The Obama administration

President Elect Obama talks with President Bush in the Oval Office (Wikimedia Commons)

President Obama: A victory for health care?

After nearly two years of the presidential campaigns, countless pages have been written about President-elect Barack Obama’s health care plan and the possibility of reform. Now that
the U.S. has elected Obama and put Democratic
majorities in both the House and Senate, people are asking what this will mean for health care.

Heavy speculation has begun, and The Health Care Blog aims to be a useful junction of these diverse opinions and predictions. This page is an attempt to centralize this debate.

Readers respond to whether Obama’s win is a victory for health care


"More government-funded health care programs, which either means
higher taxes or greater deficits for lower quality health care. As government controls more and more of the health care system, they
will control more and more of my personal health choices (a la France
or Japan)." — M

"It probably means very little in reality. Recall all the hoopla about President Clinton’s health care plans which went nowhere. I think an Obama administration will find its hands tied by an
unstable economy which cannot support the increases in taxation
required for his health care ideas." — Brutus

"Well, personally I would love to see Obama practice the diversity theme
by enabling the states to have their own universal health care programs,
including state versions of Medicare." — Tom Leith

"I believe that the first step to improving the health care system is a
national mandate for self-reporting of quality and all-payer cost data
by providers of care and publication of national provider cost/quality
scorecards."–Health IT Wonkman

"Change and Hope are the two words and the essence of what Barack Obama
has offered to the populace. Yet within health care, we continue to
muddle along with the same old concept of financing which has been
patched so often, it is no wonder that there are more leaks developing," –Richard Ferriera

Election 08, Obama, Policy/Politics  | Permalink
| Matthew Holt

Despite Democratic control, major health reform still unlikely

With 258 House and 57 Senate Democrats, it’s almost certain that major health
reform will be passed, right? Actually, that was the number of Democrats Bill Clinton started off
with in 1993 and we know what happened to health care reform in that

With similar Democratic majorities, I do not expect a major health
care reform bill like the one President-Elect Barack Obama called for
during the campaign in 2009 or 2010.

Continue reading "Despite Democratic control, major health reform still unlikely"

Obama administration, Policy/Politics, reform  | Permalink
| Matthew Holt

Health in an Obama world — what we know so far

When it comes to health care, there are a few
things we know about a President Obama. First and foremost, addressing challenges in U.S. health care will
require a multi-pronged strategy which brings stakeholders together.
The key health-aches to address will be:

  • Covering the uninsured
  • Stemming rising health care costs
  • Wiring the health information infrastructure and getting electronic health records into medical practice
  • Funding what works, and de-funding what doesn’t
  • Ensuring an innovative health discovery and commercialization environment.

This is not a one-man job, and Senator Obama knows that. He has
surrounded himself with a cadre of experts who understand these issues and are on the forefront of solutions. Here is a rundown of probably candidates for top health administration positions.

November  6, 2008 in Obama administration  | Permalink
| Comments (8)

The next president’s health agenda

A year ago, health care held a solid lead in the polls as the No. 1  concern of the American people. But by the time the Iowa caucuses
closed, and Barack Obama surged to his unexpected win, it was
supplanted by the economy.

Unlike some pundits who say the health care issue will be put on
the backburner for the first half of the next president first term, I
do not believe the nation will have that luxury. Curbing the growth of
health care spending will reassert itself as an issue next year because
it is key to restoring this nation to economic competitiveness.
American businesses are at a competitive disadvantage when they must
pay twice what companies in other countries pay (whether premiums or
taxes) to provide their workers health coverage.

The morning-after reality for the next president is that the U.S.
spends more on health care than any other nation on earth — 16 percent
of gross domestic product and rising. Yet nearly 50 million Americans
go without health coverage during the year, and in traditional markers
of national well-being — longevity and infant mortality — the U.S.
ranks below many former Communist bloc nations of Eastern Europe.

November  6, 2008 in Election 08, Policy/Politics, reform  | Permalink
| Comments (4)

Social solidarity is key to meaningful changes in health care

In his victory speech, President-elect Obama sounded that theme repeatedly, reminding his audience that he had been
elected “by young and old, rich and poor, Democrat and Republican,
black, white, Hispanic, Asian, Native American, gay, straight, disabled
and not disabled—Americans who sent a message to the world that we have
never been just a collection of individuals…”

In the recent past, some progressives have warned that liberals made
a mistake when they reached out to minorities, new immigrants, and
gays, “ignoring” the mainstream middle class. But in fact,
“mainstream” America is no longer one recognizable culture. It is fast
becoming a “magnificent mosaic.”

