Health Care Reform Coming Out of Senate Finance?

We’ve been getting lots of news these past few days leading to optimism that a bipartisan health care bill will soon emerge from discussions between the “Coalition of the Willing.” That term refers to the three Republicans and three Democrats trying to find common ground in the Senate Finance Committee.First, let me be clear that I have the greatest respect for Senators Baucus and Grassley and their four colleagues. Theirs is the kind of bipartisan approach that all of Washington, DC should be following on any number of issues.And, as I have posted here before, I am concerned that in their efforts to find compromise they are headed for a health care bill that is based on a formula of cost containment “lite,” minor paring of Medicare and Medicaid provider payments, and at least $500 billion in new taxes. I don’t see much changing fiscally if that is the final result in a health care system that is already unsustainable and on the way to spending upwards of $35 trillion to $40 trillion over the next ten years as it goes to 22% of GDP by 2018.From what we have heard, their bill would hardly "bend" any curves.

Yes, we could well cover tens of millions more people and that alone would be a noble accomplishment. But just loading all of these people onto a system that we can’t now afford seems to me to be ultimately a fool’s errand. The number of uninsured we have in this country isn’t the fundamental problem—it is the most aggravating symptom of our real problem, which is unsustainable cost.Being good guys and bipartisan doesn’t necessarily lead to the best policy!But I would also caution people watching this process not to be so certain that when the final Senate Finance product is unveiled—if it is ever reached—that we are on the fast track to legislation.We’ve literally had these Senators holed up in secret for a number of weeks engaged in a very complex group dynamic trading one policy and revenue concept for another that may be leading to a compromise that makes sense to them. But each trade-off they made, or are making, is something really important to someone outside their little group and maybe not something any one, or a group of, the other 529 members of Congress is willing to go along with.What we do know is that every time a new idea for controlling costs, getting a good CBO score, or raising money has hit the media it has about always come in for lots of criticism from one side or the other—or even both at times.For more than a year I have been telling readers of this blog that health care reform was going to be very, very difficult to do. That we really didn’t have the consensus in this country over just what the problems are and what we need to do about them, or the political will to make the tough calls we need to make. Many people have disagreed with that assessment. I may still turn out to be wrong about it being different this time—but not so far.I’d wait to see just what the “Coalition of the Willing” is able to put on the table before we go declaring any victories. If for no other reason, any product is going to have to lay on the table for all of August and that won’t be pretty.I will remind you that the last group to go off on their own and hatch a health care plan in secret didn’t do so well when it hit the light of day.Made sense to them at the time.

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  1. No one is discussing the real problem with the med mal issue. Tort reform in the form of payment caps is not the answer. The real cost isn’t the malpractice premiums or the payouts. The real problem is a legal system that forces physicians to order so many test out of fear to protect themselves. The problem for doctors is that even if they follow the most up to date guidelines and studies they can still be sued for malpractice because there are no established legal standards of care. The “standard of care” is whatever any given attorney can convince lay jury it is. Even if a physician does everything correctly sometimes bad outcomes occur, and in swoop the attorneys and their “expert” witnesses. This is so pervasive that even medical students and residents in training are taught to CYA at all costs. When someone opposed to med mal reform cites a 0.5 – 1.0 % cost saving they are missing the point. The entire culture of medical care delivery needs to be changed. That will only be changed when doctors are held to established and published guidelines and standards, and not to whims of a very flawed jury system.

  2. The Universal Health Care Reform 3200 is an insurance that is restrictive. I have read most of the bill and it gives government the access to your aocounts and they will review your ddual power of attorneys. Obama tells another verison (his own verison) that is different from the factual written reform. As for Canada the skier died because she had to be taken to a hospital far away.(No helicopter service). A friend has been waiting over a year for knee replacement and does not know when she will ever get it. (a senior)

  3. For all those people screaming just say NO!! Does this mean we should stop medicare and Medicaid so we can truly get government out of health insurance? What your saying is we have the best health care system in the world so why do we need any government intervention right? People on Medicare and Medicaid would be much better off with private health insurance right? So I will stand with that get rid of Medicare and Medicaid and the taxes I would save from helping fund them I’ll put toward a great private plan..well until I get sick and need insurance.

