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How to Get Enough Votes in the Senate

Picture 66 When Hillary Clinton was running for President, she set forth a more modest agenda for health care reform than her competitor, Barack Obama. Maybe she understood better, based on her experience, how difficult it is to get a comprehensive bill through Congress in this field.

What is possible now that the President has lost the 60-vote majority in the Senate? I think the thing to remember is that he was having trouble even holding together the 60 votes he used to have. He had to agree to an assortment of give-aways — to Nebraska, to Louisiana, to the labor unions — to get the votes he needed. In part, that proved to be the undoing, as Massachusetts voters watched this sausage being made and sent a message through the election of Scott Brown that they didn’t like what they had been seeing.

Now, it may be that the Republicans will act to kill anything that might come along. I don’t think so. I think they are willing to be part of a bill, but it has to be a bill for which they can claim credit among their constituencies. What might it be?

Insurance reform: People, irrespective of party and political leanings, despise the practices of insurance companies that limit or take away coverage. The use of pre-existing conditions to deny coverage, lifetime limits of coverage, and rescission of policies are nasty and unfair. These practices remain as sources of insecurity among Americans, even those with insurance. There should be near-universal support to change them.

Tort reform: I think that most people feel that, while people should have a right to sue for medical malpractice, the process that exists today is inefficient and arbitrary for both plaintiffs and defendants. Any doctor will tell you that fear of such suits also leads to the practice of defensive medicine, driving up costs for all of society. Tort reform does not require limitations on payments. It could be accomplished with the establishment of specialized courts and procedures that would add greater certainty to outcomes and reduce the tensions and abuses associated with the system. This should not be a partisan issue.

Payment reform: Nobody likes the results of a system that systematically underpays primary care doctors and leads them to a life of 18-minute appointments and a role as triage doctors, a way station to referrals to higher paid specialists. If Congress were to order Medicare and state Medicaid plans to take the lead in establishing reimbursement rates for PCPs that reflected their value to families and patients, we would be on the way to a more rational system of care. Likewise, if physicians were paid for care delivered by telephone and electronically, millions of unnecessary and time-consuming office visits could be eliminated. If these steps were taken for Medicare and Medicaid, private insurers would follow.

Transparency: A national mandate for public disclosure of the rates paid by insurers to providers would help drive greater rationality in payment methodologies in the states. Disclosure of clinical outcomes in clinically important arenas would provide impetus to improvement in patient safety and quality. How can this be a partisan issue?

Now what about access? I fear that expansion of insurance coverage is the third rail in this debate. Why? Because it requires revenue to support the subsidies that would be required, and tax increases are really hard to achieve. The President made this issue more radioactive than necessary by proclaiming at the start that you could get access, choice, and lower costs all in one neatly wrapped package. Everybody in the field knew that you could not. This then resulted in sleight-of-hand revenue measures that became the undoing of the bill as Christmas tree ornaments were added to undo the effect on particular states or interest groups.

As I have stated here, a fair approach to generate the revenues for expanded access is to eliminate or reduce the pre-tax treatment of insurance premiums. Doing so would use the progressive income tax system in a way that would apply a larger percentage of these costs to more wealthy people. Could this approach gain a bi-partisan consensus? It could not gain support even among the Democratic majority, so I am guessing not. And the Republicans seem to express no interest at all in mandates for greater access. Maybe we have to accept as a reality the idea that expanded access is a casualty in this debate. I hope not, but I don’t yet see an answer to this that can get 50 votes, much less 60.

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Supra Dixonacekard dsnedenleriA la droga dile NoExhaustedMD Recent comment authors
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Supra Dixon
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Your blog brings me a good deal of enjoyable. Incredibly glad to have the opportunity to meet you. Take ralax and give your self a surprise, and we will reside extra content.

acekard ds
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Every time someone tells you they need something in order to make you more safe, get ready, you are about to lose some freedom.People identify with a desire for increased participation, communication, and transparency.”A government big enough to give you everything you want is.Every one have to be on they all give themselves high scores! It’s amazing what a great job our government is doing.

nedenleri
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thanks for informing and post..;) very useful

ExhaustedMD
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ExhaustedMD

A man flew a plane into a building today to make a statement about the affairs of this county, and while a sad and terminal comment by him, imagine if he did it into the Capitol of this country and wrote a manifesto about the state of health care. Whoa, wouldn’t people pay a lot more attention to this if this was his agenda. Well, certainly I am NOT advocating for this, but, maybe any reader who reads this might want to think about this perspective. Health care reform is not going to be effective and responsible being lead by… Read more »

A la droga dile No
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Pain pills without prescription are widely used in all countries, especially in the U.S. where the economy people look for your home, as the situation facing this country still is not the best, with more reason, if the medicines they need are controlled as Darvocet, Vicodin, hydrocodone, tramadol, lortab, Percocet, etc. Therefore, in findrxonline suggest that these medications for chronic pain are very effective, but they also are very controlled should be priority for people in need, remember that health care is very important for people.

