Will Republicans Be Spoilers Or Problem Solvers on Health Care Reform?

Picture 19 In theory Congress’ return from recess next week could offer a new beginning to the health care reform process, giving everyone a chance to take a deep breath and recalibrate the components of change.

Nine months into the wrangling around a new Administration, the talk-show right has seemingly hijacked the discussion on health
care, Democrats’ signature issue, with the standard tools that demagogues have always used: leveraging popular prejudices with oversimplification, hyperbole, and distortion. The die-hard GOP faithful’s leaders – Gingrich, Palin and others (see this off-the-deep-end speech by Rep. Mike Rogers (R-Mich)) – are of course playing spoilers, independent of the cost. They hope to goad centrist voters into abandoning the Democrats so they can retake power. Witness South Carolina Republican Jim DeMint’s comment, “If we’re able to defeat Obama on this, it will be his Waterloo. It will break him.”

The problem with this approach is that we’re still early on in our national discussion about change and about health care. An increasing number of Americans may be frustrated with Democrats, but after 10 years of Republican rule, few Americans see them as a party of fresh ideas or having an interest in helping anyone but the wealthy and powerful. Americans may have short memories, but they likely still recall that Republicans were just thrown out for a multitude of significant sins. So if everyone you know sends around Obama-as-Hitler arguments, heckling and hoping the Dems will quickly self-destruct may seem like a reasonable strategy. It is doubtful, however, that the other 75 percent of us buy that thinking.

Of course, the Democrats’ health care reform offerings haven’t particularly helped. As we recently pointed out, now that they’re in power the Democrats have taken enormous contributions from the industry, and their health care proposals show it, dramatically expanding entitlements but conspicuously doing little to drive out waste and cost.

This has alarmed some influential groups that otherwise might be supportive. For example, the non-partisan Committee for Economic Development, a business collaboration focused on social issues, issued this July 20th press release excoriating the bills:

The House of Representatives and the Senate HELP Committee proposals are unacceptable. They would expand coverage without controlling costs, leaving future generations with a system even worse than what we have today. We cannot afford the government and the health-care system we have now, much less this
bloated alternative. Lawmakers have bowed to political pressure at the expense of sensible policy. The business and policy community cannot stand behind these bills,” said W. Bowman Cutter, Managing Director, Warburg Pincus.

And the Mayo Clinic, often cited by President Obama as a national model for higher quality, more efficient care, issued this strongly-worded response to the House Tri-Committee Bill:

Although there are some positive provisions in the current House Tri-Committee bill – including insurance for all and payment reform demonstration projects – the proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients. In fact, it will do the opposite.

In general, the proposals under discussion are not patient focused or results oriented. Lawmakers have failed to use a fundamental lever – a change in Medicare payment policy – to help drive necessary improvements in American health care. Unless legislators create payment systems that pay for
good patient results at reasonable costs, the promise of transformation in American health care will wither. The real losers will be the citizens of the United States.

Over the weekend, Senator Mike Enzi (R-Wyoming), a staunch conservative and a member of the Senate’s “Gang of Six” working on a health care bill, joined this chorus. He claimed that the Democrats’ proposals “will actually make our nation’s finances sicker without saving you money,” would “raid Medicare” and intrude “in the relationship between a doctor and a patient.”

It is important to distinguish this criticism from most of what we’ve
previously heard from the right. Unlike many of his colleagues, and certainly contrary to conservative talking heads, Sen. Enzi’s comments here are not so political as factual. They reflect the legitimate concerns of reasoning, mainstream conservatives who worry about simply throwing more money at health care without fixing anything.

Which constitutes the real health care reform opportunity for Republicans. The time could be right for centrist Republicans to pragmatically wrap their heads around this issue. After all, the approaches that are known to drive down costs and improve quality can easily be embraced by true conservatives who clamor for market-based solutions. Now, out of power and longing to demonstrate that they can produce substantive answers to our problems, the challenge will be to turn against their traditional industry benefactors and act on behalf of the American people. 

On August 24th, Bob Laszewski posted an important column, There Will Not Be Health Care Reform in 2009 Without Republican Leadership, that listed four major areas of health care change that should come easily to centrist Republicans.

