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Tag: 2008 Election

Cats & Dogs: Can We Find Unity on Health Care IT Change?

Today we have a humming economy and insane politics. In early 2009 we were in economic meltdown and were about one week into the sanest, soberist Administration and even Congress over many recent decades. In February 2009 they passed a stimulus bill that had a huge impact on the health IT market (and still does). At that time there was much debate on THCB about what the future of health IT policy should look like and how the stimulus “Meaningful Use” money should be spent. My January 2009 summary of that whole debate introduced the notion of “Cats and Dogs in health IT”. They’re still around today. We’re reprinting it here as part of our 15-year THCB birthday party–Matthew Holt

 

Those of you paying attention for the past few days might have noticed on the one hand a sense of optimism and unity as Barrack H. Obama, somewhat somberly, began his presidency.

Meanwhile, over the past few weeks the fur has been flying among the electrons on THCB while some very knowledgeable and opinionated health care wonks and geeks have been battling it out about what exactly we should be doing in terms of federal health care IT spending.

Given that even among you smart THCB readers this may be all a little perplexing, I’m going to try to try to make what I hope are some elucidating comments to put this argument in context. I’m doing this partly because I’m perplexed too, but also because I think that there is some hope for a middle road.

First the basics: As sometime THCB contributor & uber-CIO John Halamka makes clear in this excellent post about The Greatest Healthcare IT Generation, some $20 billion of the soon to be passed “spend it as fast as you can” stimulus package is going to be targeted towards health care IT. Now, that’s by no means the biggest part of the $800 billion or so package, and it’s not even the biggest part of the health care spending in the bill. Nearly $87 billion or so is going to support Medicaid, although that will mostly will be replacing cuts being forced on states.

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Thinking the unthinkable–no Health Care bill?

Matthew Holt

After a resounding Democratic Presidential election win, a terrible recession, and a bruising year of politics, it would be just like America that a crazy election result torpedoes the health care reform bill. It would be the first Republican Senator win in 43 years in Massachusetts, a state that’s bluer than blue, and the actual seat being elected on Tuesday hasn’t been won by a Republican since 1947!

But it’s becoming more and more possible, and the latest polls are all over the map.

Let’s play out what happens if we go back to a 59–41 Senate. The current Senate rules basically allow the minority to shut down proceedings. Harry Reid has in fact performed miracles to keep Lieberman, Nelson and some of the rest on board. Obama, Reid & Pelosi are now working the deal out with the unions and all the rest to make sure that what’s a pretty slim majority in the House will essentially accept the Senate bill—with some sop to the unions on the “Excise tax”. There are some other technicalities about the Exchange et al, but in the end we have a fair idea of what’s going to be the result.

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Don’t think anything is certain on the reform front

And in more from the “is it really bad enough out there to guarantee health reform?” front…

Pew Research is out with a poll showing that the numbers in favor of a major health care system reform are growing abut nowhere near as large as they were in 1993.

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For those of you who are real survey geeks it’s (almost) worth noticing that Harris, which asks a similar three questions about appetite for reform never got above 40% for its “rebuilding” category back in 1993. I’m not sure why these are different numbers, but the last one I saw from Harris in favor of “complete rebuilding” was at 33%.

But the answer is that support from the public is no more a dead cert than it was in 1993–4.

Divided we might get somewhere, but not yet

Matthew HoltThe NY Times describes the Republican-less lobbyist meetings with Democrats that are allegedly getting 
towards a consensus on an individual mandate as the way to universal health care. Funnily enough some of those same groups (e.g. The Business Roundtable & the NFIB) appear to be lessening their commitment to the worthily named “Divided we Fail” campaign.

And then on the second page of the NY Times article there’s this:

Many businesses, crushed by soaring health costs, say they now support changes in the health care system as a way to control their costs. But in its summary of the recent discussions, Mr. Kennedy’s office said, “There was little consensus on the employers’ role.”

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Jon Cohn: Obsessed with baseball and a hopeless optimist

Jon thinks that Baseball Teaches Us (something) About Health Care Reform. Replace the star player with a bunch of utility infielders, and we’ll still win the pennant. Don’t worry Jon, Daschle isn’t the only one who came in with high hopes and didn’t make it through the week. So long Luiz Felipe!

But more importantly, unity (for the bailout) is a bust already, less than two full weeks into the Obama Administration with only 3 Republican Senators prepared to buck Rush Limbaugh, and then at a pretty big cost to the President and common sense. As Krugman pointed out today, bipartisanship is a crock, with the Republicans telling Obama to go whistle despite his bail-out package being less in total and way less in degree than a centrist Democrat would want. He left in all those tax cuts to please Republicans and they dissed it anyway.

