The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

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.


17 Responses to “Follow-up Needed to Fulfill Health Care Reform Promises”

  1. Rick said


    They have no choice but to reconcile prior to passing the Senate bill as the members do not trust their leaders. Just a thought.

    • Rick,

      As we all (probably) know by now, the Bill passed with a straight party line vote (and 34 Democrats voting “No”).

      I heard today on CNN that TRICARE, the Military health care program, will not be recognized by this new Bill as a Provider. Should that information be correct, imagine the harm that will be done to our retired Military…TRICARE used to be called CHAMPUS.

      It should now be interesting to see how many other programs, that have worked well for so many millions of Americans, will be severely affected to the negative. . . [Medicare Advantage…was planning to get that for my wife and me…hmmm…Medicare period…those who have been using ERs for their providers, like Illegal Aliens, the poor, the almost poor…it will take time before this mistake takes effect…how many sources of care will close up shop while they can, and then, who will provide that care? Hmmm…bet no one in the Administration or Congress thought that one through]…somehow, I don’t think the final chapter has been written on this “book”.

      • I spoke too soon; it ain’t yet over.

        While the Bill has passed the House, and will go to the President’s desk for signature, it must yet go to the Senate for debate and passage of the Reconciliation language.

        Amazingly, yet somehow not surprisingly, the media pundits and analysts are now, only now, really debating the fiscal notes the CBO has attached to this Bill, and only now am I hearing strong language from these same analysts voicing real concern about the millions of Americans who will lose their Medicare Advantage Plans (“Screw the elderly, they’re old anyway”…my personal take on the lack of concern voiced until tonight), their strong comments just now about the real and implied threats from Union Leaders to Members of Congress that they’d better vote right or lose their jobs in November because the Unions will elect those they think properly represent them (and remember, the Supremes recently ruled that Unions can give until their members hurt to any campaign, in any amount they wish), and other real attempts at looking beyond the rhetoric at what the ramifications of passing this bill may present; an aggressively debated issue, which ultimately drew the reluctant acquiescence of the liberal Democratic member of the debate, is that in no way will the cost of health care go down, or the cost of this Bill prove to be a savings to our federal “Mega-Trillion Dollar” deficit. Au contraire, be prepared to open your wallets, taxpayers, because it will get worse.

        I truly didn’t expect to hear this tonight, however, also discussed was their take that “it STILL ain’t over”, and won’t be until the Senate passes reconciliation, and (paraphrasing) “then let’s see what happens in November”.

        Interesting-er and interesting-er.

        • Alan said

          Spence: the House of Representatives voted on two bills tonight. As I’ve just posted, the first, HR 3590 has passed Congress and will be sent to the President’s desk. As soon as it’s signed by the President it is the law of the land and its provisions become effective as defined in the bill itself (some, such as requiring carriers to accept children on a guarantee issue basis) and some in four or five years. The second bill, HR 4872, is the so-called side-car legislation that makes changes to the first bill. It is this second bill that now will be considered by the Senate under reconciliation rules. If that bill does not pass, the first bill is still law. That’s part of the absurdity of the what we’re about to see. Republicans will be arguing against a bill that, among other things, eliminates the special deals cut for Nebraska and Florida while Democrats will be seeking to pass legislation that includes some ideas put forward by Republicans.

          Also, I really don’t see how you can attribute a “screw the elderly” mentality to the media. First, there’s so much going on concerning the debate and the issues are so complex, it’s not surprising that not all of them are addressed equally. Second, its seniors who watch the news (as the numerous commercials about reverse mortgages, engine-powered wheelchairs, Alzheimer’s medication and the like reveals more clearly than Neilson ratings). The media has every incentive to focus on provisions of the bill that impact seniors. Although I’m no expert on Medicare supplement programs or Medicare Advantage plans, and I know you are, I’m willing to bet claims that Medicare Advantage plans are going away are overblown. Health plans offering Medicare Advantage are pretty ingenious. Where there’s a will there’s a way and they have the will to keep the program alive.

          Finally, while the unions did play hardball on lining up votes in favor of the Democratic health care reform bill, so did the business community and conservative organizations. The Supreme Court decision you refer to didn’t really loosen the spigot much for unions. The case before the Court focused more on business spending.

          None of this is to say the bill isn’t fraught with problems. The unintended consequences that will flower as a result of these bills are beyond counting and absolutely inevitable. And some of the intended consequences will limit consumer choice and increase insurance premiums. (And, to be fair, there’s a lot of good the bill will do, too, including insuring millions of Americans currently unable to obtain coverage today). This isn’t the legislation I would have passed. But the way I look at it is, it’s not nearly as good as MSNBC would have you believe nor anywhere near as bad as what Fox News claims.