  • Bulletproof Health Care Security. This is the
    idea that everyone would have significantly improved access to care, that the employer-sponsored system would remain available for those who like it, and that Congress would be required to use the same system that they pass for the rest of us.
  • Medical Malpractice Reform. The Republicans have the Democrats where they want them on this one. There is no good reason why our current Med Mal system, as capricious and ineffectual as it has been, has not been revised with expert systems, except that the trial lawyers, in exchange for hefty financial support, have received protection from the  Democrats. It’s time to fix this problem that pervades our health care provider community.
  • Paying for It. This is acknowledging that subsidies will be required for those who can’t afford health care at its current cost level, and that there are ways to structure the new cost that are more sensible. As Bob points out, the nearly forgotten Wyden-Bennett bill would be cost neutral in its second
  • Tough Cost Containment. As we said above, this has been the Congressional Democrats’ proposals’ most glaring and conflicted flaw. It is an area that, with a focus on primary care, paying for results instead of piecework, and cost/quality transparency, could dramatically drive down cost while improving quality, rightsizing our health system and going a long way toward ameliorating the most pernicious drag on our larger economy. Bob tackles cost control most effectively in his Health Care Affordability Model, a plan that would use tax incentives to encourage the industry to focus on driving out waste.

Collaborating with Democrats or, failing that, taking the lead to demand well-understood cost control mechanisms, would send a clear message that some Republicans are actually interested in problem-solving, not simply nay-saying.

It is possible that the health care reform issue has hardly begun, that the conventional back-room deals and horse-trading needed to be sorted through before the real work could begin. It is a profound truth that, town hall protests and nonsensical boasts about American health care notwithstanding, the middle class is terrified that their access to health care is slipping away. Both Democrats and Republicans have a large stake in visibly resolving this crisis. And, as Rahm Emanuel said, a crisis is a terrible thing to waste. The shame and danger of the health care reform proposals so far is that they would likely do little to actually address the crisis. The question now is whether lawmakers in either or both parties can put aside their partisanship, their petty grievances, and their special interest conflicts to do the people’s work. Pursuing the structural solutions described here would get America’s health care system headed in a new, far more positive direction. And one thing is clear. The American people are desperate for meaningful health care change, and are watching this process very closely. Whoever takes the high
road and achieves real reforms will win. The opposite is also true.

Brian Klepper, PhD and David Kibbe MD MBA write together and consult on health care market dynamics, reform issues, and health IT. Their collected writings can be seen here.

More by these Authors:

Health Care Reform’s Deeper Problems

Why Standards Matter (1) – The True Meaning of

Why Congress Should Consider Bob Laszewski’s Health Care
Affordability Model

The Health Industry’s Achilles Heel

The Parable of the Wicked EMR

13 replies »

  1. It seems evident to me that the success of the Liberal Healthcare Reform Bill is a inevitable conclusion. I understand that the Dems control everything. Still, how can these people ignore the obvious desire of the public that this legislation not pass? Medicare cuts. Government-sponsored abortion. The “Doctor Fix.” This bill is bad for America and will bankrupt several generation of citizens.
    Although this is probably the wrong venue to say this, I’ll say it anyway; we don’t need a return to power of the Republican Party. We need a return to power of the American PEOPLE! A majority of Americans consider themselves fiscally Conservative. That’s what we need! Ronald Reagan -types that have a proven record of behaving in a fiscally-responsible manner, not a “Conservative-convert” who reads the tide and starts talking the talk.

  2. Socialism does not work, read history.
    No one has the right to healthcare. Based on what philosophy? If one want’s health insurance they can purchase it. If they cannot afford it then they do not have the right to force someone else to pay, that is called tyranny, stealing via the government.
    People need to think about what they are asking for. Obama is a politician! He has never worked a day in his life. To give politicians power over healthcare is dangerous, immoral, and illegal.

  3. In reading these comments, for which both Brian and I are very grateful, what I sense is a moderation of the debate itself. Which is a good thing, I think. It means a little bit of the heat of battle, which is always about defending MY INTERESTS, is cooling, and with that there may come a new opportunity to think about OUR interests. Almost no one, not even members of the right wing of the Rep. party, will gain by maintaining our current health care non-system. Except, perhaps, in the very near term. So, think about the kids and grandkids, and we’ll do the right thing. Regards, DCK

  4. I appreciate all effort to point out that we could lose a huge opportunity to truly impact healthcare positively for Americans based on the current reform track. Having been in healthcare most of my professional life and as a patient, I wrote a letter to my friends and family to help them engage in the discussion. You can find it at http://www.healthcareletter.com
    We need to keep the conversation about value creation, patient centered healthcare and help the American public participate in that conversation just as they should in their healthcare.

