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Capitol Shortage: Can the Two Democratic Parties Get It Together on Health Reform?

Hcan-june25crowd+dome3 As an exceptionally grumpy American summer grinds to a conclusion, it is apparent that only a bipartisan solution will enable Congress and the Obama Administration to complete health reform.  No, we’re not talking about co-operating with the Republicans. Other than a handful of contrarian Republican moderates on the Senate Finance Committee, at least one of whose votes might be needed for eventual passage, the Republicans are irrelevant to the final outcome.

No, the bipartisan solution we’re talking about is co-operation between the two Democratic parties represented in Congress:  the “Safe-Seat” Democrats- the Pacific Heights/Beverly Hills/Berkeley Hills/Upper West Side/Harlem Democrats and the “Running Scared” Democrats from the western, southern and border states, who actually require independent and some moderate Republican support to get elected.  These parties have very little in common other than the Capital D after their names.

The “Running Scared” faction of the party is loosely organized in the House into the Blue Dog Coalition.  Rahm Emaneul’s successful 2006 campaign created many new Democratic Congresspeople in traditionally Republican districts, and thus, many more new “Running Scared” Democrats. Even though Senators are not exposed to electoral wrath every two years, even modest Republican years can take out senior Senators (e.g. Tom Daschle in 2004). Harry Reid (NV) and Chris Dodd (CN) are only two of the most prominent Senate Democratic leaders vulnerable next year.

Unfortunately for the Democrats, the “Safe Seaters” appear to be running things; the Speaker of the House, the Chairmen of Ways and Means and of Energy and Commerce (the two key substantive health committees) are all “Safe Seaters”.  House Democratic leaders are seething with populist righteousness after nearly two decades of Congressional irrelevance, and they are primed, first of all, to punish.  They may end up punishing their own party as much as anyone else.

The Safe Seaters produced a health reform bill HR 3200 which really was a government takeover of the health system.   It not only created a public healthcare option that imposed near Medicare rates on providers.  It also federalized the employer’s health benefits, leaving them not only with an 8% payroll tax in lieu of benefits, but a politically defined benefit and insurance rate structure.  Employers were stripped of the regulatory shield provided by ERISA, and face criminal penalties for not adhering to mandates. It appointed an Orwellian “Health Choices Commissioner” to run the whole thing.

HR3200 created a huge problem not only for a pragmatic President Obama, but more importantly for the “Running Scared” Democrats, whose House members all have to run for re-election in fourteen months. The staged Town Hall theatrics many Congresspeople encountered in August were unsubtle reminders that a vote for “government controlled healthcare” could cost marginal Democrats their seat.

Despite the fantasy that the last election represented a fundamental re-alignment of voters toward traditional Democratic liberalism, America remains a nation of skeptical political moderates (albeit with immoderate appetites) who keep their politicians on a very short leash. When political leaders attempt something as complex and multifaceted as health reform, voters are handicapped by limited attention spans, shocking gaps in knowledge and, most seriously, a profound lack of trust in their government.

President Obama entered office just seven months ago with high hopes of reforming the health system.   In this regard, the President arrived with two strikes against him:  the economic crisis and his partnership an increasingly discredited and out of touch Congress. He had ample opportunities to postpone health reform due to the economic crisis. In retrospect, this was the sensible choice.

Rather than wait, however, the President, somewhat unconvincingly, linked the two- conflating cost containment and access expansion-  and plunged ahead.  He has clung grimly to this formulation as political and economic conditions worsened through the first seven months of his term, as his own approval ratings have wilted.

The economic crisis actually began over two years ago, when American households, faced with rising food ands energy prices, and resetting mortgage interest rates, simply  ran out of cash. The crisis deepened in 2008 and 2009 with the compounding damage of foreclosures, a stock market crash, the resultant carnage in peoples’ retirement savings and a loss of over 6 million jobs (so far).   By midyear 2009, most Americans were in a state of shock and disbelief, leveraged out the window and hemorrhaging cash.

