care reform takes shape going forward will be determined by the states. If national reform fails, state legislators, who for the most part have been holding back to see what emerges from Washington, will attack the problems inherent in the status quo with a vengeance. If Congress enacts President Barack Obama’s health care reform package, the terms of the new law creates substantial responsibilities on the states to implement many of its provisions.

In short, the health care reform debate won’t be over any time soon. It’s center of gravity will, however, shift somewhat toward the states. Special interests have recognized this coming reality and some are doing something about it.

Take physician groups, specifically, the California Medical Association. Even the most ardent supporters of the health care reform bill before Congress will concede it deals more with health insurance reform rather than medical cost containment. True, the legislation being considered by Congress has some cost reducing provisions and lays the groundwork for still more, but it also contains many elements likely to increase the cost of medical insurance. Having addressed the easy part of reform (changing how carriers do business) lawmakers will eventually have to tackle the hard, complex and politically charged work of constraining medical costs.

For now, however, President Obama’s health care reform package asks little sacrifice of doctors. And that’s just the way the American Medical Association and its affiliates like it. The Medical Associations exist, after all, to look after the financial interests of doctors as their focus on medical liability reform, medical physician payment reform, balance billing issues and the like makes clear. They are a political organization looking out for the best and specific interests of its membership. Nothing wrong with that. In fact, that’s what special interests groups are supposed to do.

What’s happening in the 5th Assembly District here in California illustrates just how serious the California Medical Association takes this role. There the CMA has recruited a candidate and is now seeking to buy the seat on his behalf. Thus the candidacy of Dr. Richard Pan in the 5th AD. (The 5th AD stretches from east Sacramento to Folsom).

Dr. Pan is by all accounts an outstanding pediatrician and a fine, decent person. Whether he had any political ambitions before the CMA came calling is unknown. He certainly cannot claim to be a community-generated candidate nor boast of much grass roots support in the district. In the financing period that ended December 31, 2009 (the last reporting period available) over 95 percent of Dr. Pan’s campaign contributions came from outside the 5th Assembly District. Even more revealing: over 95 percent of those campaign dollars came from the California Medical Association, other medical PACs, doctors, dentists and other members of the medical industrial complex. Calling Dr. Pan’s support from within the district “thin” would be an understatement.

But the CMA doesn’t care. They are not concerned with the interests of the residents of the 5th Assembly District. They want one of their own in the state legislature – one of their own who can look out for the interests of the California Medical Association.

In addition to pouring money into the campaign, the CMA has provided Dr. Pan with a campaign manager enamored with the Karl Rove school of politics, Josh Pulliam. Mr. Pulliam is well known for hardball tactics of the devious kind. He’s a brawler both in the political arena and beyond (Mr. Pulliam, is the alleged instigator of a melee at a Cubs-Dodgers baseball game involving players and fans when he reached into the Dodger bullpen and grabbed catcher Chad Kreuter’s cap). In fact, Dr. Pan has already had to apologize for Mr. Pulliam’s Liz Cheney-esque campaign attack on Larry Miles, the front runner in the Democratic primary. (Mr. Pulliam, like Ms. Cheney, fails to understand the role lawyers play in America’s system of justice).

The CMA’s concerns are not limited to the 5th Assembly District of course. In 2009 the California Medical Association Small Contributor Committee contributed over $925,000 to lawmakers and candidates. And this is just from one of their PACs. Nor does this total include contributions from their allies in the medical-industrial complex including contributions made by individual doctors, county medical associations and the like at the CMA’s request.

Nor is the substantial political spending by the CMA anything new. A recent report published by California’s Fair Political Practice Commission shows that, between January 1, 2000 and December 31, 2009, the CMA has spent over $9 million to influence elections (including ballot measures and giving money to political parties) and spent another nearly $14 million on lobbying activity to help shape legislation.

