Uncategorized

Will We Get a Health Care Bill in 2009?

Democrats-cap-and-trade-bill-house-renewable

It’s decision time. The Congress will or won’t pass a major health care bill during the next few weeks.Will we get health care reform in 2009?Almost certainly not. As I have been saying for months, if we get a bill it will be more a trillion dollar entitlement expansion funded by relatively minor provider cuts and about $500 billion in tax increases.

That is not health care reform.Will we get that trillion-dollar entitlement expansion health care bill?That outcome lies in the coming convergence on Capitol Hill of three extraordinarily powerful, and contradictory, forces.


The Democrats Are Absolutely Committed to Producing a Health Care Bill

After more than 60 years of trying they have never been closer to adding a third leg to their domestic policy legacy of Social Security and Medicare. Leaders in the party are cognizant that this is their chance to do what both Roosevelt and Johnson accomplished and join them in their place in history.The leadership and the White House will do anything they can to get any bill that qualifies as a breakthrough. If they can get this to within a handful of votes in the House and one
or two Senate votes they will drag this thing across the line.Can you imagine a Senator or House member trying to deflect the pressure they will be under if they turn out to be that last vote the Democrats need? “Senator, the party has been trying to do this for 60 years. If this fails it will not be the President’s fault or the leadership’s fault. It will be on your head to explain to the Democratic Party why, after all of these years and getting so close, you alone chose to give the President and the Party what could be a crippling legislative
defeat instead of a generational victory.” Sort of like becoming the Billy Buckner of the Democratic Party!The Public Has a Great Deal of Anxiety Over the Democratic Health Care EffortThe polls are at best split about down the middle. The Rasmussen Health Care Tracking Poll has consistently showed support for the President’s
efforts on health care—really a proxy for the entire Democratic
effort—in the low 40s and opposition in the mid-50s.It is now clear that the town meetings were more than just the far right making a lot of noise.Just how do you pass something as far reaching as a health care bill with an approval rating in the 40s?The Democrats Don’t Yet Have a Health Care Bill That Can Become LawWhile a bill is highly likely to clear the Senate Finance Committee in the next few days, the real negotiations will first be in each house as both Reed and Pelosi try to draft something they can pass on their own.
If that happens, then the most critical negotiation will begin as the House and Senate reconcile their bills and the tendency of the House to move farther left and the Senate to expect something more moderate.They still don’t have a way to pay for it. Every time they have put a tax on the table it has come off that table in just a few days. The current taxes aren’t so much agreed to as just the last generation of unpopular
proposals that are serving more as placeholders than final decisions.The House has a tax on the “rich” the Senate doesn’t like while the Senate has a tax on “Cadillac” health care plans that the unions can’t wait to kill once it emerges from under Baucus’ control.While most of the special interests have been bought off with the deals they cut to limit their contributions to paying for the bill, the American Medical Association (AMA) stands out as a critical player that has not yet been
satisfied. While the House bills spend more than $200 billion to fix the Medicare fee cut issue (which is yet unpaid for), the Senate Finance Committee has ignored the problem with just a one-year patch and a “trust us.”There is also a real unease over the combination of middleclass premium support subsidies, the bare bones character of the health insurance policies people would get, and the fines they would pay if they did not comply with the individual mandate. Republicans are going to continue hammering on the new “taxes”
this would create. If Democrats increase the subsidies they have to find more money to pay for it. If they exempt the middleclass from the mandate what good have they done for what are a lot of swing voters already anxious about all of this?If millions are exempted from the mandate, the insurance industry will have a problem covering everyone and eliminating pre-existing conditions and medical underwriting provisions.Then the states are almost unanimously balking at more Medicaid unfunded mandates in the out years of the bill.Add to that the debate over an employer mandate, a MedPAC with policy powers, and growing criticism of Medicare Advantage cuts. And, that is before the thousand-page bill sees the light of day and who knows how many more “death panel” scares.On top of all of this there is the public option issue. As I have been saying since spring, there won’t be a Medicare-like public option. But just how will the Democrats
finally compromise this issue. Co-ops are fizzling and there is one big devil in the details for any kind of trigger. Recent suggestions for the states running the insurance market for the near poor and proposals to give states the flexibility to create their own public plan would add an almost byzantine complexity to what is already a complex bill.If you take the “Cadillac” tax out of the Senate Finance bill and add in
the more than $200 billion for a Medicare doc fix, you’ve created an almost $500 billion gap to fill.

……

So, there are these three powerful, and contradictory, forces about to converge on Capitol Hill. Just how will they finally sort-out?

That will make for the most fascinating domestic political battle in recent history.

Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of
his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.

Livongo’s Post Ad Banner 728*90

Categories: Uncategorized

Tagged as: ,

34
Leave a Reply

34 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
23 Comment authors
steve markMGAG, M.D., J.D.EuniceRon Recent comment authors
newest oldest most voted
steve mark
Guest
steve mark

Health Care and the Law of Supply and Demand Health care costs are soaring! It is an economic law that prices rise when there is not enough supply and too much demand. Demand that is being fueled by health care insurance and Medicare, while on the other hand the supply of Doctors is being hindered by the high costs of education. A long-term solution is needed, one that would not just help the United States, but the world. Increasing demand by offering health care insurance is not the answer! It just will bankrupt our government. Medicare is an unchecked burden… Read more »

MG
Guest
MG

Why the big rush on this health care bill? …and all government preoccupation with it. Don’t we have more pressing issues like the economy, massive unemployment, two wars? Are they living in another world?

