The Country's Political Center is Shifting and With it the Health Care Reform Debate

I always thought it was shortsighted for the Republicans to avoid comprehensive health care reform in the six years they controlled the White House and the Congress (2001-2006). Instead they just added $8 trillion in unfunded liability (Part D) to a Medicare system they've been telling us from the beginning is unsustainable as it is.

Eventually the political pendulum swings to the other side. Whatever big problems you leave on the table when that happens, you leave to the other guys.

Today's Washington Post cites a tracking poll that gives us reason to believe that pendulum is swinging the other way.

It seems that Democratic polling firm Hart Research and Republican firm Public Opinion Strategies have tested two propositions over the last twelve years: "Government should do more to solve problems and help meet the needs of people" and "Government is doing too many things better left to business and individuals."

In December 1995, a year after the Republican takeover of Congress, the poll gave a big lead to "less intrusive government"--62% to 32%.

This month, "a more activist government won out"--52% to 39%.

The Post pointed out that Republican voters still say government is doing too much--62% to 32%.

The data says two things to me:

1. Republican presidential candidates are running to the right for good reason in the Republican primary season. Republican voters are going to respond to the "free market" and "individual responsibility" health care reform messages all of the Republicans are now delivering.
2. "Free market" health care isn't going to get the job done in the general election.

Yelling "Hillary Care" may work for the Republicans with their own in Iowa, New Hampshire, and South Carolina in January but it will backfire come November 2008 if Republicans don't have more on the table by then.

The center has moved. Right now on health care, the Democrats are standing on it.

All of those great Republican health care reform ideas, where were they during those first six years?

They couldn't get them past Democratic "obstructionists?" They got $8 trillion in unfunded liability for Part D and a private Medicare Advantage program past them.

Hillary Clinton's Health Plan--the Republicans Better Take it Seriously

Sometimes I think that all the Republican candidates for president think they need do is go into a crowded room and yell, "Hillary Care," and all of the voters will run for the exits in terror.

This is not 1993 and this is not the inexperienced Hillary Clinton who tried to drop her drafted-in-secret 1,400 page health care proposal on us all in one "take it or leave it" roll out.

She has changed since 1993 and so have American voters.

Today, health care is the number-two issue--behind Iraq--and it is the number-one domestic issue.

Last week, the Kaiser Family Foundation told us that the average cost of employer-provided family health insurance is $12,000 a year. Today, the UAW and Detroit are in negotiations over the auto companies walking away from their retiree health obligations for 60-70 cents on the dollar.

Mrs. Clinton has come to the center with her plan and we've all gotten a lot more worried about health care and are ready to go a lot farther than we would have almost 15 years ago.

Mrs. Clinton recognizes that. Lots of voters know it.

But the Republican candidates seem to think rolling out the "Harry and Louise" ads, talking about tax exemptions, and giving us all HRAs will do the trick.

It might in a conservative Republican primary. But that is not where the center of American politics is these days and it is the center that it will take to win the 2008 presidential election.

And by the way, the next time you hear Mitt Romney yell, "Hillary Care," ask him just how her plan differs from the one he signed into law in Massachusetts. I do health plan analysis for a living and it looks to me like they are kissin' cousins.

The Republicans would do well to get serious about health care before, instead of getting themselves a repeat of 1993 when Mrs. Clinton's first plan went down to a crushing defeat, they get themselves a repeat of 1992 when Bill Clinton won the presidency in part because he was a lot more serous about health care than his Republican opponent!

Romney Wants to Reform State Health Insurance Regulation--Just What Does He Mean by That?

Republican presidential candidate Mitt Romney is calling for the cutting of state health insurance regulations to make policies more affordable. He blames the over-regulation of health insurance at the state level as one of the primary reasons health insurance costs so much.

Of course the reason that health insurance costs so much is that health care costs so much, but we’ve discussed that one plenty of times before.

Romney’s proposal comes straight from the conservative Republican playbook on health care. The thinking goes that state regulation has made health insurance expensive—just let the market set its own standards and costs will come down as people buy the policies they need.

To a point, these advocates are on to something. There are too many rules making costs higher from one state to another. Kentucky virtually blew its market up in the mid-1990s with excessive regulation, as one example. The new Massachusetts health insurance law (that Romney signed) refuses to recognize tens of thousands of existing health insurance policies because they don't meet minimum benefit requirements--particularly when the policy has a high deductible.