There’s nothing immoral with the CMA and like-minded attempting to foist Dr. Pan on the residents of the 5th Assembly District. They’re playing by the rules of the game. Nor is there anything wrong with the CMA spending large amounts on campaigns. It’s their money and again, they’re playing by the rules. While obnoxious, there’s nothing illegal with Mr. Pulliam’s hardball election tactics either. Politics is, after all, a contact sport. That the CMA and Mr. Pulliam are running Dr. Pan against a good friend of mine is just one of those things. May the best candidate win.

Nor is the CMA alone among interest groups concerned about how health care reform plays out. Others are spending tremendous amounts of money to influence elections and legislation, too.

What’s significant about the CMA’s efforts (and the efforts of other special interest groups) is what it says about the important role state legislatures will play in determining how national health care reform (assuming there is national reform) is implemented and how future health care reform efforts play out. Washington will still matter. Regulations will be developed there. Follow-on legislation will be voted upon there. But the role played by state lawmakers and regulators will be increasing The California Medical Association and their allies recognizes this. That’s why they want Dr. Pan in the State Assembly. They know one vote, one voice in the legislature, can make a difference.

Whether the CMA-led medical-industrial complex can purchase the 5th Assembly District for Dr. Pan is far from certain. The frontrunner for the Democratic nomination, Larry Mile, has built his campaign with a strong and broad foundation of local support. Significantly, Mr. Miles has won two elections in a school district that covers some 75 percent of the Assembly District. Then there’s the general election. Democrats only recently have come to outnumber Republicans in the District (and roughly 20 percent of registered voters are in neither party). But what’s significant is not whether the CMA wins. What’s significant is the money, resources and political capital they are spending to try.

[Note: As I mentioned at the beginning of this post, Larry is a long-time friend. I’ve contributed to his campaign (as has the California Association of Health Underwriters PAC).  Those readers of this blog wishing to join me in supporting Larry can do so at his web site or through ActBlue.]

Posted in medical cost containment, Politics | Tagged: , , , , , , , | 3 Comments »

Follow-up Needed to Fulfill Health Care Reform Promises

Posted by Alan on March 19, 2010

Presidents propose, but Congress legislates. At the end of the day the President either signs or vetoes what comes to his desk. No rewrites allowed. Which, according to the Associated Press, is one reason why some of the promises President Barack Obama has made lately won’t be a part of the health care reform package the House of Representatives will vote on this weekend. Given the public’s distrust of Washington, this not only makes the legislation less effective, but it’s bad politics as well.

Among the Administrations unfulfilled promises as listed by the Associated Press: while the Cornhusker Kickback and a special deal for Florida have been stripped from the bill, other of the special favors done for specific states (and their Senators) remain in the legislation. Sending undercover investigators to hospitals to ferret out fraud and waste, an idea President Obama cited as evidence of his incorporating Republican ideas – that’s gone, too.

One promise not kept that many readers of this blog may praise is that the President’s plan to give federal authorities the power to weigh in on carriers’ rate increases is no longer in the bill. (This idea was a mistake to begin with. State departments of insurance evaluate rate increases, but have to take into account the solvency of the carriers they regulate. To add into the mix federal regulators who would be looking at the “reasonableness” of the rate increases would inevitably have produced conflicts and confusion).

Of course, the bill to be voted on this weekend is not the last health care related legislation Congress will consider in the next few years. So there’s still time for the Administration to fulfill his promises, especially those related to incorporating Republican ideas. And the White House should make the effort to do just that. Why?

Congress may be about to pass legislation that will have a huge impact on the health and financial wellbeing of every American. And that happens it will be on a purely partisan basis. When it comes to legislation dealing with roughly one-sixth of the nation’s economy, that’s a poor way to make laws. The public, especially moderate independents, distrust one-party rule and the one-party policies that emerge from it. The messy and convoluted legislative process that brought Congress to this point has only further undermined public confidence.

Democrats and Republicans are both to blame for this state of affairs. Republicans early on chose, for the most part, not to engage in meaningful negotiations. Several of their leaders spoke of the political benefits of denying President Obama of success on his top domestic priority. 

