There is Now a Real Bipartisan Opportunity in Health Care
President-Elect Obama, and about every candidate for Congress, has said he wants to change the partisan tone in Washington. Obama, the Democratic Congressional leadership, and the Republicans have a terrific opportunity to do just that on health care when they all come to Washington early next year.
As I posted earlier, I do not believe there is any chance we can see the enactment of the comprehensive Obama health plan in the near term.
But there are a number of important steps that can be taken next year and each of them have enjoyed strong bipartisan support during the past year:
- Reauthorizing the State Children's Health Insurance Plan (SCHIP) and increasing the number of kids covered from six million to ten million. The Congress passed exactly that kind of reauthorization twice by strong bipartisan margins only to come a few votes short of being able to override two Bush vetoes of the bill. Those attempts met pay-as-you-go requirements by boosting the cigarette tax to pay for it.
- Rearranging Medicare spending by equalizing the payments private Medicare plans get with the payments the traditional Medicare plan receives for the same seniors. The Medicare physicians face a 21% fee cut on January 1, 2010 and there are other serious cost issues for Medicare. In July, the Congress took the first step toward payment equalization with a veto proof margin of 70-26 in the Senate and 383-41 in the House. The really hard part here is crafting a new Medicare physician payment system that is desperately needed but the first step, where to get the money, has strong bipartisan support.
- John McCain and Barack Obama had a number of similar and relatively non-controversial cost containment ideas in their health plans which would cost the federal government little or nothing. These similar proposals included the expansion of health information technology and a patient medical record; improving transparency about health care quality and costs including prices, errors, staffing ratios, infection rates, and disparities in care and costs; wellness initiatives including an emphasis on healthy lifestyles; development of best practice standards, requirements for disease management programs; requiring effectiveness reviews for procedures, devices, and drugs; and requiring providers to collect and report data to ensure standards for health quality are followed.
- There is bipartisan support for assisting small business in providing and paying for health insurance. In 1999, 56% of employers with 3-9 workers provided health insurance to their workers. By 2007, that had dropped to 45%. By contrast, employers with more than 200 workers provide health insurance 99% of the time. The one place employer-provided health insurance is melting away is in the small employer area. A modest bill to assist the small employer enjoys support among both Republicans and Democrats.
But, there is already bipartisan support for a children's health insurance (SCHIP) extension and the means to pay for it, reform of Medicare provider payments and the means to pay for that, a list of commonly agreed to cost containment initiatives that would cost the government little or nothing, and bipartisan support for help to the small employer to offer health insurance.
To be sure these steps would only make a dent in the number of those uninsured and these bipartisan cost containment items will only help our cost problem around the edges.
But all of these bipartisan steps would be progress, are doable, and are affordable.
President-Elect Obama and the Democratic leadership can do what the last two Presidents did--promise bipartisanship and then quickly employ the same old partisanship out of the mistaken belief they had the majorities in Congress that would enable them to steamroll the opposition. That mistake led to the 1994 Republican takeover of the Congress in the first case and two straight election defeats, in 2006 and 2008, in the second.
President-Elect Obama, the Democratic leadership, and the Republicans have the road map at hand to truly show a bipartisan commitment to health care change and progress. They could actually break the gridlock on health care and make some modest progress.
Will they take the road less traveled or just give us more of the same?
5 comments:
Dear Professor Laszewski,
There is so much that can be said about health care reform, one primary reform is in personal expectation of healthcare and its financing mechanisms. The argument bifurcates on either a prepaid healthcare model or health insurance for the unforeseen and unaffordable. These two directions should not be confused.
Secondly, I know of no one that is actively involved in healthcare reform that is not there to protect their own personal self interest. I have seen no proposals to date that serious address the continuing rise in health care cost, the driver in increase health insurance premiums. Every health care provider wants to continue to be able to sell their wares and they want no one to obstruct their endeavor.
Finally, I believe that President Elect Obama should build allies and policies around decreasing healthcare expenses by -12% for the 2009 - 2010 year. Build policies and solutions around reducing healthcare expenditures. Example: Low hanging fruit, An Executive Order ending direct to consuming advertising; the FDA should have never approved such a policy. We wittiness immediately increase in physician visits and Rx utilizations back in 1999 when the FDA gave their O.K. to direct advertising.
We saw a recent drop of 9% of oil consumption in the Country look at the ripple effect that occurred!!!!!Let us have our first year in reduced health care expenditures and see how the markets will act
We still have to have a way to control the high cost procedures/diseases that make up over 50% of health care costs:
1. Heart Disease
2. Cancer
3. Trauma Related disorders
4. Mental Disorders
5. Pulmonary Conditions
The rest of the world who already has socialized medicine controls the costs somewhat by rationing. All we are talking about in the U.S. right now is having taxpayers who make over $250K subsidize health care premiums for the rest of the workers making less. This will not work long term. One approach may be to limit new technology that is expensive with limited, or no real benefit over older less expensive technology.
1. Should new technology have to be better AND less expensive than older technology to be approved?
2. Should new technology have some kind of financial limit. That is to say, it can only cost $10K per quality of life year?
Everyone wants free universal health care. Premiums are increasing to fast and consuming to much of disposable income. Expanding SCHIPS is not that great of an idea either. Insuring children of households that make in excess of $75K does not make much sense. Always unpopular to vote agaist kids. Proably one of the few veto's from the present Administration that I would agree with.
Jim
We will need to spend billions of dollars to create jobs for Americans before this thing is over.
In a sense, with unemployment going the direction that it is going in, we have all the resources in the world. We have a highly productive and soon to be idle labor force.
The real question is how we are going to spend the dollars we do spend. Spending on health care is much more effective than tax cuts or bank bailouts since its creates jobs directly rather than relying on the uncertain response of rich people.
Full universal heath care will be extremely costly and will result in rationing because of artificial limitations in supply of medical services. The AMA restricts the number of students entering medical school to maintain physican incomes.
The greatest benefit to society per dollar spent, in my opinion, would come from increasing the supply of primary care providers rather than simply providing universal insurance. It is well documented that preventative care is the best way to keep medical costs down. One way this can be achieved would be to promote nurse practitioners as a substitute rather than a complement to the traditional physician-based medical system. Offering scholarships to nursing students in return for public service might be very cost effective in moving the country rapidly in this direction. While the AMA may resist this competition, it is well known that most med students are not interested in primary care and prefer specializations.
Why to the Democrats only ask for bipartisan coming together when they are at the reigns. We could have had that over the last 8 years, but lets be honest, it's just a buzz phrase. We have better and more workable solutions in the comments section of this blog than either party has come up with.
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