        • Rick said

          “And some of the intended consequences will limit consumer choice and increase insurance premiums”

          Alan, What you have posted indicates this health care bill will increase the cost of health insurance. That means the underlying problem cost of health care remains. We were told that those evil insurance companies were excessively increasing your insurance premiums. I thought one major goal was to reduce the cost of health care, or at least reduce the amount of future increases, and as a benefit of that favorably impact the insurance cost. What ever happened to that?

        • Alan,

          “That’s part of the absurdity of the what we’re about to see. Republicans will be arguing against a bill that, among other things, eliminates the special deals cut for Nebraska and Florida while Democrats will be seeking to pass legislation that includes some ideas put forward by Republicans.” You’re right, it’s beyond absurd.

          “Also, I really don’t see how you can attribute a “screw the elderly” mentality to the media…” I may have confused my intent, Alan. What I meant was that the media is now reporting on the “second class citizenship” being denoted to the elderly, by those who have concocted this Bill. We will have to agree to disagree regarding Medicare Advantage Plans (not about their being ingenious, they are, but about the effect of taking $500Billion from Medicare will have on the future of Med Advantage Plans) and the effect that reducing Medicare by $500Billion will have. There is no question that these components, when implemented (albeit several years from now, it is now Law), will have an enormous negative effect on Medicare Beneficiaries being able to receive quality care. It will be even more difficult to find good providers as the physicians will take some pretty healthy cuts in Medicare AND in this new ENTITLEMENT, and many will leave the profession, as is already happening. Physicians, as with us all, have the constitutional right to not have to go broke. Are we “betting on the come”? Of course. That’s okay if you’re playing poker, it’s not okay when you’re gambling with peoples lives and futures.

          I have also paid a bit closer attention to other items that “slid by” without much notice yesterday, I.e. Student Loan Provisions. In watching a detailed report just now, by Ali Velshi on CNN, it was made starkly clear that the “Middleman”, the Private Sector, which has been helping students with the vast majority of their loans is to be tossed out and the Feds, helping with about a third of what the Private Sector has done, will run it all. At least that was the bottom line of the CNN report.

          Government taking over the country’s Health Care and Student Loan program, when it couldn’t manage Medicare properly, Medicaid properly, Social Security properly, VA properly, Student Loans properly, and government anything properly, not only doesn’t make any sense whatever, it seems like a certain very powerful segment of our Congress, coupled with this new Administration’s philosophies, is bound and determined to put this country on a very straight path away from “Free-market” and Capitalist philosophy (stressing that each individual has the opportunity to succeed by investing the efforts they wish into their future) to a “Socialist” philosophy of government, not akin to Canada, Great Britain, or Germany, but more akin to Marxist-Leninist philosophy, though that comment now, at this time, is an overstatement.

          We aren’t discussing “Equality of Opportunity”, a basic tenant of our Constitution, we are discussing “Equal Distribution of the Results” of the efforts put forth by the individual, to be spread equally among all members of society, regardless of effort or quality of the end product produced.

          That same philosophy is evident in Obama and the liberal members of Congress’ goal in achieving “Immigration Reform”, which we now understand to mean, “Amnesty for all ILLEGAL ALIENS”, no credit or “Huzzah’s” to be given to those who came to America, LEGALLY, IMMIGRATED, learned English, learned to drive, bought insurance, learned the Law…no, Immigration Reform means give it to them all, no rules required, let ’em stay, and change the definition of the word “ILLEGAL” to Legal.

          There is something inherently wrong when a large segment of our society is in such a rush to throw away those values that helped to make us a great country in order that we can become simply a mediocre country along with the rest of them.

          Lest any forget, I am an independent, not a Libertarian, not a Democrat, and not a Republican. I am Fiscally Conservative and Socially Very Liberal. I believe in so called “Gay Marriage” which I refer to as “Equal Rights”, I fully believe in a Woman’s Right to Choose, I believe in helping those who cannot help themselves, financially, with paid for education, whatever it takes. I have lived my life by those rules. I have done well (and I, as you, Alan, have worked 12 to 15 hours a day, six days a week to achieve my success), and I have given a lot of my earnings and time away to those less fortunate. It has been my CHOICE to do so, the guv’mint didn’t tell me what I had to do.

          Now, they are telling me what to do, and want to tell me that I have no place in saying NO to those who want to suck the sweat and blood off of those who have chosen to work hard and give, to those who haven’t worked hard and have CHOSEN to not give, and even to those who came here ILLEGALLY and now want it all, on a silver platter, no work, no effort, no nothing…just hold their hand out and say “Put it there.”

  2. JimK said


    I thought the Cornhusker deal and the other bribes were still included and that after this Bill is passed (it already passed the senate), it would be revised via reconciliation and it was at this time the special provisions were to be added or stripped away. Did I miss a lesson?

