Op-Ed: On Health Reform, Obama Faces a New Foe: Other Democrats

Harris Meyer Democratic Senator Maria Cantwell of Washington is a prime reason President Obama will have a hard time getting health care reform passed this year. Let me explain this seeming oddity. At a news conference on May 27 in Yakima, Wa., the purportedly liberal Cantwell, who represents a state that voted 58 percent for Obama, announced her support for two new, bipartisan bills that would advance a key goal of Obama’s reforms — increasing access to primary care physicians and other doctors who are in short supply. As Massachusetts has discovered, making sure nearly everyone has health insurance doesn’t help if there aren’t enough doctors to take care of them.

The two bills Cantwell endorsed feature provisions that would cost the federal government billions of dollars a year — scholarships and loan forgiveness for medical students who serve in shortage areas, increased funding for the National Health Service Corps, higher Medicare payments to primary care doctors, more Medicare funding for resident physician training, interest-free loans for hospitals starting new residency training programs, etc.

All these sound like good ideas. The U.S. is experiencing a growing shortage of family physicians, general internists, and pediatricians. That’s largely because primary care doctors earn much less money than specialists, and most medical students are opting for higher-paying specialties. The shortage of primary care doctors leads to patients seeking care in an unorganized way from more expensive specialist physicians, which costs the nation more money and results in poorer quality care. We clearly need to encourage more young doctors to go into primary care. President Obama has been frank that this and other parts of his health reform plan are going to cost a lot of money, probably more than $100 billion a year. That’s why he asked Congress in his budget proposal to set aside a “down payment” of $634 billion over 10 years to help pay for the new system in which all Americans have access to affordable health care. He proposed to raise $318 billion for that purpose by capping itemized tax deductions for mortgage interest and charitable donations for Americans earning more than $250,000 a year. That’s where he lost

Sen. Cantwell, who made a small fortune in the technology business. On top of opposing Obama’s funding proposal, she and eight other Democratic senators recently supported a Republican-sponsored Senate proposal, opposed by the Obama administration, to reduce the estate tax for very wealthy Americans. That bill, if passed, would cost the U.S. Treasury $100 billion — money Obama badly needs for health care reform. During her news conference, I asked Cantwell how she would pay for her expensive bills to boost the supply of primary care doctors, given that she has opposed two of President Obama’s tax proposals. She dodged, insisting that training more primary care doctors would lead to better, less expensive care that would save the nation $55 billion. Thus, she contended, the new programs would pay for themselves. Actually, even experts who support better primary care aren’t sure more and better primary care would reduce health care spending, or by how much; some say it could increase costs. Cantwell also argued that the nation could save a lot by reducing levels of care in high-cost states like Florida to the levels in lower-cost states like Washington. That’s true, of course — except that the smartest medical brains around the country haven’t figured out how to do that. After the news conference, I pressed Cantwell further on the funding issue, asking her how her projected savings would pay for the steep upfront costs of her proposals. She gave another non-answer, saying the challenge is to “bend the curve” of rising health care costs downward over the long term. I then asked her to explain how she would prefer to pay for health care reform since she opposes Obama’s approach. She again insisted that her proposals would pay for themselves. In the 1990s, President Clinton’s universal health care plan was killed as much by opposition from anti-tax congressional Democrats as by Republicans and health industry groups. Watching Cantwell will tell us whether that is going to happen again.

Harris Meyer is a journalist based in Yakima, Wash., and winner of the Gerald Loeb Award.  He has 18 years of reporting experience for law and health care publications, alternative newsweeklies and television news.

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  1. Thanks for the comments, Michael. You’re very politic in not pointing out that well before firing the editor, the AMA fired me in late 1995 for my impudence in reporting politically uncomfortable facts about policies the AMA favored. Unfortunately, I see the same anti-reform dynamics now playing out within the AMA — and the Democratic Party — that I reported on during that dark 1993-1995 period. Of course you’re right that experts have devised good medical and management strategies to steer more appropriate utilization. But no one has figured out how to bring entire communities like Miami into convergence with lower-utilizing, high-quality communities like Rochester. As you suggest, it probably can’t happen without political and social changes in the health system.
    –Harris Meyer

  2. Harris:
    Good to see you back in the mix.
    First, let me disagree with you, then praise you. You say the smartest medical minds haven’t figured out how to reduce waste. Not true in the slightest. There’s a huge medical literature on how to do this. What we need is the smartest political minds to get the incentives right, but the medical knowledge and management knowledge is largely there. I’ve spent many, many years in the trenches and researching the literature both.
    Oh, yes: we could have single payer tomorrow run by all the Best Liberals, and it wouldn’t do it. It’s doable, but no easy solution.
    Now, the praise part
    I still remember your performing one of the bravest journalistic acts I have ever seen. It was at an AMA meeting in the 1980s when you were working for American Medical News (owned, of course, by the AMA). At a cozy press conference around a large conference table, the chairman of the AMA board was waxing indignant about government (I think – could have been private insurers) auditing docs whose fees were discounted because of the worry that they would increase office visits to make up the lost income.
    How could anyone believe that physicians, as professionals, would do such a thing?
    And you raised your hand and cited a study that showed exactly that.
    This kind of behavior, of course, is why the AMA eventually fired the editor, replacing her with a former PR person for a medical society in Texas, got rid of that independent-minded staff, and, by carefully turning all power over to a super-conservative board of directors, made the organization what it is today.
    And, of course, opened the door for folks like you to pursue other opportunities.

  3. Those of you screaming about potential tax increases to fund universal health care … wouldn’t you rather pay for that than some fat-cat’s bonus? The system has been broken for a long time and fixing it won’t be cheap. The engine light on the health care car has been ignored too long; after neglecting pay-as-you-go $25 oil changes, the motor either needs to be replaced or it’s time to buy a new car. Can’t afford it? Too bad. If you need transportation, you’ll just have to find a way to suck it up. If you keep your lemon and replace the parts piece by piece, over time, you will have invested at least double the original price of your car despite it’s depreciated value. Examine the health care systems of other countries, pick the top two and then decide. Money is a moot point- we either continue to strangle ourselves with higher premiums/out-of-pockets and pay higher taxes to cover those who are excluded, or pay the same in taxes to cover everyone. Get over it! If you’re one of the screamers, all you’re doing in the long-run is delaying the change and supporting on-going profits for the A.M.A., malpractice attorneys, drug companies, insurance companies, for profit hospitals….

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