Congress has reacted to the economic crisis by flinging trillions of taxpayer dollars at them. They burned up a huge amount of political capital with voters by doing so.  First TARP, then the Stimulus Bill, then a bailout of the automobile industry- all hasty, unpopular, untransparent and financed by the kindness of strangers. In  fiscal year 2009, we borrowed an unimaginable half of federal spending from the Chinese and other trusting investors. These actions have not only drained down official Washington’s political capital; they also burned resources that could otherwise have been used to grease health reform.

Until this summer’s Town Hall theatrics, Obama had some successes in managing the health reform process.  The White House made a sound tactical decision to neutralize health industry opposition to health reform by cutting deals with hospitals, physicians, the pharmaceutical companies and the insurers. These deals are fragile, and may unravel if universal coverage cannot be achieved.  But these deals also made it virtually impossible to fund the entire expansion of coverage by reallocating present spending, which was the prudent fiscal course.

The deals with the industry required the Administration to raise taxes to fund reform, leaving it with a very difficult political challenge.   It is hard to explain to cash strapped voters how throwing another trillion dollars at a system whose costs are already too high, and growing at an unsustainable rate, will somehow make care more affordable.  No one with more than a high school education believes that health reform will be “deficit neutral”. And the Republicans, in a spate of rank political opportunism that they will later regret, are attempting to close the door on any Medicare funding reductions to finance health reform, fully aware that this will doom the process.

The President’s handlers have attempted this summer to staunch rising public anxiety. One stratagem has been subtly to repackage health reform as “health insurance reform”, attempting to focus voters on how the proposals will help the vast majority (94%)  of the voting public that already has insurance. Even though the health insurers have been at the table and bargaining vigorously for a year, the President’s campaign disingenuously paints them as the evil core of resistance to health reform. It is not clear that voters noticed the subtle shift in emphasis here.

The other stratagem has been to attempt to explain over all the shouting what the typical voter is likely to get out of health reform. Health reform advocates have done a terrible job of articulating what those actual benefits are.  Denying insurers the ability to deny coverage due to pre-existing conditions, to rescind coverage after someone becomes sick, to shift cost onto patients  (by restricting cost sharing) all represent tangible gains for those with insurance.  HR3200 also cuts the Medicare Part D prescription drug plan’s hated doughnut hole in half, a tangible savings for people over 65.  So far, these efforts have not stemmed the rising tide of public skepticism.

So how does the President salvage health reform when he returns from his non-vacation on Martha’s Vineyard?   Not by demonizing the irrelevant Republicans and not by demonizing a healthcare industry that by and large supports reform and would benefit tremendously by it.  Demonizing anyone is only going to further raise temperatures and burn up the Administration’s rapidly dwindling store of political capital. Populist outrage will not git ‘er done.

Some health insurance reforms such as eliminating pre-existing conditions and limiting recissions of coverage after someone become sick have broad bipartisan support and could be enacted with or without the health insurance industry’s support.  Health insurance mandates and the public option, on the other hand, lack even the Democratic votes to pass the Senate, and should be put aside, regardless of the price paid on the party’s left wing.

The President should focus on covering as many of the uninsured as he can, the original impulse for health reform.  It’s surprising how much good could be done on this front if one postpones, at least temporarily, the politically and fiscally unachievable goal of universal coverage in 2009. It is certainly within reason to cover at least 30 million of those presently uninsured, with the balance to be covered by Congressional action when the economy recovers.  This would be a huge victory and it is within reach.

Up to twelve million young people aged 19-30 could be covered by innovative insurance  policies that cost as little as $60-80 a month.  You cannot do that with modified community rating.  Many parents would gladly pay for this coverage voluntarily, with no mandate.  There are also nearly 11 million uninsured baby boomers, by far the scariest and costly segment  of the uninsured, that could be covered by a 45 year old “public plan” called Medicare or by letting them enroll in the Federal Employees Health Benefit Program.    You could finance the subsidies for low-income boomers  to enroll in either existing plan with soft drink and alcoholic beverage taxes.  The balance of subsidies to the low income uninsured can be financed with the Medicare payment changes already agreed to.