  4. Facts!! We aren’t being given the facts. We are being brainwashed. No, the health care reform bill does not use the exact words “forced abortion” or “euthanasia” that they scream at us are not in the bill, but hidden in the ambiguous excessive wordage, these things, are a distinct possibility. It takes a sharp mind to detect it, but the scariest thing is the phrase that does hit one in the face over and over. “As determined by the Commissioner”. Those exact words are in the bill over and over. To further define what this administration is about one only needs to look at the background of his czars who are in favor of population control by radical means as evidenced by John Holden’s book Ecoscience. And the fact he has an avowed Communist who has served time in prison as one of his czars doesn’t instill confidence in the astute voter. People need to research things for themselves to the extent they are capable of doing it and not accept any party’s interpretation of what the bill is about. Also use logic, math, and common sense to realize utopia is not reality.
    Wake up people before it is too late. It is cumbersome and you won’t read the bill in a day but it does open your eyes. Don’t be a sucker and fall for a slick salesman. With the internet today, no one has to be gullible.
    The most conspicuous change in this bill from what is already on the books is “control,control,control and the power in Washington to hold that control”
    This is not a bill to help the people or to hold down costs. It is the very opposite but read it for yourself.

  5. now im not saying our country doesnt need serious reform.
    but has anyone taken time to look at the new healthcare bill?
    end of life counseling? seriously?
    requiring vaccines? it would actually save money if they allowed parents to opt out of getting their children certain vaccines, but that wont be allowed.
    mandates on state family planning services? isnt that where they do abortions?
    Section 1121 – all doctors will be paid the same no regards to specialty. say goodbye to your specialists everyone.
    the government will have access to ALL of our financial information?
    Section 58B- nonresident aliens exempt from individual taxes
    section 152 -healthcare provided to all non US citizens…that will just increase costs more.
    the U.S. could do so much better than this.
    why are we settling?

  6. Those of you who are blaming tort reform, i.e., law suits & medical malpractice for the rising health care costs, would do well to keep this statistic in mind. Medical malpractice costs only make up about 1-2% of the total cost of healthcare!!!! That’s not where our money is going, despite what the politicians (& some doctors) are trying to tell us! And while some specialties (OB, neurosurgeons, etc.) by their very nature are more prone to malpractice, not every physician has to carry such super high malpractice insurance! Even when you factor in the testing that doctors often do, to cover themselves against malpractice, it’s still only 1-2% of the total cost of healthcare!

  7. jd seems to forget that this year, our federal deficit equals 50% of total spending.
    That is, we’re borrowing HALF of the money were spending on federal programs this year, including Medicare. We are spending money, other peoples’ money, our childrens’ money, like drunken sailors. Letting cost containment wait three or four years until we’ve gotten all the new people enrolled in health insurance is not responsible social or economic policy.
    The first boomer arrives on Medicare in TWO YEARS, the advance guard of 76 million additional customers for a program that is already living beyond its means.
    Wake up, people! If we really want to bequeath our children and grandchildren a bankrupt society, all we have to do is continue writing checks we cannot pay. At some point very soon, no-one wants to finance our profligacy and no-one wants to own dollar denominated assets and WE ARE FUCKED! The next battle is now.

  8. Certainly it’s true that Robert Laszewski, like many of us, has been saying for a long time that health care reform that substantially improved the value equation (outcomes as function of cost) would be difficult and have to overcome entrenched and powerful opposition.
    However, Mr. Laszewski has also been a member of a rather large club of serious thinkers who heavily criticizes reform packages whenever they appear to have weak cost control measures built in.
    That is not the best attitude to take if you want to get real reform with real cost controls. Health care reform is a war, not a battle. Take the big victory that is achievable in 2009, access reform, and whatever smaller victories can be gained in quality and cost reform. Then, let universal access set the stage for victorious battles in future years on quality improvement and especially cost control.
    People act as though if you don’t bend the trend in 2009 we won’t get a second chance and won’t be able to stop the runaway train until it crashes the entire US economy. That is nonsense. What do you think a second Obama administration would be doing?
    I don’t know how much clearer it has to be that we may slow the cost trend a little bit with whatever package gets voted on in 2009, but (a) the public does not understand the real cost drivers so can’t agitate effectively for real reform and (b) providers are in too good of a position to obstruct reforms that would lower their pay in real terms. So take the access victory and prepare for the next battle!

