Matthew Holt

Jonathan Cohn on the internal politics of Obama’s health care plan

Jonathan Cohn has started blogging almost daily on the politics of health care at The Treatment. And it's a treat to read. Jon is a member of the recently exposed vast left wing conspiracy (so am I, but that’s because Ezra’s soft), but the difference is that instead of being a San Francisco based ranter with an unfocused cynicism, Jon actually knows the inside Obama players and cares what they do. And he’s an optimist.

His latest piece at TNR, Stayin' Alive describes the inner story of why the Administration decided to come up with the $65bn a year number in the budget for health reform, rather than just brushing it under the rug. And the somewhat surprising (to me) answer is that the member of the Obama team who would not let health care die was Obama.

Now I know I’m very cynical about both the chances of any reform passing and the value of said reform, but there is the (ever so slight) chance that I might be wrong. So paying attention to Jonathan is a smart idea.

CODA: BTW, why are health care reform costs always quoted as “$1.5 trillion” or whatever. Why are they not quoted like everything else, in annual terms?. After all $1.5 trillion over 10 years is a pretty small fraction of the $30+ trillion we’re going to spend on health care in the next 10 years.

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  1. Matt
    Seems to me that much of the current problems with healthcare in the US is that the “system” defaults to intervention even when not proven beneficial. The default is manifested by heavy utilization of proceduralists for basic care because reimbursement has robbed the “system” of PCPs and such PCPs that are left are incentivized to outsource risk through early referrals to those same specialists. the fact that patients seem to have better outcomes where there are more primes and less referring suggests that procedural interventions usually carry more risk than benefit in addition to expense.
    Any word on whether anything drastic is being contemplated to address this dynamic? Moritoriums on taxpayer funding of the training of over-supplied procedural based specialties, and more importantly, eliminating the AMA’s RUC from having any input on reimbursement would seem to be two very good places to start.
    You really don’t have to make cognitive specialties such as FP and ID that much more attractive, you just have to make derm and orthopedics a whole lot less renumerative and let the barriers to training in them do the rest.
    Heard anything?


    “A new study released this week by a California advocacy group shows that U.S. Sen. Max Baucus has received more campaign contributions from health insurance firms and pharmaceutical manufacturers over the past four years than any other Democrat in Congress.

    According to the Consumer Watchdog study ( using Federal Election Commission data, Sen. Baucus has received $413,000 since 2005 from insurance companies and drug makers, third behind U.S. Sens. John McCain, R-Ariz., and Mitch McConnell, R-Ky.” 


    Sen Max Baucus, who ruled single-payer health reform off the table, is now pressuring the Congressional Budget Office (CBO) to favorably judge his health plan as financially sound–even though it isn’t. The CBO issued a series of recent studies which have found that most savings claimed, in the effort to keep private-for-profit insurance companies in the mix, do not exist.

    Alternatively, a single-payer system would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.


    Write to Baucus:

    ** 2.6 Million New Jobs,
    ** $317 Billion in Business Revenue,
    ** $100 Billion in Wages, and
    ** $44 Billion New Tax Revenues
    You can find out more about this study here:
    The press release is here:

  4. It is true that much money is spent for health information, but it is also quite true that so far no will find the cure for terrible diseases and quickly became generalized in our body, it calls on the authorities to better distribution of this money because it is spending so far in vain, I have friends who suffer from cancer, HIV, Alzheimer’s, and so far we can not find any solution to the disease, only the medicines in oxycontin to control their pain, but until you take the same? actually there will be some day, the cure? Please have to be sensible and remember that nobody is free from disease and therefore it is important for everyone.

  5. healthcare advocate – I share your belief that chronic disease, most of which is preventable, is the root cause of our problems! However, I don’t share your desire to applaud the Administration for its budget allocation to prevention. It paled in comparison to the IT portion of the budget.

  6. The solution to healthcare reform is very easy but the implementation is equally difficult. We have already seen the language shift.
    btw, Mathew, I would not call my self leftist or rightwind, but I can put both of them to shame with my ideas 🙂
    My healthcare ideas are more people focussed and I bet the businesses would benefit. Right now they are afraid of change.

  7. In today’s Star-Ledger:
    Health care reform, let’s do it right
    Posted by By James J. Florio and David Knowlton/Star-Ledger Guest Bloggers
    March 18, 2009 6:44AM
    It appears that America is finally on the precipice of transformational health care reform. President Barack Obama’s recently announced long-range budget plan provides the down payment necessary to fund affordable and accessible health care for all Americans. For many of us, who have dreamed of this day for a long time, we are not only saying “It’s about time,” but we are also cautioning, “Let’s do it right!”
    As co-chairs of the New Jersey Partnership to Fight Chronic Disease, we have worked during the past year to educate public policymakers on one critical component to the health care reform effort: the need to recognize the role chronic disease prevention and treatment can play in this endeavor. It appears our message is getting through. The president’s budget makes the largest investment in preventive care in our nation’s history. He is to be applauded.
    We do not use the word “investment” lightly. Of the $2 trillion spent each year by families, businesses, governments, patients, labor unions and others, three out of every four dollars, or $1.5 trillion, is spent on chronic diseases, many of which are preventable. We believe this is the root cause of today’s health care cost crisis: the alarming escalation of preventable chronic diseases and the astronomical percentage of the health care dollar that is then required to treat them. Investments in chronic disease prevention can actually help lower costs and make health care reform affordable.
    Simple lifestyle changes can help prevent many chronic diseases such as heart illness and stroke, Type-2 diabetes and some cancers. Better diet and exercise as well as smoking cessation will not only improve the quality of our lives, but save billions of dollars.
    The Partnership to Fight Chronic Disease is a national coalition of patient groups, providers, community organizations, business and labor groups, faith-based organizations and health policy experts that are working to save lives and reduce health costs by addressing the underlying problem in health care — chronic, but preventable, disease. Here in New Jersey, more than 130 organizations and businesses have joined.
    We have rallied behind a set of core policy beliefs we call “Principles for Meaningful Health Reform.” These principles provide an overview of several key areas in which the PFCD partners hope to see reform in health care in the coming months, in particular through policy changes aimed at improving Americans’ ability to actively prevent, detect, and manage chronic illness.
    And while our cause seems like a political “no-brainer,” as most Americans understand that preventing and better managing disease will save money in the long run, critical questions remain.
    · How will we pay for the additional costs including expanding coverage?
    · What will happen to the tax treatment of employer-provided health care?
    · Is an individual health care mandate essential and should there be a public health plan as part of the effort to provide universal coverage? If so, how do we make it fair?
    As Congress and the president struggle to answer these and other questions related to health care reform, we do know that one answer is unacceptable: do nothing. Health care costs are crippling our economy and threatening our international ability to compete. The status quo simply cannot be maintained.
    The Partnership to Fight Chronic Disease stands ready to work with Washington to achieve real and meaningful reform. Our “Principles for Meaningful Health Reform” can provide a road map. While these principles can be reviewed in their entirety at, put simply, they urge our leaders to realign incentives in the health care system to encourage prevention and management of chronic diseases, improvements in health care quality, elimination of health disparities, promotion of community health intervention, and the adoption of “best practices.”
    By following a course of action that provides both incentives and investments in chronic disease prevention, we can save lives and dollars at the same time. We can move America away from the current system of “sick care” to a system that provides comprehensive, affordable and accessible health care for everyone.
    James J. Florio served as governor of New Jersey from 1990 to 1994. David Knowlton is president and CEO of the New Jersey Health Care Quality Institute.