In fact, you can argue that the minimum health policy standards Massachusetts now has, because of the new law Romney signed, makes it the most regulated health insurance market in the union.

It would also be helpful if we had one regulator in the health insurance space rather than more than 50 and policies that could be sold on a national scale.

But those who advocate a “free market” for health insurance also need to heed recent history.

In the 1980s and early 1990s we had a virtual free market. Health insurers could cover whomever they wanted, drop people when they became sick or give them a whopping rate increase to drive them off. The vaunted “association health plans” many conservatives would like to bring back were in their glory—and largely made money “cherry picking” the best risks.

Most of the state health insurance regulation we live with today came out of the “cherry picking” controversy of the late 1980s and early 1990s.

There is plenty of regulation that is counterproductive and adds unnecessary waste.

But, most of it—the rules that add the biggest costs—were the direct result of some pretty bad free market experiences.

Is Romney looking to trim bureaucratic waste from the health insurance market?

Or, is he calling for turning the calendar back to 1990?

Just where is the health insurance regulatory waste he wants to eliminate? The voters deserve the details on this one.

Mitt Romney's Health Plan--A Foot in Each Canoe

Up in Wisconsin's Northwoods, camp counselors play a game with the kids in which they put two canoes together in the lake and have the kids try to stand up with one foot in each canoe. As you can imagine it's an almost impossible balancing act.

I was reminded of that last week sitting by our lake reading reports of Mitt Romney’s health plan proposals.

Romney has two canoes to deal with:

• He signed, and participated in the development of, the Massachusetts health plan law that has become the basis for the health plans proposed by Democrats John Edwards and Barack Obama—and likely the plan Hillary Clinton will offer.
• He is running as a conservative where there is a virtual requirement to offer market-based health reform ideas and to stay away from big government plans—which about all conservatives consider the Massachusetts plan to be.

Romney clearly has a foot in each canoe:

• He has referred to the Mass health plan as an “example of how he used conservative principles to provide affordable health insurance to all state residents."
• Recently in New Hampshire, Romney charged, "Barack Obama [whose health plan looks like the Mass plan Romney signed] said we're going to have the government take over health care. He at least had the integrity to say he wants to raise your taxes." He added, "The right answer is not a government takeover, it's not socialized medicine. It's not Hillarycare." Later, Romney said, "I don't want the guys who ran the [Hurricane] Katrina cleanup running my health care system."

Romney is trying to position himself as the darling of the conservative wing of the Republican Party—a smart thing to do if you want the nomination.

So, it comes as no surprise that his health plan principles come right out of the conservative Republican playbook on health care:

• Changing the tax code so more people are able to buy health insurance in the individual market.
  
• Promoting health savings accounts (HSAs) and high deductible health plans.
• Giving states more flexibility in how they use federal health care funds.
• Encouraging states to reform their state health insurance regulatory oversight to reduce the cost of insurance.

Romney seems to be trying to rationalize the two canoes by saying what worked in my state isn’t what I would do in yours, “A one-size-fits-all national health care system is bound to fail. It ignores the sharp difference between states, and it relies on Washington bureaucracy to manage. I don’t want the people who ran the Katrina cleanup to manage our health care system.”

But the same day he announced his health care plan, Romney spokesmen Eric Fehrnstrom, had this to say, “What’s important about the Massachusetts health care law is that it’s working, and Mitt Romney got it done by reaching across the political isle. We have fewer uninsured, the cost of policies is coming down, and more and more people are taking personal responsibility for their own care.”

So, if Romney is elected and has a Democratic Congress unwilling to enact a conservative Republican health program, will Romney again do the same deal he did with Massachusetts Democrats? I am sure that Senators Obama and Clinton would vote for it.

Watching someone with a foot in each canoe try to maintain his balance is always a hoot!

You can also see the complete Romney health care PowerPoint.

Fred Thompson—Too Good to Be True? Thompson Says He Will Shake Things Up In the Health Care Debate

The Washington Post’s David Broder is one of those people I have only the greatest respect for. So his recent column, recounting an interview with soon to be Republican presidential candidate Fred Thompson, caught my eye.