So what would the Republicans do if serious health reform came up for discussion? I think I know! And if Obama starts with an already watered-down plan, it’ll just get more watered down.

Cats & dogs: Can we find unity on health care IT change?

Those of you paying attention for the past few days might have noticed on the one hand a sense of optimism and unity as Barrack H. Obama, somewhat somberly, began his presidency.

Meanwhile, over the past few weeks the fur has been flying among the electrons on THCB while some very knowledgeable and opinionated health care wonks and geeks have been battling it out about what exactly we should be doing in terms of federal health care IT spending.

Continue reading…

After 12 months of recession, whither health reform?

We’re in a recession; actually, we’ve been in one for the past year, but no official agency decided to tell us. Perhaps "they" wanted to wait until after the November ’08 Presidential election?

The declaration of recession is the official news from The National Bureau of Economic Research (NBER), whose mind-numbingly-titled press release, Determination of the December 2007 Peak in Economic Activity, provides the following important details:

    * The Business Cycle Dating Committee of NBER met by conference call on 11/28 to discuss whether the U.S. economy was in recession.

    * The group figured out that the U.S. economy "peaked" in December 2007.

    * They calculated that the 12/07 peak ended the economic expansion that started in November 2001, lasting 73 months.

    * The previous expansion in the 1990s lasted 120 months (that would include, but not be limited to, The Clinton Era).

    * Other measures of a declining economy — including personal income less transfer payments, real manufacturing and wholesale-retail trade sales, industrial production, and employment estimates based on the U.S. household survey — also peaked some time in the past 13 months.

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Open Wide: Here comes the change you thought would never happen

The morning after the election, I posted a speculative blog in Health Affairs on three possible scenarios for President-elect Obama’s implementing health reform: folding it into a bold, ambitious emergency legislative package (Complete the New Deal), carving funding out of the current $2.5 trillion national health spend (Braveheart), and postponing implementation until the economy recovers but taking steps now to prepare for it (Wait/Lay the Groundwork).

At the time, the Wait/Lay the Groundwork option seemed 70 percent likely. But with economic conditions worsening, I’m now convinced Obama will probably opt instead for the Complete the New Deal option, and try to implement health reform in the first 120 days of his Presidency, before the health care industry “dragon” can even stir from its cave.

Let’s call Obama’s program The Real Deal. We can already see its contours: an economic stimulus program including highway construction and other state-directed public works, a green energy spending initiative, emergency housing assistance including a foreclosure prevention measure, an auto industry bailout, labor law reform and income supports through tax credits for low income people.

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The Mormon Church has forfeited its right to not pay taxes

I don’t often use THCB for direct political protests. I don’t care what the obscure cult known as The Church of Jesus and the Latter Day Saints does in the privacy of its own congregation, even though it (like many other churches) discriminates against all types of people and actively excommunicates homosexuals.

I don’t even care that a group that left the east coast because of the discrimination it faced from people and groups there (including the killing of its founder by an angry mob) has somehow become a bastion of its own bigotry. I don’t even care that many in the Mormon church hypocritically wink at the concept of "non-traditional marriages" so long as they contain one man and many women. And I guess that I don’t care that a group of any kind decides to spend $20 million and organize to influence election results, even if their stance is riddled with bigotry and hatred coded with terms about "defending marriage."

But I do care that as a taxpayer I’m forced to subsidize that activity. The Mormon Church pays no taxes, which means that the rest of us pay more and part of the deal they’ve agreed to is that they are a church and not a political organization.

Well, there’s an easy way to try to do something about it. This is an IRS form pre-completed that you can download, complete and email to the IRS asking that they review and change the Mormon church’s tax-exempt status after its appalling behavior over Proposition 8.

Is much more than we think really possible?

On THCB today Maggie Mahar basically tells the health reform crowd to be patient. But two members of the unreconstructed left in other venues don’t agree. In the NY Times Paul Krugman says that deficit spending is OK, and correctly points out that Obama has a real mandate to fix the underlying problems of middle America (and yes that would include health care). And yes polling data shows that on balance America is as liberal now as it was in the 1960s. 35 years of blind-ish belief in conservatism is more or less over.

And if you want to see the optimist’s view on what Obama might do, Jonathan Cohn has a long article in The New Republic called Surgical Prep explaining why now is the time for health care reform and how the brass knuckles approach is being put together to get it done.

I’m not sure I’m there but let’s not underestimate how big a political win this was.

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