By Robert Laszewski
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:
1. 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.
2. 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, 2010Medicare. 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. and there are other serious cost issues for
3. 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.
4. 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.
A big $100 billion comprehensive health care reform plan like the Obama
health plan is not realistic in these times of financial crisis.
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 the cost containment items there is bipartisan support
for 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 President’s 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?
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I must agree with point 3. Implementing efficient Information Technologies would improve transparency significantly.
One question I ask myself is: How realistic would it be to mandate health care reform on a state wide level vs. nationally? This is considering if we were not in the financial situation that we are in now.
Another meaty post, Bob. One point I’d like to underscore – this should really be subsumed under your mention of “improving transparency about health care quality and costs” – is that if HHS simply released the Medicare physician data, that act would precipitate much greater knowledge for consumers and purchasers on high vs. low performing docs by specialty and market. Especially in a period when consumers are becoming more financially responsible for their own care, it would help health care begin to act according to market rules, and would bring much greater pressure on physicians to practice in ways that produce quality outcomes.
These data have been in limbo since Consumer Checkbook sued HHS last year, and won. But then HHS appealed arguing that physicians have a right to privacy. This was cynical at best, since in these cases physicians are vendors taking public dollars, and since hospitals, as institutions, apparently do not merit the same privacy privileges.
The only other physician data sets that are as robust are owned by the commercial health plans, and they’ve not been forthcoming with the data.
This simple, inexpensive step, would drive tremendous transparency into the system, and would likely produce significant improvements in the process.