Meanwhile, Democrats, confident with their large majorities in both Chambers chose to go it alone. In fact, the liberal wing of the Democratic Party had the hubris to believe they could enact reforms without reaching out to moderates in their own party. The President’s promises to incorporate some of the ideas put forward by Republicans during the health care reform summit he conducted was recognition of the need to broaden support for the reforms. The absence of those GOP proposals, consequently, weakens the package as a whole.

Whether this is the result of Congressional Leaders being unwilling to accept these ideas or the inability to include those GOP proposals due to the requirements of the the reconciliation process being used to pass health care reform is immaterial. Health care reform is being passed in a manner that undermines its credibility.

If President Obama wants his health care reform plan to become a part of the nation’s norm, much as has happened with Medicare, which was passed over strong and emotional opposition, he will need to continue to continue the health care reform effort. Given the need to attack rising medical costs in a far more direct way than the current legislation does, some follow-up will be inevitable. The Administration should embrace this necessity and assure that this follow-up is credible, both in policy and in process. Doing so would go a long way toward healing the rifts in the body politic caused by the current debate.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics | 17 Comments »

At Long Last the CBO Weighs in on Obama Health Care Reform Plan

Posted by Alan on March 18, 2010

The critical role the Congressional Budget Office plays in federal lawmaking cannot be overestimated. Both parties know their own economists generate numbers designed to bolster their bosses’ ideology. Meaning they lack much credibility. So Congress established the CBO to be a neutral arbiter of the financial impact of legislation. Both parties, whether in the majority or minority, rely on the integrity of the CBO.

This doesn’t mean they accept reports from the CBO blindly and completely. Especially if the results are at odds with a party’s political needs, there’s harping about the assumptions used and the like. But the fact that both parties cite the CBO’s analysis as fact so often means their analyses have immense credibility – enough credibility to settle disputes and sway votes.

So the CBO’s score (as their analyses are called) concerning health care reform has been long anticipated. President Barack Obama built his health care reform package on the chassis of the legislation passed by the Senate on December 24, 2009. But he wants substantial changes (as do House members before they’ll go along with it). President Obama submitted those changes to the CBO and everyone has been waiting to see what their financial impact would be. How important is the CBO analysis? So important Democratic leaders have withheld the actual text of the changes they want to make to the Senate’s health care reform legislation until they knew whether the CBO would score the bill as costing less than $1 trillion and would be, at worse, deficit neutral.

The wait is over. (Almost. The actual report will be issued later today and I’ll add a link to it from this post. In the meantime word of it’s findings have leaked out). Note: the Congressional Budget Office’s preliminary estimate of the direct spending and revenue effects of President Obama’s health care reform proposal is now available.

As reported by Ezra Klein of the Washington Post, the Congressional Budget Office has concluded the health care reform bill proposed by President Obama will cost $940 billion over the first 10 years, reducing the deficit by $130 billion during that time. The impact on the budget is even greater in the next decade: the CBO estimates it will reduce the deficit by $1.2 trillion between 2020 and 2029.  The President’s proposal is also expected to result in near universal coverage with 95 percent of the eligible population having private or public health care coverage.

All the news outlets are reporting the same figures. While it will be critical to see the qualifiers and methodology used by the CBO to reach these conclusions (which will be available only when the actual report is published later today), Democrats are already celebrating the figures. One reason: as Fox News reports, the CBO analysis makes it far more likely the clean-up legislation necessary to amend the Senate health care reform bill will meet the requirements of the reconciliation process. This means the clean-up bill can side-step the filibuster process and pass with a 51 vote, simple majority in the Senate.

Next up in the health care reform roller coaster ride: the CBO report will be issued today and the House will vote on the Senate health care reform bill and the clean-up legislation on Sunday. Then the clean-up bill heads over to the Senate where Democratic leaders hope to hold a final vote before the end of March.

At least, that’s the plan. And very little concerning this health care reform effort has gone according to plan.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics | Tagged: , | 31 Comments »

Support for Health Care Reform Gains Support from Left and Middle

Posted by Alan on March 17, 2010

Health care reform is likely to pass the House of Representatives as early as this weekend or beginning of next week. The vote will be close. The methodology may open questions concerning legitimacy. But health care reform is likely to pass.