Broder described a Fred Thompson that sounds too good to be true:

“When Fred Thompson makes his long-delayed entrance into the Republican presidential race, he will not tiptoe quietly. Instead, he will try to shake up the establishment candidates of both parties by depicting a nation at peril from fiscal and security threats—and prescribing tough cures that he says others shrink from offering.”

He quotes Thompson as saying he, “will take some risks that others are not willing to take, in terms of forcing a dialogue on our entitlement situation, our military situation and what it’s going to cost” to ensure our nation’s future.

“There’s no reason for me to run just to be president,” Broder quoted Thompson as saying. “I don’t desire the emoluments of the office. I don’t want to live a lie and clever my way to the nomination or election.”

Thompson said in the interview that he would have opposed the Medicare Part D prescription drug program, “a 17 trillion add-on to a program that’s going bankrupt.”

Referring to the crisis that is looming over America’s out-of-control entitlement costs, “Nobody in Congress on either side in the presidential race wants to deal with it. So we just rock along and try to maintain the status quo. Republicans say keep the tax cuts; Democrats say keep the entitlements. And we become a less unified country in the process, with a tax code that has become an unholy mess, and all we do is tinker around the edges.”

Referring to national security and the fiscal crisis of an aging society with runaway health care costs, Broder quotes Thompson as saying these challenges, “are worth a portion of a man’s life. If I can’t get elected talking that way, I probably don’t deserve to be elected.”

Is Fred Thompson too good to be true?

Speaking of "clevering" your way along, see my recent post: Good Riddance to Karl Rove--How Part D Left an $8 Trillion Debt and Got Them Nothing

Democratic Presidential Candidate Bill Richardson Announces a Health Reform Plan

Democratic presidential candidate Bill Richardson recently announced his health reform plan.

Richardson's health care proposal follows the general outline offered by other Democratic candidates in that it focuses first on getting everyone insured and falls short in getting at the fundamental problem creating so many uninsured--health care costs.

Bill Richardson's health plan also builds on existing public and private health insurance programs.

Richardson would:

• Provide tax credits on a sliding scale to help residents purchase health insurance.
• Require employers to pay a share of their worker's health care costs.
• Allow people ages 55 to 64 to buy into Medicare.
• Expand Medicaid and SCHIP to cover more low-income families and children.
• Allow individuals and businesses to buy their health insurance from an expanded Federal Health Benefit Plan (the same program Congress and the President use).
• Improve health care efficiency through the increased use of health care information technology.
• Mandate that health insurers no longer can deny coverage to people with pre-existing conditions.
• Expand veterans care by giving them a "Heroes Card" enabling them to access the private system.
• Limit interest rates applied to health care bills and credit cards.
• Allow the federal government to negotiate Medicare drug prices directly with pharmaceutical companies.
• Establish incentives for preventive care programs.

Richardson claims his plan would cost an estimated $110 billion per year but that the savings from the plan would cover the cost.

Richardson was quoted as saying, "Despite Republican hand-wringing about the cost of universal care, it is clear that the cost of doing something--in lives and dollars--pales in comparison to the cost of doing nothing." He also said, "My plan does not build a new bureaucracy. The last thing we need between patients and doctors is another sticky web of red tape."

Like all of the leading Democratic candidates, Richardson is ready to move forward with a big and comprehensive reform plan. But he is not interested in a big government-run plan that would "build a new bureaucracy."

His claim that his program will cost nothing is at the outer edge of wishful thinking. Getting everyone covered will save lots of money. But it will take bundles of money up-front to get a program like this going.

Because the structure of his plan is similar to the plans already announced by rivals Barack Obama and John Edwards--and the plan coming from Hillary Clinton--his program costs will not be lower than theirs.

In many respects, this plan is comparable to the Massachusetts health plan that has found that granting access to insurance is only the beginning--being able to afford to get everyone in and then running the plan in a way that does control costs is the real challenge.

The Richardson health plan takes that first step but hardly addresses short-term affordability and long term costs.

But he is right about this, "It is clear that the cost of doing something--in lives and dollars--pales in comparison to the cost of doing nothing."

But that statement will quickly become fatally flawed short-term thinking if he doesn't more realistically deal with the long-term costs and create an affordable strategy.

Series of posts on the Massachusetts health plan

Rudy Giuliani Announces a Health Care Proposal That Would Provide Tax Incentives for Consumers to Purchase Individual Insurance

Rudy Giuliani announced that he will be proposing a system of individual tax incentives to enable consumers to purchase individual health insurance in addition to any employer options they might have. His proposals are also designed to shift the U.S. health insurance system away from employer-sponsored coverage.