November  7, 2008 in Maggie Mahar, Policy/Politics, reform  | Permalink
| Comments (5)

Health care information technology in an early Obama Administration

When Obama takes office in January, the economy will be his first
priority, followed by the war in Iraq. Health care will follow as his
next major issue to address. What will he do?

I imagine
he’ll take a phased approach to ensuring all Americans have access to
health care. Given the change management needed to accomplish this, it
will take a while. However, Health care Information Technology
has broad bipartisan support and is his best strategy to reduce
health care costs, reimburse providers for quality instead of quantity,
and to ensure coordination of care. Here are my predictions for
health care IT in the first year of the Obama administration.

November  7, 2008 in Electronic Medical Records, Obama administration, Technology  | Permalink
| Comments (2)

Baucus unveils reform proposal with individual mandate

Senate Finance Committee Chairman Max Baucus’ unveiling of a health
reform proposal yesterday fed speculation about the possibility of
Democrats tackling health reform from the get-go of the new

The Montana Democrat’s proposal is detailed in an 97-page "call to action" document.
In his letter of introduction, Baucus says the plan is not a
legislative proposal but his vision for policy reforms and the
political process.

Policy/Politics, reform  | Permalink
| Matthew Holt

Baucus’ proposal proves no consensus on key reform issues

Max Baucus will be a key player in the health care debate the next
two years. As chairman of the Senate Finance Committee he has
jurisdiction on many of the key issues including Medicare and provider
payment reform. He is also a leader in the true bipartisan spirit–something crucial to actually getting reform done.

If you read all 98 pages of his "Call to Action" it is clear there is no consensus on many of
the key details, what health reform would cost, the timetable for
implementation, or the source for paying for it.

Policy/Politics, reform  | Permalink
| Matthew Holt

Will Democrats Muck up Health Reform?

<a href="http://www.buzzdash.com/index.php?page=buzzbite&BB_id=130601">Will Democrats muck up health reform by infighting and power plays?</a> | <a href="http://www.buzzdash.com">BuzzDash polls</a></center>

Open Wide: Here comes the change you thought would never happen

The morning after the election, I posted a speculative blog in Health Affairs
on three possible scenarios for President-elect Obama’s implementing
health reform: folding it into a bold, ambitious emergency legislative
package (Complete the New Deal), carving funding out of the current
$2.5 trillion national health spend (Braveheart), and postponing
implementation until the economy recovers but taking steps now to
prepare for it (Wait/Lay the Groundwork).

At the time, the Wait/Lay the Groundwork option seemed 70 percent
likely. But with economic conditions worsening, I’m now convinced Obama
will probably opt instead for the Complete the New Deal option, and try
to implement health reform in the first 120 days of his Presidency,
before the health care industry “dragon” can even stir from its cave.

Let’s call Obama’s program The Real Deal. We can already see its
contours: an economic stimulus program including highway construction
and other state-directed public works, a green energy spending
initiative, emergency housing assistance including a foreclosure
prevention measure, an auto industry bailout, labor law reform and
income supports through tax credits for low income people.

Continue reading "Open Wide: Here comes the change you thought would never happen"

Economics, Election 08, Jeff Goldsmith, Marketplace, Obama, Obama administration, Policy, Policy/Politics, reform, The Industry  | Permalink
| Matthew Holt

Cost containment is the missing link in Obama’s health plan


Barack Obama’s health care plan follows the Democratic template—an
emphasis on dramatically and quickly increasing the number of people
who have health insurance by spending significant money upfront.

The Obama campaign estimates his health care reform plan will cost
between $50 and $65 billion a year when fully phased in. This is highly doubtful. He assumes
that it will be paid from savings in the system and from discontinuing
the Bush tax cuts for those making more than $250,000 per year.