ExhaustedMD
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ExhaustedMD

Oh, come on Matt and other extremist positions. This is about moderate positions, not the Democrats “let’s get legislation put out now so we can get voters to keep us in office” or Republicans “let’s satisfy minority big business so they can fund our minority status and return us to office”. Both parties suck, and why can’t average, moderate americans see this is a one party system, republocrats, who in the end know they need each other to keep their minority system in check to screw the majority. God, why can’t people see the truth!? Politicians have no real interest… Read more »

Matt
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Matt

Health care spending is out of control because people do not own the constitution anymore. It is owned by financial backers of elections, usually large businesses. But here’s the thing. Why don’t the people just start writing a bill themselves rather than just criticizing everthing that is done in Washington. Is that too much too ask. We are all people that live in real communities and see what really goes on. We can come up with solutions ourselves.. We should stop being such babies and just do start putting specific ideas together ourselves. I am so sick of so called… Read more »

nick
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nick

No to higher taxes.
No to bigger government.
No to government intrusion.
No to abortion that might comes of this.
No to the return of the welfare state.
No to “free” anything.
Down with the New-deal.
Government is not the solution, it is the problem.
Let’s not kid ourselves. There is a fundamental disagreement between the parties on the role of the government. Which leads to my other point: healthcare reform will have to be done with out the aid of republicans.

Peter
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Peter

“Ok, I’ll bite: If we’re truly on the cusp of a health care cost meltdown” Ok, I’ll ask you the same question about the deficit, are we truly on the “cusp”? Why all the right wing/Tea Party screaming now – in a Democratic presidency? When the “left” was talking deficit in the Bush years Republicans were poopooing it as ok when measured against GDP, no Tea Parties then. But I guess it’s different when funding connected private war contractors or wealthy campaign donors through tax cuts. Right now healthcare is only a meltdown when YOU can’t get healthcare due to… Read more »

archon41
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archon41

Ok, I’ll bite: If we’re truly on the cusp of a health care cost meltdown, why the fanatical insistence on linking cost control with “increased access”? Looks like “bait and switch” to me, with the former acting as “cover” for the latter.

Peter
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Peter

“and now you think “healthcare dollars” should be a “shared resource” Actually I thought that prior to my “going naked”, just not in a system designed to extract every last dollar from it’s citizens and the U.S. treasury. I’m also in favor of a mandate as well, not just the one the insurance industry salivates over if it can per$uade enough politicians that it’s their entitlement. And yes, la vengeance est un plat qui se mange froid. But I’m not naive enough to think (or care) my little posts will have any effect on BCBS, and I’ve already taken steps… Read more »

Hal Horvath
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archon41, you say “lurid.” Where you thinking ‘lurid’ like this? — “LOS ANGELES (AP) — The Obama administration on Monday asked California’s largest for-profit health insurer to justify plans to hike customers’ premiums by as much as 39 percent, a move that could affect some 800,000 customers. “In a letter to the president of Anthem Blue Cross, Health and Human Services Secretary Kathleen Sebelius said she was very disturbed to learn of the planned increases, calling them “extraordinary.” “I believe Anthem Blue Cross has a responsibility to provide a detailed justification for these rate increases to the public,” Sebelius wrote.… Read more »

archon41
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archon41

So, Peter, you got into a spat with BCBS over a $1,500 bill, decided to “go naked,” and now you think “healthcare dollars” should be a “shared resource,” heh.
These lurid predictions of a catastrophic collapse of the “system” are but a revenge fantasy.

Peter
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Peter

“Ah, yes, what might have been, had only Harry and Nancy been content to focus on overtreatment, waste and “overutilization.” archon, I too wanted that, but I assume you would prefer to have the patient spend more of their money to control this and not to impede the ability of providers to push their need for billings. I’ll also assume you have ample healthcare coverage (employer provided?) so that you won’t have to consider any choke on your “overutilization”. So this is really all about “them” not you? We already have that “focus” of a reduced access system in place… Read more »

Nate
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Nate

ironic that one thing that could get bipartisan Congressional support is also one of the most damaging ideas being considered. Eliminating pre-ex without a strong individual mandate with a penalty equal to the cost of insurance would double rates in a couple years.
It was bad ideas just like this passed years ago that created the present day problem.