Under the proposal:

• Giuliani is proposing a $15,000 family/$7,500 individual standard tax deduction for anyone who does not get their health insurance coverage through an employer--they purchase it individually.
• He would also provide additional subsidies to help low-income people buy health insurance.
• He provided no details as to the amount of the subsidies or the plan's overall costs but said he would provide more detail in the coming months.

Giuliani said that he expects the proposal would increase the number of people who buy health insurance in the individual market. He also expects the standard deductions would enable consumers to put extra money into health savings accounts (HSAs).

While the Democratic candidates proposals focus on dealing with access first and cost later, Giuliani's focus is on bringing the cost of health insurance down with these market reforms and as costs come down more people would be insured, "You have to start bringing the price down before you can figure out how many people you can include. It has to be done incrementally. It can't be done with a magic wand all at once."

Read Giuliani's op-ed piece in the Boston Globe: "A Free Market Cure for the U.S. Health Care System"

A more comprehensive analysis of the Giuliani proposal in an earlier post: Giuliani Set to Announce a Health Care Proposal--But He Has to Make it Affordable for Everyone

Romney Condemns Obama's Health Plan--But Obama's Plan is a Clone of the Massachusetts Plan Romney Signed!

Mitt Romney criticized Barack Obama's health care proposal over the weekend in New Hampshire. According to The Baltimore Sun, Romney said, "Barack Obama said we're going to have the government take over health care. He at least had the integrity to say he wants to raise your taxes." He added, "The right answer is not a government takeover, it's not socialized medicine. It's not Hillarycare." Separately, at a Sunday town hall meeting, Romney said, "I don't want the guys who ran the [Hurricane] Katrina cleanup running my health care system."

I am not here to tell you Obama has the best plan, or he doesn't--or that any other candidate does or doesn't for that matter. I do feel comfortable in telling you that Obama pretty much has the plan Romney signed into law in Massachusetts.

In fact, Obama's plan doesn't go as far as the Mass plan Romney signed--the Obama plan doesn't have an individual mandate!

Which planet is Romney from?

Previous post on Obama plan details: Clinton, Edwards, Obama--Offering Health Care Reform Proposals More Similar Than Different

Previous post on the Mass plan as political "baggage" for Romney: Mitt Romney Looking for Support Among Conservative Republicans--A Health Care Achilles Heel?

Hillary Clinton Doesn't Like Health Insurance Companies and Never Has--But Demonizing Them Again Won't Get Us Health Care Reform

At a recent health care forum attended by Democratic presidential candidates, New York Sen. Hillary Rodham Clinton observed, "The insurance companies make money by spending a lot of money employing a lot of people to try to avoid insuring you, and then if you're insured, to try to avoid paying for the health care you received... ." (Newsday 4/14/07)

I'm sorry to hear her say that.

Health care is one of those things where it might be good to remember that no one is in the position to throw the first stone. You can come up with a pretty long list of health care actions it's hard to defend the insurance industry on. The list is about as long for hospitals, drug companies, doctors, lawyers, and all the rest--and includes U.S. Senators on both sides of the isle.

In 1993, when Senator Clinton launched her failed health reform plan, she made a point of declaring the insurance industry enemy number one. Instead of trying to bring the insurers into her tent, she pointedly excluded them and tried to create political leverage by making them the bad guys in the debate.

Insurers, seeing no chance to play on the inside, concluded they might as well dig in and fight in what came to look like a fight for survival. The result was those now famous insurance industry financed "Harry and Louise" ads that are credited with making a major difference in turning the tide against Mrs. Clinton and her health plan.

Hillary Clinton could be the next president. If she is, health care will certainly be at the top of her list.

Will Hillary Clinton make the same mistake by isolating and demonizing the health insurance industry once again?

I hope not.

For health care reform to work we will need to get all the of stakeholders to the table.

The major stakeholders, like the health insurance industry, already have enough selfish reason to undermine fundamental reform without being forced into another counterproductive corner.

Come on Hillary!

Democratic Presidential Candidate Bill Richardson Supports the Employer Mandate as a Way to Provide Health Insurance

Democratic Presidential Candidate Bill Richardson has weighed in on the health care debate with comments about what he would do on the issue:

"You know, every time a Democrat, it seems, we propose a new [health care] plan, it's more spending or more taxes. I'm not that way...I would have a mandate. I would say every employer...has to have a health care plan. That's how you pay for it."

