The Outlook for a Health Reform Bill in 2009

CongressReaders know of my year long pessimism over our getting a trillion dollar health care bill in 2009.

With the historic passage of the House bill, are we now on our way to a big health care bill in 2009—or even by early 2010? Clearly, Democrats desperately want to pass a bill. Given their compromise over abortion and the neutering of the public option in the House legislation—things most liberals said they would never agree to—it is clear the Democratic leadership will take any deal they can get.

But there are still some giant obstacles on the way to a Rose Garden bill signing late this year or early next:

  1. Getting and keeping 60 Senate votes across a wide spectrum of complex issues. Senate Majority Leader Reid has not achieved a 60-vote consensus on any of the dozen or more contentious issues. In the wake of Pelosi not being able to get more than a two-vote margin for the neutered public option, some Democratic Senators will have no interest in the “robust” version with the state opt-out Reid has been talking about. He has made even less progress on all of the other contentious issues–and you can put abortion on the top of that list. Figuring out the “sweet spot” on each issue that keeps the same 60 votes on side for the entire bill would take a super computer—if that were even possible. The growing angst over these health bills not bending any cost curves and actually getting the savings from Medicare that is projected. With the demise of the robust public option even a lot of “sympathetic voices” are having second thoughts. How many op-eds and editorials can you have announcing this is not health care reform and it is likely to continue adding to deficits before everyone wants out?The latest blow was the report from the CMS actuary that says Medicare beneficiaries will suffer from the program cuts in the bills and health care costs will more likely continue to add to the deficits. I expect opponents are cutting new ads using the CMS report against the Democratic bills at this moment.
  2. The polls are still showing opposition well ahead of support for the Democratic bills. Pollster.com combines a number of polls finding 42.5% favor and 48.6% oppose. How do you pass so big a piece of legislation with approval ratings in the 40% range?
  3. If Reid finds a way to keep 60 Senators onside it will be an example of a political master performance. If he fails it will be the more likely outcome.

    More than anything else, I sense a rising tide of anxiety particularly among people who understand this issue and want a health care bill: Somewhere we lost our way on the road to health care reform and we now find ourselves headed to an entitlement bill that falls far short of achieving universal access and a bill we still can’t afford. This will eventually spill over to mainstream voters already anxious about a trillion dollars in new spending in the midst of an economic crisis.

    That is not the place Democrats would have wanted to be just when they need to overcome what would have been stiff resistance under the best of all circumstances.

    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.

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2 replies »

  1. I think politicians are rightly concerned that if nothing passes now, there won’t be another chance for years to come – years during which the cost curve will continue to get worse, the rolls of the uninsured will continue to grow, and people like the bloggers here will continue to moan about how badly we need ‘real reform.’
    The bills on the table would get us to virtually universal coverage at a remarkably low cost (e.g. the CMS Actuary’s estimate of the House bill has 34 million people getting insurance at a net cost of around $2,000 per year per person when the plan’s fully phased in; and that cost would stay flat, i.e. go down in real terms, after 2015).
    The bills on the table put cost containment measures in place that aren’t as ambitious as i or many other readers of this blog think are necessary – but they are real, and they can be improved over time (the CMS Actuary is correct to point out that they’re going to be difficult to implement, but that would be true whether or not we were expanding coverage; and anyone who thinks that the political system will produce strong cost controls without the ‘carrot’ of expanding coverage need only look at the reform alternative bill that the House GOP introduced, which does almost nothing to bend the cost curve just as it does almost nothing to expand coverage).
    These bills are a long way from perfect, but they’re a dramatic improvement over the status quo & better than anyone could expect the political system to produce if the reform effort fails having come this far.
    Fifteen years ago we had a chance to pass an imperfect health system reform. We passed on it, because everyone had a ‘better alternative’ that they were holding out for. That was a colossal mistake, one that that has cost us untold billions of dollars & untold harm to millions of lives. The WORST thing we could do BY FAR would be to repeat that mistake.

  2. I think politicians are too concerned about passing ANY bill rather than waiting to pass a bill that will actually work.

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