The Changes We Need

If the burst of new Democratic health care reform proposals is any
indication, a fresh breeze of the Obama campaign’s "Yes We Can"
optimism is blowing across the nation. Mr. Obama’s team is expected to
make health care one of its priorities. First out, though, was Senate
Finance Committee Chair Baucus (D-MT), who introduced an aggressive health care reform package
that builds on Mr. Obama’s campaign platform of cost controls and
extended coverage. Senator Kennedy (D-MA) and Representatives Dingell
(D-MI) and Stark (D-CA) are expected to offer proposals soon, and
undoubtedly there will be others.

The rub is that Congress’ old-guard lobbying system remains in place. Congress is awash in special interest contributions – $2.8 billion from 15,500 lobbyists in 2007
– that exchange money for influence over policy. When the Democrats
retook Congress two years ago, they did not substantively change the
lobbying rules.

So it is reasonable to ask whether a new day of governance in the
common interest is possible. Can we make progress on health care or on
any significant problem – climate change, education, energy policy,
finance, the social safety net – without addressing the underlying
problem of Congress’ receptiveness to special interest influence?

Brian Klepper, Marketplace, reform, The Industry  | Permalink
| Matthew Holt

Is health care a right?

The idea of health care as a “right” is
usually pitted against the idea of health care as a “privilege.” When people claim something as a “right,” they often sound
shrill and demanding. Then someone comes along to remind us that people
who have “rights” also have “responsibilities,” and the next thing you
know, we’re off and running in the debate about health care as a “right”
vs. health care as a matter of “individual responsibility.”

As regular readers know, I believe that when would-be reformers
emphasize “individual responsibilities,” they shift the burden to the
poorest and sickest among us. At the same time I’m not entirely happy making the argument that the
poor have a “right” to expect society to take care of them.

October  8, 2008 in Maggie Mahar, Policy/Politics  | Permalink
| Comments (71)


If you have a right to health care, how much care?

By Our American love affair with
medicine — and in particular, medical technology — is all  tied up with our
fear of death, and a feeling  in some quarters, that “American
optimism” demands that to strive for immortality. We put such
emphasis on the individual, and the individual ego; how can we accept
that, someday, it will be extinguished?

We need to begin setting limits on that technology.
This is especially true if we are aiming for universal coverage. We need to recognize that covering everyone will cost more — much
more. Some well-meaning reformers have suggested that  once everyone
has access to care, we will save money because those who are now
uninsured or underinsured will receive preventive care. I have come to realize the
ugly truth: The uninsured die sooner than the rest of us. By leaving
a significant portion of the population poor, and uninsured, we save

Continue reading "If you have a right to health care, how much care?"

Economics, Maggie Mahar, Policy  | Permalink
| Matthew Holt

The affordability factor must accompany discussions on health care coverage

Somehow, we’ve divorced the coverage/affordability question from the
cost question, and we pay for it – everyday. It shouldn’t be that hard
to accept the notion that it’s easier to
cover more people if health care costs are under control – and harder
to cover more people when they are not. But, most of the time, the
coverage debate has been only about coverage – and not about cost.

pretty sure there’s a morality play in here somewhere — that covering
people is a moral issue, while controlling the increase in health care
costs is an economic one. For some, arguing the rightness of providing
coverage is more compelling than engaging in the grind that comes with
discussing what to do about health care cost increases. But, the
simple fact remains that covering more people is intrinsically linked
to health care costs. If costs go up, coverage goes down – and vice

July 31, 2008 in Charlie Baker, Economics, Marketplace, reform  | Permalink
| Comments (42)

This isn’t the early 1990s

Several stories in today’s papers make it clear that the atmosphere
for health reform today truly is different than when the Clinton
Administration took over in the 1990s.

Here’s the bullet points in support of that thesis:

  • Obama selected veteran policymaker Tom Daschle to head up the Department of Health and Human Services, signaling he wants the former South Dakota Senator to head up reform efforts.
  • The Washington Post quoted  Sen. Ron Wyden
    (D-Ore.) saying, "Tom Daschle sees this as a once-in-a-lifetime opportunity. On the premier domestic issue of our time, the
    president-elect sees Tom Daschle with the skills and abilities to bring
    people together and get this over the finish line."

  • Marking a clear deviation from the past, the Association of Health Insurance Plans announced
    it would be willing to accept guarantee issue and community rating in
    exchange for a mandate requiring all people to buy insurance.
  • But Bob Laszewski provides WSJ readers with a reality check, "Talk is cheap on the front end of this thing," he told the Journal. "The
    rubber hits the road when that 1,000-page document comes out with

Policy/Politics, reform  | Permalink
| Matthew Holt


Will layoffs take us closer to single-payer?