Well Governor, an employer mandate is a tax and it would be used for more spending. It's just a matter of who you would tax and how much you would tax them.

There are a number of ways we can accomplish universal health care coverage. An employer mandate is one of them. An employer mandate would target the employers who do not provide coverage. The problem is that the vast majority of these employers would like to provide coverage--they just can't afford it. With the average cost of family health insurance at about $11,000 a year, an employer paying the typical 75% of that cost would have an obligation of $8,000.

Governor Richardson, you are suggesting an employer head tax of $8,000.

We do need to move toward universal coverage but we need to do it in a way that spreads these high costs as widely as possible. An employer mandate could be part of that strategy, as it is in Massachusetts, but it has to happen in a way that doesn't put small businesses--where so many new jobs are being created--out of business.

We also need to recognize how much health care does cost and understand that huge burden cannot be sustained by any one of the potential payers--individuals, their employers, or government.

And, once we figure out who is going to pay for it, we need to assure ourselves that we can contain health care costs.

The only thing worse than how much health care costs today is how much it will cost tomorrow if we don't make cost containment a big part of any solution.

The Real Reason Health Care Reform is Hard—Hillary Clinton Leads the Presidential Candidates With $26 Million in First Quarter Campaign Contributions

Reading the press, it’s as though raising money for a presidential run is a sweepstakes to be won—like it’s something to be proud of.

Just exactly what should we all be celebrating?

Hillary Clinton leads the way with $26 million raised in the first three months of the year before the presidential election. Senator Obama is reportedly going to come in well over the $20 million figure and John Edwards has broken the old record with a now paltry looking $14 million in the first quarter.

On the Republican side, Mitt Romney is surprising everyone inside the Beltway with $23 million while Rudy Guliani as at $15 million and John McCain has collected $13 million.

To raise $26 million in 90-days, Senator Clinton had to raise $288,000 a day or $12,000 an hour!

When I began coming to Washington in the late 1980s, the constituency you represented probably counted the most, followed by how good your ideas were, and then followed by whether or not your company’s political action committee (PAC) gave the senator or representative maybe $1,000.

I am convinced that, in the wake of the 2008 presidential election, this country is going to have a major league debate about where our health care system will go.

I’d feel a lot better about that debate if constituency and ideas were more important than where the winning candidate raised $12,000 an hour.

Oh for the good old days when $1,000 bought you some quality access.

The system wasn’t anywhere near as corrupt—and, to the degree it was, it cost us a lot less to boot.

If Medicare Advantage Rates Are Going to Be Cut, Why Have the Big Medicare HMO Stock Prices Been Up Since the Election?

That question came from Matt Holt today over at his blog: The Health Care Blog.

Good question.

As any regular reader of this blog knows, I have been arguing that the Democratic Congress is going to cut Medicare Advantage payments to HMOs as soon as they get their hands on the federal budget.

If that is a good bet, why wouldn't Medicare HMO stocks be reflecting that risk? Instead, they have generally been up nicely in value since the election.

It is also notable that Wall Street analysts have estimated that Medicare Advantage HMOs will receive a 3% to 4% payment increase in 2008--based upon the payment policies instituted by the Republican Congress.

In fact, a number of key managed care analysts just reaffirmed their confidence in the Medicare HMOs. Matt Perry of Wachovia recently wrote, "We view 3% as a reasonable increase that will sustain membership growth and margins for most plans in 2008." Carl McDonald of CIBC wrote that some Medicare Advantage plans might have to reduce benefits a bit because health care inflation will likely be more than 3% to 4%, "which means products will not be as attractive as they are this year." Matt Borsch of Goldman wrote, "It appears likely that the 2008 MA rate increases will lag medical-cost trend, implying a modest level of benefit reductions and/or member-paid premium increases will be needed to maintain profit margins." However, "We continue to believe that the [Medicare Advantage] program will provide strong growth for managed care companies in 2007 and 2008." (Source: Kaisernetwork.org 2/22)

So, Wall Street would appear very confident that Medicare HMO payments will continue at minimal, but adequate, levels in 2007 and 2008. Based on the fantastic Medicare Advantage profits reported by the Medicare HMO players in 2006, they apparently feel confident the Medicare Advantage growth and margins will remain strong through 2008.