One can cover the 6-7 million illegals and transient legal immigrants, who are apparently untouchable for mainstream coverage, as well as many others,  by expanding community health center funding, as many health reform bills have proposed. And you can subsidize 100% of states’ costs of funding Medicaid coverage for low income adults, delaying state matching until their local economies has recovered.

The entirely predictable primary care physician shortage should be addressed by doubling Medicare payment for evaluation and management, paid for by modest cuts elsewhere in the Medicare program. Rebalancing Medicare can await the huge Deficit Reduction bill Congress will consider after the Congressional elections in 2010. >
Politically, the reality for President Obama is that his own  party could easily kill health reform unless he can unify the Safe Seater and Running Scared factions.   His advisors remember that the Clintons had substantial majorities in both Houses of Congress when they attempted health reform in 1993-94.   Rather than unifying their own party, the Clintons made a disastrous decision to cast aside the Running Scared faction, actually threatening to “demonize” one of their leaders, Jim Cooper of Tennessee.   The price paid: 15 million more uninsured and a fourteen-year delay in addressing the problem.

Obama has to convince members of his own party that it isn’t merely his skin that is at risk if the Party fails to enact health reform.  Congressional leadership already has Richard Nixon/George W. Bush level approval ratings.  Those ratings will sink still lower if the Party cannot use its huge majorities to enact some form of health reform. And a lot of Democratic leaders could be looking for new jobs themselves in fourteen months.   I think President Obama will sign health reform legislation this fall.  If he is to get a bill he can afford, however, it’s time to get busy and knock some sense into his fellow Democrats.

There is a severe and growing shortage of political capital on Capitol Hill just now- a capitol shortage, if you will.   Husbanding that scarce capital will require making difficult choices in the next three weeks.  For better or worse, health reform is the central Democratic issue.  To mismanage it twice in fifteen years could give the entire Party a durable and, unfortunately, richly earned black eye.

Jeff Goldsmith is president of Health Futures Inc. He is also the author of a book released this year titled “The Long Baby Boom: An Optimistic Vision for a Graying Generation.” Health Futures specializes in corporate strategic planning and forecasting future health care trends.

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29 replies »

  1. Lifelong Liberal Democrat but also a Realist. We clearly dont haev the votes to pass a strong public option. I agree with the author. We need to go for a compromise that atleast insures about one-half the current uninsured (additional 22 million). I just hope we can drive some sense into our good, ideologically-hardened liberal friends.

  2. “they’ll pay a huge price next year.”
    With who, highly bonused insurance executives?

  3. As I expected, the NYT today reported on a number of Blue Dogs who are ready to cave and back ObamaCare.
    If the Dems keep going toward screwing up health insurance markets, they’ll pay a huge price next year.

  4. Jeff,
    As usual, an interesting post.
    My question regards your view of covering the uninsured. In my (painstaking) review of HR 3200 and the Senate HELP plan, as well as the CBO analysis of those plans, I still see 15-18M uninsured in the best out-year between now and 2019. Not surprisingly, the Feds leave it to Medicaid to address that. As our Governor Bredesen notes, it is easy for the Feds since they can both borrow and print money.
    Where do we get to a bill that provides coverage?

  5. IT Geek FYI, I’m a lifelong moderate Democrat w/ no ties whatever to the health insurance industry- ownership, consulting, advocacy. I voted for Obama (twice) and actively support what he is trying to do. Read the rest of my posts on this blog before popping off. . .

  6. This is a really simple and understandable proposal. Most people are confused about various reports on what is really on the table in congress.
    I wish there is a way that we can have a poll on readers’ sentiment.
    JC

  7. Jeff; This is a terrific blog, offering sensible solutions, and I have so indicated in my own blog medinnovationblog.blogspot. When are the Democrats ever going to learn that incremental reforms work and sweeping reforms fail and that the American people reject big government solutions?