  5. If the Republicans have hijacked the debate, then isn’t it the Democrat’s fault for not being more convincing?
    Last time I checked, there were a couple more Democrats in office than Republicans.

  6. I agree in concept. In practice, wanting the current incarnation of the Republican party to do something constructive is like wanting to walk on water. It would be cool if it could happen, but really, you’re more likely to wind up wet.

  7. Er, Spike. One reason to want Reps to do something constructive is that, at times, they control a majority of the votes, and at other times, they control enough votes to thwart the Democrats efforts. And maybe you haven’t noticed, but the Dems aren’t demonstrating that they’re directly tethered to good policymaking, either.
    In our system, calling everyone on the other side idiots is pragmatic only when your side is so solidly in the majority and in power that you always get your way.

  8. All of my elected representatives have been informed that they better have another job lined up if we don’t get “at least” a strong public option.
    We really need to find a way to replace the Republican Party. Conservatives need legitimate representation in the halls of government, not the disingenuous pandering provided by the RP.
    Maybe if the Republican Party was renamed the “Corporate Party” and they ran on an honest platform, like say;
    “We are here to protect corporate greed”
    “Americans are obviously to stupid to govern themselves, but fortunately Corporations know whats best for Americans”
    “Just send us all your money now, so we don’t have to work so hard to screw you out of it.”
    “The U.S. Constitution is a wonderful document but should not be allowed to interfere with profits”
    “The U.S. Constitution is a wonderful document but it’s limitations to Executive power don’t apply to Republican administrations”
    Then we could have voting decisions based on the reality of the situation. What a concept.
    Personally I think Republican voters fall into one of two groups, the wealthy, and the the gullible. If you voted Republican and are not sure which group you fall into, check your bank statements, if you balance doesn’t run into seven or eight figures, you would be part of the latter group.

  9. It’s like the posters on this blog have been in a cave for 15 years. When have the Republicans done anything that actually makes things better for the average person? Tax cuts? Not when they blow a hole in the deficit.
    Why are people even pretending that the Republicans could do something constructive at this point. It’s not in their skill set. They don’t understand policy, they don’t craft policy, they don’t know what they’re talking about and they don’t care that they don’t know anything.
    How about fewer posts about what the Republicans are going to do? They’ve made themselves irrelevant through decades of incompetence and bad faith.

  10. At long last–a reasonable and rational approach with the right questions asked and answered. The fundamental missing link in all of the discussions has been how much new health will we get for the new dollars we will spend? It is unconscionable that this country does not land in even the top 10 healthy countries of the world. What we need is a defined vision: we will be the healthiest country in the Western world by 2015, with affordable access and choices for those who desire employer-sponsored v public-sponsored health. But we should demand, and plan for, nothing less than improved health for ALL of the stakeholders: clinical health, financial health, community health.

  11. I don’t know how you can post this in the face of the relentless lies from the Republicans. Even “centrist” (ahem) Judd Gregg is lying and manoevering. It is time to call them on it.

  12. The real question is is anyone going to give us real reform of the health care system as opposed to expanding coverage into the current system? Are we going to continue bash insurance companies as the problem rather than deal with costs and delivery systems and misdirected incentives.
    I seriously doubt that either party has more on its agenda than getting credit for something, good bad or indifferent and that the short and long term losers in all this will be the American people.
    I tried to sum it up here.

  13. There will be no true health insurance reform until the insurance industry loses it’s anti-trust exemption. The fact that they can collude and price fix on premiums and provider fees is the real reason why premiums are so high.
    The Republicans have been protecting the health insurance companies since Newt took over and that’s actually the biggest problem we face.Let’s see if they want a true free market for health care. If so, they should repeal the anti-trust exemption asap. They argue the health insurance industry is “restricted” by state regulations but fail to acknowledge that they’re more free to collude and price fix than any other industry.
    For a true free market in health care…Republicans should call for a repeal of the insurance industry’s anti-trust exemption and make them actualy compete against each other. If they refuse then they are bascially, and outwardly, just human shields for insurance companies. Let’s expose them.