However, all of this is based on CMS continuing to pay the HMOs from the Republican payment base.

Apparently, these analysts don't think the Democrats will be able to cut Medicare Advantage payments presumably because they think the number of seniors enjoying these plans constitute a powerful political force and because George Bush will still wield a powerful Presidential veto until January 2009.

I will counter that they don't know Pete Stark, John Dingell, Charlie Rangel, and Ted Kennedy very well. They also don't understand the power committee chairmen have in the Congress--particularly late in the budget process. They also don't seem to understand how badly the Democratic Congress needs the Medicare Advantage "over payments."

The CBO report yesterday, estimating these "over payments" to be worth $65 billion over five years, just put the icing on the Democratic cake.

Wall Street needs to do a better job of factoring in the political risk to Medicare Advantage plans:

• A Bush veto will do the MA plans no good --an earlier post.
• Why the Democrats Hate Medicare Advantage Plans--an earlier post.
• Why the Democrats need the MA money--an earlier post.

The Democratic Congress certainly won't be able to impact 2007 Medicare Advantage payments making the next few quarters almost certain to look good for the Medicare HMOs. It may also be that the Congress won't be able to impact 2008 payments since that process will pretty much be put to bed by this summer. But maybe not--the Congress makes the rules and the Congress can change the rules. And, then there will be 2009--maybe the first real Democratic budget year for the HMOs.

Whey are the HMO stocks doing so well in the face of these Medicare Advantage political risks?

Short-term versus long-term.

Since when did Wall Street care about the long-term?

Deja Vu in Massachusetts--We've Been Down this Road Before--The Massachusetts Health Care Plan and Health Care Costs

The good news is that the health policy world is full of new and exciting health care reform proposals.

The bad news is that while these plans focus on the all important access problems (the uninsured) they almost ignore the underlying problem that makes so many people uninsured in the first place--health care costs.

With the federal government (The National Health Statistics Group at CMS) projecting that we will spend 20% of GDP on health care by 2016 (from 16% today) it is clear cost is something we can not ignore.

Cost is the big elephant in the room none of these reformers seems to be ready to hit head-on. That came home last month when the Massachusetts Health Plan regulator announced that the average bids for its new plan came in at $380 per member per month—much higher than the original $200 estimate.

Even if the regulator can get the cost of their mandated plan down to $250 per month, that would mean a family of three would be expected to pay $9,000 per year. In Massachusetts, a family of three making more than three times the poverty level ($48,000 per year) is expected to pay the full cost of coverage. It is going to be very hard to implement this plan by forcing a family like this to pay almost 20% of its pre-tax income for health insurance. The regulator can get the price down by cutting benefits—but how do you help this family by putting a big deductible on the program, or otherwise cutting what they get, for their $9,000 per year?

There is this story about a Governor from Massachusetts who runs for president touting his role in passing a state universal health reform bill, when reform was stymied at the federal level. He boasts that his reform legislation will eliminate almost all of the uninsured in his state because it mandates coverage for everyone and is therefore a model for other states and the Congress to follow.

No, I am not thinking of Mitt Romney, I’m thinking about Michael Dukakis, circa 1988.

Just after Dukakis lost the presidency to George H.W. Bush, Massachusetts repealed the universal health care bill because mandating expensive health insurance coverage payers couldn’t afford made the whole system go tilt.

Sound familiar?

If Massachusetts doesn’t solve their affordability problem they are going to dump a big bucket of cold water on all of this new health care reform enthusiasm.

They will also remind us of what the cause of America's health care crisis is--it is cost.

The uninsured are just the biggest symptom.

Barack Obama is a Rookie on Health Care Policy Reform

Barack Obama was recently quoted as saying he would institute a system of universal health care by the end of his first term. He provided no other details for what would be the Obama Health Care Reform Plan.

He is apparently new at this--health care reform policy and fixing America's health care problems.

Apparently, he doesn't understand it is the details that matter when it comes to health care reform. Or maybe he thinks people are so enamored of him that they aren't going to worry about his being able to deliver the rest in any kind of detail. We just need his leadership, optimism, and fresh ideas (whatever they are) to lick this most frustrating of domestic issues.

