The late great newspaper columnist Mike Royko suggested that Chicago’s motto be changed from “Urbs in Horto” (“City in a Garden”) to “Ubi Est Mea” (“Where’s Mine?”). Unfortunately, Barack Obama and his Chicago political brain trust remembered this basic lesson when it came to cutting deals with Congress, but completely forgot it when communicating with actual members of the public on health care reform.
As a result, the fragile flower of reform may not have been completely plucked, but the manure dumped on it in Massachusetts was not meant as fertilizer.
Throughout this process, Obama and his Chicago-bred advisers have been intent on avoiding the mistakes that sunk reform during the Clinton administration. But their diagnosis was flawed. Yes, Bill and Hillary stiff-armed both the special interests and their Republican opponents, falsely believing that public opinion polls showing widespread support immunized them from the insidious need for compromise. But while the Obama administration cut early deals with doctors, hospitals, insurers and the pharmaceutical companies, attempts to bring moderate Republicans into the fold conspicuously failed.Continue reading…
There’s no doubt that despite my thoughts that Obama wouldn’t (and shouldn’t) have pushed health reform in 2009, it was a very big year for health care. Death panels, public options et al—one hundred thousand visits to THCB in August don’t lie.
So what should you look for next?
- The finish is the start: It looks like some version of the Senate bill will be a done deal by sometime late January. That means that there’s about two years of health care industry players figuring out what it all means. The biggest two questions are; what will the types of plan sold in the exchanges look like? (high deductible with some preventive care thrown in is most likely), and what will the cuts and changes in Medicare payment actually look like in practice? (More of the same or real re-alignment around some kind of bundling). All these changes need reactions from the incumbents to reorganize around the new revenue streams.
As the State of the Union approaches Democrats are considering their health care policy options. There are lots of reports about “Plan B”—pushing through the Senate bill with a parallel corrections bill that could be passed in the Senate using reconciliation rules.
That’s as dead as the original House and Senate health care bills. Moderate Democrats have no stomach for such a legislative stunt in the face of Massachusetts and bad health care polls. Many liberals even question that strategy.
Everyone is awaiting this week’s State of the Union speech. Will the President:
- Embrace the call by many on the left to Democrat-up and just ram it through?
- Call for a scaled back bill built around modest and popular first steps that could attract bipartisan support?
- Just jabber in a way no one can figure out which course he really supports?
My bet is on number three.
The Obama administration’s commitment to cost control in health care can now be summed up in four words: Not on our watch.
Health and Human Services Secretary Kathleen Sebelius told American women this week that they have nothing to learn from the science that led to the U.S. Preventive Services Task Force guidelines on mammography.Insurance companies won’t change their payment policies, and the independent doctors and scientists who made up the USPSTF task force “do not set federal policy” or determine what services are covered by the federal government.”
What a golden opportunity has been missed to educate Americans about the implications of their health care choices. Otis W. Brawley, the chief medical officer of the American Cancer Society, in an op-ed in today’s Washington Post condemning the USPSTF guidelines, confirms that mass screening would only save at a maximum 600 out of the 4,000 women under 50 who die of breast cancer annually. What he failed to point out is that 1.14 million American women would have to be screened annually for ten years to achieve that goal. To cover the entire cohort (all women between 40 and 49) to replicate that benefit every year would require screening 11.4 million women annually. The cost, at $200 per mammogram (my initial estimate was accurate, according to this New York Times business section article), would come to $2.24 billion annually for the health care system.
In the campaign of 2008 and the first six months of 2009, the call for healthcare reform has been a refreshing and important theme. It has been widely recognized that
1. Healthcare costs are out of control. You cannot have healthcare expenses inflating at 8% in an economy that is growing in the best of times at 4%. (today, the current inflation rate is negative 1.3%)
2. 47 million Americans need coverage
3. 14,000 Americans lose their insurance everyday
4. Medicare is in peril, and along with Medicaid, the combination of ever-increasing costs are the main drivers of this government’s budget deficits that threaten our economic future.Continue reading…
For all those Obama-ites confident that they won’t make the same
mistakes pushing health care reform that the Clinton administration
did, might I suggest a trip back home?