Consider: Liberals are falling into line. Some may have assumed this was a given, but some on the left oppose President Barack Obama’s health care reform package for failing to go far enough. They want their single payer system or their public option and don’t want to settle for anything less. Unless, it seems, anything less is nothing at all.

That, at least, is the explanation Representative Dennis Kucinich gave today when he switched his position and announced he’d vote “yes” on the President’s health care reform bill. As Sabrina Eaton of the Cleveland Plain Dealer writes about her home town Congressman, Representative Kucinich “acknowledged this morning that his choice now is to either vote ‘no’ on principle, and thereby possibly block the biggest (though imperfect) advance in health coverage in decades, or compromise for the good of the estimated 30 million more Americans who could gain insurance.”

More evidence: the opinion shows on MSNBC. Virtually all of the talking heads in their liberal line-up speak of the need for Democrats to pass the current version of health care reform even though it lacks their beloved government-run health plan. Even former Governor Howard Dean, speaking to a pro-health care reform march in Washington DC last week, was arguing for the legislation he often criticized , proclaiming, “We deserve a vote! Are you for the insurance companies or are you for the American people?”

The left, in short, has fallen into place. Liberals will not kill health care reform.

But liberals alone will not pass health care reform, either. That feat requires the support of moderate Democrats. And while centrists may not be rushing to support the current health care reform, at least a few are stepping forward. Representative James Oberstar was among the moderate Democrats who were following Representative Bart Stupak in opposing the Obama Administration’s health care reform bill over abortion language. This group of 12 (now, presumably fewer) Democrats, were holding out for the more restrictive abortion language in the House’s version of health care reform. Representative Oberstar today announced he would support the President’s health care reform bill saying “On balance, it does what we need to do,” according to the Minnesota Independent. Another pro-life Democrat, Representative Dale Kildee, a close ally and friend of Representative Stupak also announced his support of the Administration’s health care legislation today. According to the New York Times, Representative Kildee said “he was satisfied that the provisions in the health care bill passed by the Senate would prevent the use of federal money for insurance coverage of abortions.”

The U.S. Conference of Catholic Bishops and anti-abortion groups like the National Right to Life Committee have been the driving force behind the more restrictive abortion language included in the House bill.  As reported by McClatchy Newspapers, the Bishops believe the Senate abortion language would “open the door to federal financing” of the procedure. But today a group of 60 nuns, leaders of orders comprised of 59,000 Catholic nuns sent a letter to House members urging them to pass the Senate health care reform bill. According to the Associated Press. in their letter, the nuns claim that “despite false claims to the contrary, the Senate bill will not provide taxpayer funding for elective abortions.”

Whether the split between bishops and nuns will be enough turn all of Representative Stupak’s faction into supporters of health care reform is unlikely. But as Katie Connolly notes in her post on the Newsweek magazine, “Having high-profile support from a key Catholic group nudges fence-sitters in (the Stupak) group toward a yes vote. At the very least the (nuns) letter damages the validity of Stupak’s argument.

(What’s ironic about the fight over how health care reform addresses abortion is that, as a practical matter, both the House and Senate versions of health care reform are victories for anti-abortion advocates.)

Passage of health care reform is not a done deal. Momentum is not victory. Patrick O’connor of provides an excellent summary of the challenge Speaker Nancy Pelosi faces in assembling 216 votes to in support of health care reform. And even if the bill passes in the House of Representatives, who really knows what will happen in the Senate? Given the twists and turns of our story so far, anything could happen.

But with liberals falling in line and moderates slowly coming to support President Obama’s health care reform package, passage is certainly more likely today than it was yesterday. For those who consider this the ruin of American ideals, the end of quality health care in this country and the demise of the health insurance industry, my advice is to take a deep breath.

There’s thousands of regulations yet to come. There’s plenty of opportunity for Congress to tweak the reforms for the better. And there’s always the adaptability of American business. Somehow these things have a way of working out. Careers continue. The country endures. Health care reform, 2010 style, is unlikely to be any different.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics | Tagged: , , , , , , , | 7 Comments »