  8. In Goldsmith we have a benighted partisan who inveighs against health care reform and also seeks to fix the blame for the housing meltdown on Fannie and Freddie and its Dem champions in Congress. What a creep.
    And it’s good to hear from the other Health Insurance lobbysists, too.

  9. That is basic problem with the democrats. They do not have any idealogy that binds them… If you expand upon the meaning of word liberal….well they are. They are free bird.
    and there-in-lies the problem.
    Healthcare reform will be a test of leadership. They have spend too much time infighting than creating a meaningful proposal.
    What we have is more of the same!
    rgds
    ravi
    blogs.biproinc.com/healthcare
    wwww.biproinc.com

  10. 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 is the real reason why premiums are so high.

  11. Except that it never was a Depression in the first place, merely a potentially ruinous financial panic (fed by naked shorting and speculation). The voting public won’t believe things are better until there is job growth, instead of “only 250 thousand jobs lost last month”. Wealthy people are still frightened enough not to be buying things, and the non-wealthy are trying desperately to pay down their installment debts and refinance in the tiny windows the markets give them to bring down their mortgage payments. The only reason we haven’t had actual rioting at these town meetings is the stock market rally, that has given people the temporary illusion that they might be OK.
    Most people know we’re still deep in the ditch, unfortunately, so there’s nothing to take credit for, other than stopping the panic, and Obama correctly acknowledged that Bernanke was the real stopper by reappointing him.
    It is not clear that enacting the Safe Seat version of health reform (HR3200) would make healthcare “safer” in any sense, because it would have led directly and immediately to a ruinous shortage of primary care docs that would have affected everyone, including the insured voting public. People would be waiting all weekend to have their chest pains evaluated, or for the emergency surgery they needed because hospitals couldn’t accomodate the call coverage demand of unattached patients.
    And we’d have a health insurance” Czar” (how many “Czars” are there in this administration?) making decisions about employer benefits costs from 50 thousand feet, and a lot of employers just saying “fuck it” and not hiring back the workers they laid off in the last year. The Stimulus Bill and the Fannie Mae/Freddie Mac episodes fatally damaged Congressional credibility, and, by inference, the “outsourcing” of drafting health policy by the Administration. Obama might be fighting the last war, with markedly inferior Congressional partners.

  12. Jeff, I’m not saying that it actually is all the Republicans’ fault–although to be fair it is mostly their fault. I’m saying that the Dems have to capture the “we got you out of the depression” meme that’s going around, and add to it a “we’ll fix the health care system so that you’re safe” meme. Not easy I know but then I’ve never been one to believe that much can be done before we hit a much much worse situation.

  13. So I agree with Donald. But what about the impact of Fox news?
    What is happening with the media taking all of these people who are angry at the town hall meetings. Learned something about mirror neurons today and that they are what causes all the people watching fox to get experience the same emotion as all those angry town hall members.
    And I am not even making it up:
    http://ebtnews.blogspot.com/2009/09/knowing-your-number-president-obama.html
    So what do we do about fox?

  14. Pretty good analysis, Jeff.
    I don’t see that anything will pass this fall. It may not pass until next spring or until the spring of 2011, when it would have to be a bi-partisan product.
    Obama’s going to get more specific about what he wants in the bill. He’s had seven months to learn more about the issues and listen to the debates, but I’m not convinced he has really listened or has the guts to take strong positions. He’s the president who gets rolled, and everyone is trying to roll him on health insurance reforms.
    At the same time I’m not convinced the Blue Dogs are that Blue. I think they’re really liberals looking for an excuse to back Obama, but he may not give it to him.
    We haven’t heard from the Blue Dogs for some 45 days. It will be intereting to see what they’re thinking and how unified they are now. At the same time, the Congressional Progressive Caucus in the House has dug in its heels for the public option, or Fannie Med. Will they cave to get something done? They’re not that smart, so possibly not.
    Norman J. Ornstein has a different take in WaPo.
    http://www.washingtonpost.com/wp-dyn/content/article/2009/08/31/AR2009083102913.html?hpid=opinionsbox1
    He thinks Obama’s strategy all along was to let Congress find the sweet and sour spots in the debate and then to bully a bill through the conference resources. And he thinks this will work.
    It should work, but I’m not betting on it. And I”m hoping he’s wrong, because no matter what gets passed, it won’t be health care reform or health insurance reform. It will be a power grab.