Just a few minutes into the Second City comedy troupe’s latest show, America: All Better!,
the usual japes about the Jesus-like hopes projected onto our 44th
president gave way to a quick bit about health care reform. A doctor
was telling a woman that her diagnosis gave her only three months to
live. When she pleaded for help, he told her that the good news was
that Obama’s health reform plan meant she was scheduled for her next
visit just six months from now.
Bad news for Obama — the audience laughed.
Conventional wisdom says that the shopworn distortions and
deceptions that killed health care reform in the past have lost their
sting due to combination of middle-class economic worries and soothing
on-message reassurances. Perhaps. But comedy works only when it
connects with real anxieties. The fact that Second City comics in the
heart of Chicago are successfully playing to GOP-fueled fears of
rationing should raise a bright red warning flag at the White House.
As we enter summer, the health reform process is moving into its Newtonian phase: irresistible forces meeting immovable objects. In both health cost and access, the trend is not our friend. There is ample evidence not only of intolerable inequities, but also intolerable waste and inappropriate use of expensive clinical tools. President Obama embodies the need for change. He has assembled a very talented and politically savvy crew of helpers. He confronts the sternest test of any Presidency, fixing a poorly tuned and fragmented health system that is, by itself, larger than either the French or British economy.
As a former citizen of the Washington Post newsroom, the recent disaster about the newspaper’s “salon” project is heartbreaking and embarrassing.
I won’t belabor the issues many others have so thoroughly covered, including today’s “apology” by publisher Katharine Weymouth, which feels a bit short of fulsome.
Instead I want to point out something that’s gotten lost in the media frenzy: That
the topic of the first “salon” [sorry, I find I have to use quotes when
referring to that] was to have been health care reform.
As an independent journalist [among other things] and participant in
the “health 2.0″ movement, I find this particularly distressing.
The fact that Weymouth and her team identified health care reform as
the first ripe target for a scheme to bring together “the powerful
few”: CEOs/lobbyists, “Congressional and Administration officials” and
Washington Post health care reporting and editorial staff” demonstrates
the peril faced by the group with the biggest stake in health care
I refer, of course, to patients.
What are people saying about health reform beyond the beltway and outside the health wonk debates? I’ve been meeting with Rotary Clubs and local Chambers of Commerce during the last several months, and they’re talking about different issues than the ones being debated in Washington, DC. When I talk with these groups about the prospects for national health reform, what are the top three questions they ask?
- Is this going to lead to a single-payer system with rationing, just like they have in Canada?
- Why isn’t the malpractice problem being addressed?
- Will this include illegal immigrants?
These are not the top issues being debated on Capitol Hill. If you just read Politico.com, the Washington Post, and the pundits’ blogs, you would think that the big issues are the public plan option, the employer mandate, and the cap on the tax exclusion of employer-paid benefits. There are important, but they aren’t the issues that most small employers and consumers are worried about.Continue reading…
“You never want a serious
crisis to go to waste.”
– Rahm Emanuel, White House Chief of Staff
Timing matters. The health industry has demonstrated steadfast
resistance to reforms, but its recently diminished fortunes offer the Obama
Administration an unprecedented opportunity to achieve meaningful change. The
stakes are high, though. The Administration’s health team must not miscalculate
the industry’s goals, or waver from goals that are in the nation’s interest.
The two are very different.
Aligning the forces of reform will be the first challenge. The White House and Congressional Democrats appear to be
collaborating to develop a unified reform design. Even so,
the effort is hardly pure. Lawmakers have been receptive to industry influence.
The non-partisan Center for Responsive Politics
reports that, in 2009, health care interests have already spent $128 million on
Congressional lobbying contributions, more than any other sector.
The tide now turned, most of that largess has gone to Democrats.