Obama better be careful with his health care policy naivete. It just may be that health care will be the issue that gives him a taste of political reality!

See if you can find the plan (sort of like finding Waldo): The Obama speech to the Families USA Conference 1/07.

10 Bipartisan Senators Offer a Health Care Reform Outline

Just a few weeks ago I wrote a post that began, it's a new day in the health care debate. Health care reform is breaking out all over.

My point was that I haven't seen such enthusiasm for reform since the early 90's and the resulting Clinton Health Plan effort. Everyone seems to have a plan--not the least of which are offered by some very powerful bedfellows.

That trend continued this week when five Republican Senators and five Democrats sent President Bush a letter arguing it's time to move forward. They outlined only broad points that included:

• Universal coverage done in a way that protects Medicare and Medicaid.
• Agreeing with Bush that the current tax treatment of employer health benefits needs to be on the table. The value of that tax benefit is almost $200 billion a year--money that can be shifted to pay for new coverage.

These concepts cover the things that many Democrats want--reform built upon existing programs--and something many Republicans favor--moving away from the employer-based system toward one more oriented to individual responsibility.

There isn't a lot of detail here.

What there is--and this is huge--is a bipartisan agreement that we need to find common ground and begin to solve this problem. They are saying the possible is more important than the perfect because this problem just can't continue for the good of our people and our global competitiveness.

The initial White House reaction, to what was merely an invitation to begin a process, was positive.

As I have said before, major health reform will not occur until after the next election and we elect a new President and Congress--in great part based upon what they say about health care reform. This debate needs a great deal more progress beyond the conceptual level it is at.

But the process is under way----for real.

Health reform is breaking out all over!!

Mitt Romney Looking for Support Among Conservative Republicans--A Health Care Achilles Heel?

Former Massachusetts Governor Mitt Romney is working hard to boost his popularity among conservative Republicans. He seems to be saying all the right things for conservatives. That, plus the longstanding suspicion conservative Republicans have had for both Rudy Giuliani and John McCane have given Romney a shot at the party's powerful conservative wing.

Romney has a certain amount of health care reform credibility in the run up to the 2008 elections because he signed the Massachusetts Universal Health Bill. That legislation was a major bipartisan accomplishment when no one at either the state or federal level has been able to accomplish much toward solving the problem of the uninsured.

But that accomplishment could turn into a real political problem for Romney among those same conservatives if the program isn't able to get past a very serious threat to its success. As we have posted before, the average insurance company bids for the mandated health plan averaged $380 per person per month--or $13,680 per year for a family of three. When the legislation was passed, it was estimated the average per person monthly cost would be $200.

The Mass regulator is now in the midst of trying to solve that problem by looking at more limited plan designs and pressuring insurers to bid more aggressively. But that will be very hard because a comprehensive health plan insurance plan just plain costs that much in Massachusetts.

The regulator can add deductibles and big copays to get the cost down. However, what good does it do to give a poor person a health insurance plan with a $2,000 deductible?

The Mass regulator has a choice--pay the real cost of a health insurance policy or offer some stripped down coverage that does a low income person little good.

The middle class would fare no better. A family of three making more than three times the poverty level ($48,000 per year) would be expected to pay the full cost of a family policy--$13,680 per year at the $380 average premium. Even if the regulator gets the premium down to $300 per person the annual cost for a family of three would be $10,800 per year--23% of a $48,000 before tax income. And, that policy might have a $2,000 front-end deductible.

What kind of reaction do you think conservatives are going to have if they hear Romney is taking credit for a health insurance bill that requires all Mass families to buy a health insurance policy at those prices?

Conservatives seem to be getting more and more interested in a Romney candidacy.

But if the Massachusetts health plan looks like just another fiscally irresponsible foray into health care policy, Mitt Romney's conservative honeymoon many be over.

The Edwards Health Plan--Where Are the Other Plans?

Democratic presidential candidate John Edwards has proposed a comprehensive health care reform plan. (See the entire plan on his site).

Good for him!

It is going to be very easy for all of us to point to all the things we don't like about it.

But I will suggest there is something more important for all of us to do--ask where all the other candidates, Democrat and Republican, are with their plans.

It is conventional political wisdom in this town to keep your own health reform agenda as vague as possible and hope the other candidates will shoot themselves in the foot with a detailed comprehensive health care plan.