  9. I think everyone should be required to have medical insurance because all of us insureds pay for each and every one of the uninsured through our health premiums. Just like auto insurance…if you drive a car, you must carry the insurance. If you are a human being and breathe, then you must have health insurance.

  10. You must admit that this bill will be the closest bipartisan solution that we’ve had yet. Once the details emerge…it may not be as bipartisan as we once thought! A mandate that everyone must have medical insurance is a step in the right direction.

  11. The “debate” seems to be taking place on two levels. I think the PUBLIC has a very different idea of the health cost problem than the experts and Congress.
    To the public, 46 million of whom have 100% exposure to health costs, its the costs to THEM of healthcare use that is the # 1 concern. This concern has been massively aggravated by this recession, the terrible household liquidity crisis and by the steady twenty year accretion of deductible and copay exposure.
    To address this (which HR 3200 actually does by capping cost sharing), you’ve got to promise to reduce their out of pocket outlays by making healthcare even cheaper to the consumer than it is now (only about 12.5% of total spending comes out of pocket). What the public wants is an open bar tab at the doctor, pharmacy and hospital.
    This is, of course, completely indefensible economic and social policy. What experts like Peter Orszag and, now, the President, mean by cost is what we pay as a society, which is truly on an unsustainable path. So when politicians talk about “controlling cost”- they have to straddle two completely different meanings of “cost”. They talk in code, which can mean what you wish it to mean, instead of talking honestly about why what we collectively want as individuals is unmanageable as a society.
    Until someone talks meaningfully and honestly to the voters about what we have to give up, as well as gain, from health reform, this debate poses real political dangers to health reform advocates. Being in an obscene rush to pass something just raises public suspicions. The only antidote to those suspicions is telling people the truth. That’s why Obama’s credibility and skill as a teacher may hold the key to actually getting this done.
    Keep up the great analysis, Robert.

  12. I frankly do not understand how Senators Baucus and Grassley along with the other four participants in negotiations on the contents of the Senate Finance Committee can be accorded any level of respect. The machinations – I would not even call them negotiations because that presumes some rationality and factual basis for discussion – have no relationship to the realities of the healthcare system in the USA.
    The explicit exclusion of the so-called public health plan is truly despicable. The fact that Senator Grassley trashes repeatedly in his public statements any healthcare system such as that in Canada outside the USA’s system is symptomatic of the underlying lies that this and the other bills are based on.
    How Republican politicians in Congress are allowed to routinely get away with blatant lies about any relevant fact is beyond me. Senator Grassley is just as guilty as his Congressional nitwit brethren.

  13. This post is accurate and comes closer than any other I have seen to acknowledging the real problem – run away health care cost (not to be confused with health insurance costs). When housing prices went up at an unsustainable rate, we called it a bubble. That bubble might not have popped if wall street had never discovered that the emperor had no clothes. No one is talking about how to actually reform the health care system – including tort reform. Until we fix the run away cost increases for health care itself, it will not really matter if we “fix” the health insurance issue.
    Seems like we are trying to fill a bucket with sand when there is a big hole in the bucket. Let’s work on fixing the hole before we create a system that will be doomed for failure because it fails to address the real problem.

  14. A friend told me few years back that research shows that a team approach to a solution is worse than you can from individual….
    But it is the team solution that can be implemented and be useful. Our fear si not that they are working and that they are compromising. Our fear is that I am not sure they have clear set of goals…so that they can negotiate a process.

  15. Crowell, if you were a soldier you would get free government healthcare for the rest of your life. Your parents are getting free government Medicare for the rest of their lives; believe me they will get all the useless and expensive lifesaving and life extending healthcare they want.

  16. I have to understand this..My parents work all their lives to pay taxes and be good citizens. They are proud of this country and even risk their lives to defend it. Know we celebrate Health Care reform and praise cost savings based on withholding health care to seniors and the sick. We as a country are ready to watch unnecessary deaths to save our government money so they can tax us to watch our family age and die before their time, all the while the lawmakers and their families are exempt. Yes this country is on the path to a change that wont be easy to take and it will hurt us all. If I were a soldier I would walk right off the battlefield.