  15. The US needs more HIT computers to print cookbooks for medical care and to achieve blue plate compliance with political needs.
    Alex S comments that it is standard to sell programs without knowing what recipes for disaster are in its cookbook.

  16. Living in NC I’ve come to understand that “Blue Dog” Democrats aren’t Democrats at all, just Republicans by another name. It’s their citizens that need affordable healthcare the most, along with education and social services and something above minimum wage. But hey, god forebid we give them a public option that maybe they’ll be able to help pay for when they can just show up at the ER when they need help.
    “The economic crisis actually began over two years ago, when American households, faced with rising food ands energy prices, and resetting mortgage interest rates, simply ran out of cash. The crisis deepened in 2008 and 2009 with the compounding damage of foreclosures, a stock market crash, the resultant carnage in peoples’ retirement savings and a loss of over 6 million jobs (so far). By midyear 2009, most Americans were in a state of shock and disbelief, leveraged out the window and hemorrhaging cash.”
    Then doesn’t this make solving the cost of healthcare even more important?

  17. I come from one of those battleground states, OH. In my younger years, I tended to vote Republican. With good a strong belief in the do-it yourself values. Let’s minimize government. I have noticed that my moderate Republican friends and I have switched our allegiences. The 2nd Bush administration has done irreperable damage to the Republicans. They have been exposed as liars, hypocrites and criminals who defiled our constitution and our most fundamental American values. More amazingly, his administration managed to collapse the free-market system. For the first time in my life, I am actually for increasing government because the free market system failed us.
    The so-called “Running Scared” Democrats know that a public option is the middle ground. It will get passed. They know that giving their constituents a choice is the ultimate political victory.
    Those 19-30 year olds are a cash cow for whoever can rope them in to buy insurance. They have no real health issues and don’t access the health care system. Mandating them to buy insurance is like printing money! Oh that’s right the gov’t already does that.
    None of these issues have anything to do with health care reform. They are just the sideshow. Real health care reform only comes when you disrupt the system. Otherwise, by definition it is more of the same.
    How you manage the disruption is what makes it viable or not. A poorly managed reform will collapse the system. A well managed reform will have an easy transition and create a robust system that will work well for everyone for many generations.
    An overnight change to a single payer system will have a far reaching impact that is likely to severly traumatize the system and could collapse it. A phased change to a single payer system will be less traumatic, but will be fraught with problems.
    A capitlistic approach is to revise the payment system from fee-for-service and pay-per-pill to fee-for-access. You don’t pay for delivery of services. You pay for the right to have them without paying at time of delivery.
    I could write a book on all the changes that occur as a result. The bottom line is this: In a fee-for-service pay-per-pill system we pay for quantity of care. In a fee-for-access system we pay for quality and efficiency of care.
    From the public perspective we already pay in a fee-for-access model. The only real change is that there would no longer be any direct payments to providers. I don’t foresee anybody crying about not having to pay them. From a provider perspective there business model completely changes. Doctors each get a retainer when a patient chooses him. They need to start thinking in terms of patient satisfaction and efficient mechanisms for delivery. It means reshaping a mindset and a way doing business. There will be upset, but if given a support system the transition will be easy. If they take care of their patients, they can greatly expand their income and simultaneously reduce their work load.