    Jim Kirk

    • Alan said

      Hi Jim. You’re mostly right. The various deals are in the primary health care reform bill . And it was the clean-up legislation that was supposed to eliminate those special deals. The problem is, at least according to the Associated Press, the clean-up bill is apparently only eliminating the Nebraska and Florida deal. Others (e.g., money for a hospital in Connecticut) are apparently untouched. Whether this is because stripping them out is non-germane to a reconciliation bill or because the Democratic Leadership lacked the will, interest, or ability to strip them from the bill, is unknown. But the key is they’re still there. And their presence undermines public confidence in the bill.

      • JimK said


        If the House deems the Senate Bill as passed the reconciliation process should be a real circus. Just think if it had not been for The Kaiser you would probably have nothing to write about today.
        Anyway, thanks for the quick response and I guess I will give myself a B minus. Also good luck to your friend in the 5th District, here in NY we have enough problems keeping Governors employed.

        Jim Kirk

        • JimK,

          My understanding is that the House has chosen to NOT use reconciliation, and instead go forward with a “REAL” vote. Apparently, “Reconciliation” received a very poor Public response. The Public said, “Do not do it.”.

          The results should be in, by now.


        • JimK said


          The attached article in Sunday’s NY Times describes the process. My reading of the article indicates they did drop the so-called deem and pass provision, which would not have required a direct vote by the house. The Democrats have instead opted for an up or down vote on the Senate Bill. If the Senate Bill is passed the reconciliation process will be used to clean up the Bill.
          If nothing else, I am getting an updated civics lesson.

          Jim Kirk

        • Jim, you’re not the only one getting a new civics lesson.

          I’m frankly amazed at how much I didn’t know and have learned, just in the past few weeks (and that’s after 40 years of being exposed to and absorbing all that I have. It seems that there’s always something new!).

          Many thanks for the link. That information was very helpful. I am left a bit confused, I must admit…if the Bill receives a “Pass” vote tomorrow (Sunday) and goes to “reconciliation” for clean up, is it still subject to another vote, or is the “clean up” just that, with no further vote necessary (I feel like adding a “Duh”, but have learned so many new “processes in bill-making” recently, perhaps my confusion isn’t singularly mine?)? 🙂


        • JimK said

          One other thing. There is a school of thought among conservative economists that the actions of FDR during the Great Depression actually exacerbated the Depression and without Government intervention the American economy would have recovered much sooner.
          I have not researched the contentions of this particular conservative school of thought and I doubt that healthcare reform matches the scope of The New Deal but I have been thinking lately that if there is any creedence to their philosophy the passage of Healthcare Reform may provide a present day laboratory for their theories.

        • JimK said


          I think the clean up is it for this phase of the Bill, however since many of the provisions do not take place until further in the future I am additional updates will be added.

          Jim Kirk

        • Jim,

          If the “Daily Beast” is correct, this will be the voting schedule for today:

          “The day’s schedule, via CBS News, has voting in the House beginning at 2 p.m today. There will be three major votes: first on the rules of debate. Then a vote on the reconciliation package—what will be taken out of the Senate bill. Ultimately, the House will vote on the original Senate bill itself. This last vote will likely come at 6:15 p.m.”

          The Dems appear to be pretty confident that they will have the necessary votes (38 House Dems would be needed to stop the bill from passing, and 38 “appear” to be voting “Yea”). As not all of the necessary votes to confirm have been validated, the House Leadership is not yet declaring a victory.

          More on this seemingly latest news can be found here: This article also contains the most current analysis of what is in the bill, and what has been changed and the difference in language.

          Orin Hatch says “It ain’t over”, here:

          This should prove to be an interesting “Long day’s journey into night”.


        • Rick said

          Commonsense tells me you must pass a bill prior to reconciling it. Therefore to reconcile the Senate bill before it has been passed is opening this to litigation. Does anyone agree with that thinking?

        • Rick,

          In candor, after all of the years I’ve spent in the “Nasty World of Politics”, I thought that I knew the various stages and processes of legislating a bill.

          Over the past couple of weeks I’ve learned that there are some “wrinkles” in certain procedures I thought I knew, such as the actual “Reconciliation” process, many things I didn’t know, such as “Deemed and Passed”, and now the order of passing on “Procedure”, “Reconciliation”, and an “Up or down” vote (again, it’s the process, the order of these votes, that has surprised me). While I wouldn’t think that this Democrat controlled Congress would risk the future of HCR on an incorrect or inappropriate procedure that could be easily challenged in court, maybe they would.

          I’m reminded of an old saying, “Politics is like sausage; if you knew what went into it, you’d never eat it!”

          I haven’t had an appetite since I got up this morning.


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