Only a few months ago, Goldman Sachs was touted as an incredible
bastion of strength in the face of the credit crunch. Sure some other
institutions might have been suffering, but Goldman was savvy enough to
earn record profits in 2007. The average bonus was a whopping $600,000 per employee.
Then very suddenly Goldman and pretty much the whole industry
collapsed. The federal government has stepped in, and a partial
nationalization of the financial industry is underway. That’s not the
free market, it’s socialism.

While actual socialism was being carried out by the Republican
Administration in Washington, out on the campaign trail, McCain and
Palin were bashing Obama for allegedly socialistic policy proposals,
namely rolling back the Bush tax cuts for high earners. Obviously the
voters didn’t buy it.

Thanks to the credit crisis, companies and non-profits are starting
to lay people off. My inbox is filling up with messages from people
who’ve been given the sack and are searching for their next gig. Today
I received such a notice from a close friend at Goldman Sachs itself.

Continue reading "Will layoffs take us closer to single-payer?"

Economics, Policy/Politics  | Permalink
| Matthew Holt

CAP’s Blueprint for reform

The Center for American Progress (CAP) released a new “Blueprint for Reform” that focuses on how to fix the delivery system. This well-constructed
document and provocative forum was spearheaded by CAP CEO John Podesta (former Clinton White House Chief of Staff) and Jeanne Lambrew.

There are a few things that really show good progress in the
national debate. First, the fact that CAP has chosen this critical time
at the precipice of the national health care reform debate to focus
attention on reforming care as well as coverage will be helpful to
facilitating that discussion in 2009 policy debates (they, of course,
support coverage initiatives as well but those aren’t addressed in this

Second, the quality and thougtfulness of the work and recommendations is high. Not surprising given the exceptional collection of authors with each chapter co-authored by a physician and a policy expert. These
include: Don Berwick, Tom Lee, Judy Hibbard, David Blumenthal, Bob
Berenson, Paul Ginsberg, Steve Schroeder, Dora Hughes, Chiquita
Brooks-LaSure, Karen Davenport, and Katherine Hayes.

Continue reading "CAP’s Blueprint for reform"

Joshua Seidman, Policy/Politics, Quality, reform  | Permalink
| Matthew Holt

Health care costs are crippling small businesses


I’ve got news for the folks doing the International Foundation of Employee Benefit Plans’ survey:
Smaller businesses, especially those defined as true small businesses
with two to 50 full-time employees, are strapped beyond belief when it
comes to paying ever-higher premiums for health care.

The survey’s results are NOT indicative of what is happening in the small group market (much like the Kaiser Family Foundation’s (KFF) annual survey on total premium and the portions shared by employees,
which always makes me laugh. The employees at my businesses would kill
to have the low percentage of total premium passed on to them that is
reported in the KFF survey).

Across the board, the 100+ businesses I represent, all of them two
to 50 full-time employees, have received increases between 13 percent
and 75 percent this year.  The average has been around 20 to 24
percent.  That’s on top of more than 15 percent average increases last
year, the year before, and the year before.

Continue reading "Health care costs are crippling small businesses"

Health Plans, Marketplace, The Industry  | Permalink
| Matthew Holt

America’s CEOs set priorities for Obama Administration


This past Monday and Tuesday, The Wall Street Journal convened an extraordinary conference of about 100 CEOs to develop and recommend issue priorities for the new Administration. (See the participant list here.)

This meeting brought together the nation’s industry power players.
Several Senators and Congressional representatives participated, as
well as Rahm Emanuel, the President-elect’s new Chief of Staff, and
others who advise Mr. Obama.

Based on their business’ core focus, the attendees were assigned into four major areas: 1) Finance and the US Economy, 2) Energy and the Environment, 3) American and the Global Economy, and 4) Health Care.

Then in the General Session that followed, the focus groups’
recommendations were incorporated into a final list and reranked by all
the participants. Here’s the graph showing the relative ranking of all issues.

Continue reading "America’s CEOs set priorities for Obama Administration"

Brian Klepper, Conferences, Economics, Quality, The Industry, Transparency  | Permalink
| Matthew Holt


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