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Our President is on the Ropes

Stephen Kardos

Recent pictures of President Obama suggest he is battered and on the ropes. Our President can recover if he chooses to change his fighting strategy to improve health instead of budgeting health. There is clearly emerging consensus against yet another health plan sponsored by the federal government.

There is already much oversight at federal and state levels of all insurance programs, yet all of these programs experience unsustainable cost trends. Medicare, Medicaid and the Federal Employee Health Benefit Plans are modeled after private insurance plans and they do not work for our country. In the instances where profit incentives have been removed from government-run programs such as the federal employee health plans, the trends in these plans are not significantly different from private insurance plan trends.Continue reading…

The Town Hall Effect

Picture 7 We’ve all been reading a lot about the congressional town hall meetings around the country, where protesters rail about President Obama’s health reform plan. News reports and video clips indicate that half or more of the protesters yelling about socialism and a government takeover are of Medicare age.

I’ve wondered about these senior citizens and other protesters. They look like ordinary working- and middle-class people who probably have the same problems with the U.S. health care system as millions of other Americans. How can they just say no to legislation that would help them personally, or that would give others the kind of guaranteed coverage they already enjoy?

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Op-Ed: Sustainable Healthcare Reform

President Obama made a risky wager when he decided to let Congress take the lead on crafting health care legislation, rather than presenting his own reform package. Congress is not known for taking bold, decisive leadership on tough issues. Normally, it reacts and gridlocks; it doesn’t lead.

As Congress takes its usual August recess without acting, it appears that Obama’s strategy has failed. But, has it? Is there a deeper strategy? What’s really at stake here?

Obama reportedly reasoned that Congress will do better in the long-run if it protects its institutional prerogative as law maker and doesn’t take on the appearance of being the President’s rubber stamp. This is a plausible calculation. The last time Congress was asked to respond to a President’s health care reform proposal during the Clinton years it did so by throwing the whole package in the trash can.Continue reading…

Health Reform and Obama’s Leadership

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By all accounts this is crunch time for President Obama on health care reform, and things couldn’t be more tenuous. In the past several weeks, we’ve seen unified Republican opposition to his ideas, a revolt against reform from leaders inside his own political party, and the head of the non-partisan Congressional Budget Office testifying that the only direction he is bending the cost curve in is sharply upward.

As a physician who supports the President’s vision to improve the quality, access and lower costs, I’ve been following this debate closely. I’ve also been wondering what the debate about health reform tells us about the President’s leadership style. While I see him continuing to communicate his vision eloquently, there are two key leadership qualities Obama seems to lack that may prevent him from achieving his goals for reform.

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A Second City Warning to Obama

MillensonFor 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.

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How Relevant is the American Medical Association?

Like most doctors, I was busy seeing a full schedule of patients when President Obama addressed members of the American Medical Association at their annual meeting in Chicago.  The speech was billed as a crucial confrontation over health reform, and anticipation had been building for quite some time.   So I was too busy to learn anything about his remarks and the response until I got home.

Then again, I’m not a member of the AMA.  I never have been.  Neither are very many of my  physician friends and colleagues.  In fact, the odds are that your doctor isn’t a member of the AMA, because at best, only between 25-30% of the approximately 800,000 doctors in country belong to it.  And a good percentage (up to half of members according to one report) of those include residents and medical students, who get big discounts on membership and a free subscription to a journal when they join.Continue reading…

Health Care Leaders Say Obama Overstated Their Promise to Control Costs

Capital

That was the headline in Thursday’s New York Times regarding Monday’s promise by health care  stakeholders to reduce spending by $2 trillion.

A couple of snipets from the Times article:

Hospitals and insurance companies said Thursday that President Obama had substantially overstated their promise earlier this week to reduce the growth of health spending.

“There’s been a lot of misunderstanding that has caused a lot of consternation among our members,” said Richard J. Umbdenstock, the president of the American Hospital Association. “I’ve spent the better part of the last three days trying to deal with it.”

One of the lobbyists, Karen M. Ignagni, president of America’s Health Insurance Plans, said the savings would “ramp up” gradually as the growth of health spending slowed.

Right after the $2 trillion announcement I posted:

Don’t also assume that the American Medical Association (AMA) really represents doctors—I don’t think anyone or anything really represents doctors. If the AMA makes a commitment that actually means sacrifice among the docs you will see just what I mean—especially if the national association folks do a deal with the insurers “on behalf” of all the docs back home requiring real sacrifice. To some degree, you can say the same for the thousands of hospitals out there.

If these stakeholders don’t deliver $2 trillion in something Orszag can take to the bank will the Democratic response be a “public health plan?” Watch the fireworks.

Someone dug themselves one heck of a hole yesterday.

Is it the stakeholders that now have to do in a few weeks what no one has done in decades of pondering this dilemma—make a tangible, measurable, and enforceable offer that cuts real money? If you think coming up with $2 trillion was a big deal actually figuring out the mechanism to carry it off will be a dramatically bigger challenge.

Was it the Obama administration that just raised expectations exponentially trusting these guys can actually deliver something measurable? Or, is the Obama administration just setting them up?

Or was the Obama administration just setting them up?

When those stakeholders walked into the White House on Monday they never intended to make more than a vague promise. When they walked out it was to headlines that they would make “scoreable” proposals by June 1st.

They also had some very angry constituents across the country wondering just what kind of deal they were doing.

They never had $2 trillion and now they have one big problem!

As one insider told me this week, “They got smoked!”

The Obama Health care Budget

President Obama signs the State Children's Health Insurance Program (SCHIP) bill into law on February 4th. The bill expands coverage to an additional 4.1 million school age children.
Pieces of the health care portion of the Obama budget are leaking out.

Based upon published reports, the Obama “down payment on health care reform” will include:

  • $634 billion to help pay for health care reform over the next ten years.
  • $318 billion of that—about half—will come from tax increases that include reducing the mortgage and charity deduction for high income Americans.
  • Charging wealthier seniors more for the Medicare Part D drug benefit—as is done for Medicare Part B now.
  • Cutting Medicare HMO payments by $175 billion over ten years.
  • Reducing Medicare hospital payments by $17 billion over ten years by bundling inpatient and outpatient reimbursement to include the 30-days after discharge.
  • Cutting Medicare hospital payments by $8.4 billion over ten years for re-admissions resulting from substandard care.
  • Requiring drug makers to increase the rebates on drugs sold to Medicare patients from 15% to 21% saving $19.5 billion over ten years.

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