The Clinton Health plan fiasco of 1993 and 1994 taught politicians to stay as far away from health care reform details as they possibly can. I used to say about the Clinton Plan that it was 1362 pages of which every man, woman, and child in American could find 300 pages to strongly disagree with--it's just that everyone had a different 300 pages to hate.

Health care is one of those issues that if you put any kind of detailed plan on the table you are going to gore a lot of very powerful oxen.

John Edwards has gored his share with this plan.

But, if the American public (and the health policy establishment) now does what all the other candidates want them to do--hoot it down hard--we will get what we have had in the past. The other candidates--Democrats and Republicans--will only confirm their fear of being too forthcoming with health care reform details and not tackle this issue. They will give us just vague platitudes about health care costs, quality, and the uninsured. But they will not tell us about the important parts of what they would do--which oxen they would gore and how.

Don't take this as an endorsement for Edwards or his plan. Just his willingness to put the plan out there, gore some oxen (and not gore some he should have), and his courage in doing it. Sure, he's a distant third in the Dem polls and a dark horse with nothing to lose and a lot to gain. But at least he did the right thing in putting his plan (really a 7 page outline) out there.

If we all do what the other candidates expect us to and give Edwards the usual cynical reaction then the remaining first tier presidential candidates get exactly what they want and we get exactly what we don't want.

Wouldn't it be great to suspend our health care policy cynicism for a few months and let the hooting be focused at the front runners who haven't put their detailed proposals (oxen and all) on the table?

If Clinton, Obama, McCain, Giuliani, Romney, and the rest, all gave us their details, then we'd have something really productive to talk about!

Why the Republicans Lost

After six years of one-party government, things here in Washington were getting kind of boring.

That’s already started to change.

The November Election
In past years, I have told you that the chances the Democrats could capture the House of Representatives were low because of all the highly political gerrymandering of districts that took place in the wake of the 2000 census. That redistricting made the vast majority of House seats permanently safe for the party that controlled it. Because of all of this, perhaps only 45 seats would really be in play in any election year.

Those odds made the Democratic victory in the House this month all the more impressive.

But perhaps even more surprising is the Democratic sweep of Senate races giving them a one-vote advantage in that body.

The single issue that dominated the elections was Iraq but it goes even deeper than that.

Marlon Brando and the Republicans
There is this old Marlon Brando movie—“Zapata,” that’s the story of the Mexican revolutionary period at the turn of the 20th century. The movie starts out with the corrupt government shooting the peasants. The movie ends with Marlon Brando’s revolutionary character playing a key role its overthrow and with the new guys shooting the peasants.

The Republicans had their own revolution in 1994. They lost this election because they ended up shooting the peasants.

The Republicans forgot that 12 years ago the electorate threw the Democrats out because the swing voters came to the conclusion that after decades of control, the Democrats were out of touch (the Clinton Health Plan) and had been corrupted (the post office scandal, House Ways and Means Chair Dan Rostenkowski in jail, and various other problems) by their power after many years of unilateral control of the government.

In 2006, the Republicans got the boot because they were seen to be out of touch (Iraq) and corrupted (Folly, Abramoff, and “ear marks”) by the power coming from their almost complete control of the government.

In short, power did to the Republicans exactly what it had done to the Democrats by 1994, and the result was the same.

The toughest criticism of the Republicans has been coming from leaders in their own party:
• George Will on why Republicans lost the election in his weekly column on November 12: “Tuesday’s election results were fresh evidence that two events that profoundly shaped American politics during the last two presidencies were episodes of irrational exuberance unrelated to economic behavior.” Later in the piece, “The Democratic episode was the Clintons’ attempt to radically restructure and semi-socialize the 16 percent of the economy that is the health care sector. The Republican episode is Iraq.”
• Dick Armey, the former House majority leader and Gingrich chief lieutenant during the 1994 Republican takeover, in a October 29 op-ed in the Washington Post on why the Republicans were on their way to a loss: “The answer is simple: Republican lawmakers forgot the party’s principles, became enamored with politics over policy. Now the Democrats are reaping the rewards of our neglect—and we have no one to blame but ourselves.” Later in the same article, “Now spending is out of control. Rather than rolling back government, we have a new $1.2 trillion Medicare prescription drug benefit, and non-defense discretionary spending is growing twice as fast as it had in the Clinton administration.”

“Zapata” should be mandatory viewing up on the Hill.