  18. From my current blog post “Public Optional” –

    I am really sick of hearing about the “public option” wrangle 24/7 in the media these days. I am increasingly skeptical of its inclusion of any final legislation that may or may not reach the President’s desk, and likewise skeptical that it would comprise much of an improvement even should it pass the Congress (and, it looks increasingly to me like a slickly orchestrated “misdirection” strategy). Without a “public option” (our having taken Single Payer off the table a priori), it is difficult to see what “health care reform” would truly amount to. But, then, “public option” as currently proffered (e.g., H.R. 3200) merely looks like — as I’ve said before — [1] corporate welfare (“Play or Pay” forcing everyone to buy health insurance policies under threat of tax penalty for non-compliance), and [2] outright “welfare” (means-tested government subsidy for health insurance “affordability”).

  19. So our accumulating $14 trillion in household indebtedness we couldn’t pay back was the Republicans’ fault?? We were as a society on a fifteen year long credit drunk, and we’re now in the morning after. It wasn’t ever going to be pretty.
    A lot of the regulatory problems in our housing market were created by the Democratic guardians of Fannie Mae and Freddie Mac and a bipartisan fervor to encourage homeownership, whether people could afford a home or not. Lots of blame to go around on both sides. Of the three bailouts, I think the TARP was arguably the best managed bailout- it averted a ruinous financial panic, and it may end up making a profit on a lot of the equity positions the government took.
    The Stimulus Bill, on the other hand, was a shameless porkfest, not a responsible remedy. So far, we’ve only spent about $80 billion of the bailout money, so when we are in the middle of a serious economic emergency, the Democrats couldn’t get the money to where it would actually create jobs. So much energy was spent protecting the public sector unions and teachers that the numerous vital things we needed to do- repairing roads and bridges, public health preparedness, you name it.- didn’t get done. The autopsy on the Stimulus Bill will be truly ugly. A lot of that money was flat out wasted.
    On the timing of health reform, I was in earlier posts a advocate of “wait and lay the groundwork”- spend money on demonstration projects to test better ways of paying for healthcare services, fix the primary care Medicare payment problem, ramp up the community health/public health spending for those who cannot be covered by conventional health insurance, etc., then tackling the benefits expansion when the economy recovered and was throwing off cash.
    Now that the panic is over, we’ve just got a lot of angry, frightened people of both parties who aren’t ready for a further huge expansion of government influence. They’ll feel differently when they have paid down their debts and gotten back to work, and the Administration will be in a stronger political position to demand the changes and sacrifices needed for health reform. Obama was burdened with absurd expectations, and is doing a credible job of managing his agenda. If the economy doesn’t improve, Obama and the Democrats are toast. . .

  20. Even though complaints from chronic pain patients are easier to diagnose and document we now have created a situation where doctors are under-prescribing out of fear, especially if their patient are in their last stages of life because the docs can be charged with murder if autopsies shows high traces of pain medication, this indicated findrxonline in article. I pray this madness comes to an end and I sincerely hope none of you will ever be dying in extreme pain in a hospital, nursing home or maybe at your own house while the doctor is afraid to give you that prescription or injection during your last moments. Yes, definitely keep this medication away from kids but do make it available to those who can benefit from it!

  21. Jeff’s identified the problem all right. Yup America is a crazy place where 33% of people identify as Conservative Repulicans. Those are the people kicked out of every other country in the world. So the other 66% are divided along European lines and somehow have to make one party out of two.
    But his solution–somehow encourage more young’uns to buy underwritten insurance than they currently do, let sick middle aged people (that’s all of them) buy into Medicare, and expand community health centers, just piles more incremental baggage onto an already overbagagged system.
    And worse, I don’t see how it can be done without more spending–the thing we’re trying to avoid.
    One more thing–the Dems need to explain properly that without the stimulus & the bailouts it would have been back to the 1930s (and it might still be) and that it WAS ALL THE REPUBLICANS’ FAULT. Somehow the bailout has become a political problem for the Dems, when it was the only thing stopping us from actual disaster.