AG, M.D., J.D.
Guest

Check out what MD JD lawdoc posted on his blog at http://www.lawdocblog.com on the healthcare madness in:
IT’S A MAD, MAD, MAD, MAD WORLD

AG, M.D., J.D.
Guest

IT’S A MAD, MAD, MAD, MAD WORLD No, I am not talking about the 1963 Stanley Kramer hit of the same name starring Spencer Tracy, Milton Berle, Sid Caesar, Dick Shawn and many more screwball celebrities. Do you see a pattern? The movie characters were Captain Culpepper, J. Russel Finch, Melvin Crump, D.D.S., and Sylvester Marcus, respectively. The names sound kind of kooky, too. The film portrays the dying words of a thief that spark a madcap cross-country rush to find some treasure buried under a “big W.” The actors were crazy, zany, greedy and selfish. Pelosi, Reid and Obama… Read more »

Phillip
Guest
Phillip

Nate, You think you have some kind of intellect because you shill for the insurance companies who rip this country off every day. Any idiot can find examples from any healthcare system in the world that shows problems, but the big picture points to a joke of a healthcare system in this country. Some very good dedicated healthcare professionals, but a complete F’ed up system. Other than a third world country can you please point to one OECD country that has basically an entirely private system please? Where the government is less involved than in the U.S.? Waiting?? Robert, I… Read more »

Eunice
Guest
Eunice

Healthcare is a disaster in the USA because of GREED on the part of insurance companies, medical profession, hospitals & employers. Its a disgrace that all elected are swayed by lobbists for employers, the medical profession, insurance companies and the well-being of the citizens of this country. The direction of reform will be a burearchy which will cut cost of health care on the backs of everyone except who the lobbyist represent. Why should tax payers stand for this? We must take action- we have the power of our votes to send a message to these useless politicans that if… Read more »

Ron
Guest

If my care gets a flat tire, I replace it with a new tire…not a new car. The fact that congress is legislating (steamrolling) a complete overhall of OUR health care system is a frightening. Ironically, congress is not requiring that their personal health plans match those which they are legislating. The free market (capitalist) system that grew this great nation has been canibalized by our power seeking govenment for the last 70+ years. What’s left is being shredded in a final wave of (guilt driven) ignorance. You better not learn how to catch fish…they’re preparing a nice line for… Read more »

Nate
Guest
Nate

Phillip do me a favor and shove this guys arm down your throat. http://www.moonbattery.com/archives/2009/10/the_shape_of_so.html “Do you realize that the U.S. is the only country that has basically an entire private healthcare system?” Actually no idiot that isn’t any where close to true. What your where trying to say in your ignorance is industrialized, as many countries have no form of government care at all. People are responsbile for 100% of their care with no saftey net. If you want to get technical our free market system is the most predomonate in the world. Do you ever tire of looking the… Read more »

jd
Guest
jd

Read it and weep: http://www.nytimes.com/2009/10/11/health/policy/11cost.html?hp Though, no surprises for those who understand the forces at work. Peter, I agree there is no chance for a public option with teeth that would be universal. I was made optimistic that something less universal might pass by the recent proposal to offer states the choice to accept or reject a public option. If they accept it would use Medicare-like rates (and utilization controls Medicare does not have). I think the opt-out is a smart strategic move, but it seems that it will now probably get squeezed out and not included in a final… Read more »

Robert Russell
Guest

Forget the right and left of this argument. The majority of us vote our pocketbooks, still, in this day and age. If Congress passes anything that smacks of increased debt, we will vote them out of office at the next chance, regarless who they are or whom they represent. Remember: WE are the government. This debt is OURS. Paying it off is OUR RESPONSIBILITY. All the chatter about benefiting this segment and that segment of society, relieving seniors of our burdens, safety nets, and the rest is simply that: chatter. WE will have to pay the piper. We better define… Read more »

Phillip
Guest
Phillip

Nate, Up to your usual right-wing nutcase ideological discussion and talking points. “Health care is a crisis created by government, exasperated by government, and feed by stupid liberals with no clue what they are talking about when reform is discussed.” Do you really believe your line above? Of course you do, coming from someone who believes government is always evil. Do you realize that the U.S. is the only country that has basically an entire private healthcare system? Seems funny logic to blame government. How do governments around the world do a far better job at providing healthcare to their… Read more »

Phillip
Guest
Phillip

Dennis, What is with the hatred of immigrants? You a very bitter individual. The cost to pay for illegal immigrant healthcare in this country is less than 1/2 of 1% of the annual cost we pay of healthcare. Illegal immigrants are such an incredibly small part of the healthcare cost problem in the U.S. it is not even worth talking about. People who try and bring the illegal immigrant issue into the healthcare issue are playing politics pure and simple. There are far bigger fish to fry with regard to healthcare costs than the costs to pay for illegal immigrants.… Read more »

Phillip
Guest
Phillip

A couple of points about this post: 1) There have always been three legs to healthcare reform: coverage, quality, and cost. To say that adding to the coverage is not healthcare reform is disingenuous by the author. Getting +94% of people insured in this country is reform from where I come from. And if the costs are started to be tackled that is also reform. I would also add that healthcare reform is not a static event. This will be the start of a process that will take years to develop. One thing we know is that the problems are… Read more »

Peter
Guest
Peter

“If a new public option passes, watch for private insurers to start driving their rates closer to Medicare even before the new public option can take effect.” jd, I don’t have much hope now that Democrats have the guts to cross their healthcare backers and pass a public plan, even one that will probably be toothless in driving down costs. My own state’s congressional delegation received $5.2 million between 2003 and 2008 from drug makers, health care professionals and the insurance industry. Our new Democratic Senator Kay Hagan received over 200K in 2008 and has been opposed to a public… Read more »

Hal Horvathhalb
Guest

An analysis of the emotions that make reform politically challenging:
http://findingourdream.blogspot.com/2009/10/real-reason-reform-is-so-difficult.html