  22. Geek, by your alias I assume you have something to do with IT, am I right? Then you probably know that without IT we would still have paid cash or written a check for every purchase, and eBay, Amazon and the Internet itself wouldn’t even have existed. No, I am not a member of any trade association. But I did witness a few successful HIT implementations that brought numerous benefits to both users and patients. Are existing HIT systems perfect? Sure, they aren’t. Do they require changes in care delivery workflows? Yes, and that can be disruptive when doctors and nurses just start using them. Any tool can either help or hurt you. HIT systems will hardly be 100% fool-proof, ever. This is where internal processes and protocols come into play, to prevent, mitigate and correct errors, ensure data safety, and protect patient privacy. I hope you are not implying that paper charts guarantee you, a patient, from errors, are you? Let me repeat, HIT systems have a lot of room for improvement, they need to be thoroughly tested before going into production, but saying that we should wait until they are absolutely perfect is naïve, at best, and strange from an IT professional. As long as HIT vendors get honest feedback from users, their applications will get better.

  23. I have high regard for Jeff Goldsmith, but in this piece he says things that seem to contradict each other. He doesn’t want an insurance mandate but he wants insurance reform including eliminating preexisting conditions? The insurance industry is right that that doesn’t make sense. I wouldn’t be too sure that insurance reforms could be passed over industry opposition. Just wait for a new gazillion-dollar Harry & Louise campaign.
    As far as the Republicans ruling out Medicare cuts, take a look at their own health reform plans. They have significant cuts in mind, just as they’ve proposed in the past.
    Jeff says it was prudent to neutralize health industry opposition through deals. Then he says that was imprudent because it will require raising taxes. Which is it?
    Obama should have postponed health reform until when? 2010, in the middle of mid-term elections? 2011, when he might have a more Republican Congress? 2013, when he might or might not win re-election. Come on, Jeff, you know how narrow the political window is for major change.
    Jeff’s proposed ways to cover the uninsured are going to be just as politically controversial as what the Democrats propose. Putting under-65 Boomers into Medicare, as Clinton and Gore proposed? Republicans and the insurance industry will tear that one to shreds. Government takeover!!!

  24. Jeff, I wish I was as optimistic as you about signing a bill in the fall, but so far I don’t see anything “signable”, nor do I see anybody headed in that direction. Maybe some good will will come from an attempt to honor Sen. Kennedy’s memory. Maybe not.
    I believe the major mistake was throwing the entire thing down to congress with no real guidance. I do understand the need to avoid a Clinton “task force” approach, but this administration went too far in the other direction and the results are 1000 pages of something that cannot be implemented.
    Maybe if the White House takes the reins back and comes up with a succinct and drastically scaled down proposal (along the lines you mention), for congress to flesh out, maybe then there will be something to sign in the fall. Capitol Hill seems to have shortages other than just political capital.

  25. Alex is dreaming of systems that do not currently exist.
    His statements are studied propaganda from the trade groups and conflicted HIT industry intellectuals.
    Until HIT and EHR systems improve, do not subject my family to experiments to benefit the monied interests of HIT vendors without signing them up as guinea pigs via IRB approved protocol.

  26. HIT is a must if we want to achieve coordinated care, avoid errors and adverse drug interactions due to incomplete patient information, monitor and contain epidemics, etc. I blogged on that on http://betterhc.blogspot.com/2009/06/what-ehr-can-do-for-us.html and http://betterhc.blogspot.com/2009/06/how-meaningful-can-be-meaningful-use.html . No doubt, EHR and other HIT systems have to improve a lot. Sometimes, though, medical professionals reject HIT on the spot, without even trying to see possible gains, in workflow efficiency and care quality.

  27. Excellent analysis! If health reform is to be successful, then it is going to take compromise. An incremental approach may be the only way forward.

  28. They all agree on spending billions on HIT systems that are the scourge in England.
    Why can they not get together on something simple like getting a conversation going with doctors to establish the true needs of the patients?

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