Tag: Policy/Politics

Two rules by which to judge a health reform bill

Jul 31, 2009• 49

By Matthew Holt

Right now we have sausage-making going on in DC and lots of uninformed opinions and outright lies being strewn across the front pages and on cable from newly declared experts. I sat in an airport last night and heard 5 Wall Street pundits spewing rubbish about health reform on one cable show. It even included an aging upper-class British twit declaring that government health care was more expensive than private systems. Clearly he’d managed to miss comparing the 8% of GDP his (and my) original homeland spends on health care versus the 17% we spend here. Later on CNN had 4 random people including Christine Hefner—yes one of those Hefners—talking about it. I suspect that if you know something about health care and your name’s not Michael Cannon you’re just not allowed on cable TV.

But all the hot air aside, even those of us in the punditocracy who know something about the subject matter (i.e. anyone reading THCB) seem to be so deep in the weeds that we have lost the basics about what we should be looking for from a health care bill. So it’s time to make that very clear, and here in my not so humble opinion are the rules by which to judge reform.

Rule 1 A health care reform bill needs to guarantee that no
one should find themselves unable to get care simply because they
cannot afford it. Neither should anyone find themselves financially
compromised (or worse) because they have received care.

Rule 2 A health care reform bill needs to limit the amount of
GDP that is going to health care to its current level, with an overall
aim of reducing the share of health care going to GDP.

Health Care Reform Coming Out of Senate Finance?

Jul 29, 2009• 20

By ROBERT LASZEWSKI Baucusgrassley110th

We’ve been getting lots of news these past few days leading to optimism that a bipartisan health care bill will soon emerge from discussions between the “Coalition of the Willing.” That term refers to the three Republicans and three Democrats trying to find common ground in the Senate Finance Committee.First, let me be clear that I have the greatest respect for Senators Baucus and Grassley and their four colleagues. Theirs is the kind of bipartisan approach that all of Washington, DC should be following on any number of issues.And, as I have posted here before, I am concerned that in their efforts to find compromise they are headed for a health care bill that is based on a formula of cost containment “lite,” minor paring of Medicare and Medicaid provider payments, and at least $500 billion in new taxes. I don’t see much changing fiscally if that is the final result in a health care system that is already unsustainable and on the way to spending upwards of $35 trillion to $40 trillion over the next ten years as it goes to 22% of GDP by 2018.From what we have heard, their bill would hardly "bend" any curves.

Op-Ed: Sustainable Healthcare Reform

Jul 29, 2009• 12

By LAWRENCE W. ARRINGTON

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…

A Health Insurance Premium Tax Would be a Chicken Tax

Jul 27, 2009• 9

By ROBERT LASZEWSKI

The Congress has looked at taxing about everyone and everything to pay for half the cost of a health care bill.

They’ve considered sugary soft drinks, beer, “millionaires,” and “gold plated” health benefits to name a few. Every time they come up with one it gets shot down by the interests it would offend.First, as I have asked on this blog before, why do we need to use at least $500 billion in new taxes to pay for half the cost of a health care entitlement expansion bill? We will spend somewhere between $35 trillion and $40 trillion on health care in this country over the next ten years. Many experts contend there is as much as 30% waste in what we spend.Advocates of a health care bill say we need it to reduce the cost of health care in this country that will otherwise bankrupt us if we don’t fix it.

With as much as $10 trillion to $12 trillion in waste, and cost containment as the stated goal, why do we need to raise people’s taxes $500 billion to pay for an expansion of coverage?But since it is clear that the Congress and the White House have all but given up on real health care reform that would really “bend the curve” they are adamant they are going to raise taxes to pay for at least half the cost.

Live from Aspen: the moderates’ view on Obama health reform

Jul 27, 2009• 14

By Matthew Holt

Paul Krugman’s article today excoriates the Blue Dogs and a former dog Billy Tauzin in particular. He also (as I did a week or so back) wonders where the Dogs were when the Bush tax cuts were bumping the deficit more than the proposed health reform bill will and redistributing wealth from future poorer taxpayers to the very rich in the process.

Funnily enough I’ve been at the Aspen Health Forum where the self-same Billy Tauzin used his not inconsiderable Cajun charm and a dollop of PhRMA’s money to buy me (and a bunch of others) a whisky and a s’more on Saturday night, and took part in a couple of panels I watched on Sunday. We had a couple of brief chats, one about his cancer treatment and another about getting big Pharma to behave better. He claims some progress there (voluntary restrictions on DTC, better posting of clinical trial data, reductions in marketing excess to docs). I suggested that there was more progress required both in pricing policy and PR. He said it was hard, I told him that was why they paid him the big bucks.

Health Reform and Obama’s Leadership

Jul 26, 2009• 13

By RAHUL PARIKH

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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.

Costs v Coverage: Krugman gets it–Brooks is almost quite close

Jul 24, 2009• 11

By Matthew Holt

So Paul Krugman, the NY Times Nobel Prize winning lefty columnist, says this (and echoes what I’ve been saying for a while)

So where in America is there serious consideration of moving away from fee-for-service to a more comprehensive, integrated approach to health care? The answer is: Massachusetts — which introduced a health-care plan three years ago that was, in some respects, a dress rehearsal for national health reform, and is now looking for ways to help control costs.

Why does meaningful action on medical costs go along with compassion? One answer is that compassion means not closing your eyes to the human consequences of rising costs. When health insurance premiums doubled during the Bush years, our health care system “controlled costs” by dropping coverage for many workers — but as far as the Bush administration was concerned, that wasn’t a problem. If you believe in universal coverage, on the other hand, it is a problem, and demands a solution.

So universal coverage systems find that they can’t just let the health care system increase costs because there is no safety valve of the uninsured to dump out of the system. We’re all in it.

Can HR 3200 Be Fixed?

Jul 23, 2009• 55

By ROGER COLLIER

Washington-united-states-capitol-washington-d-c-dccap1 Health care reform looks like it’s stalled. And rightly so, based on the provisions of the House Democrats’ health care reform bill. The grossly misnamed America’s Affordable Health Choices Act (HR 3200) combines the worst of all possible worlds: high taxpayer costs, big increases in federal deficits, and disincentives for businesses to hire, while leaving up to twenty million individuals still uninsured and doing little or nothing to control runaway national health care expenditures.

Although the bill would make health care coverage available to many of the millions who currently cannot afford it, its provisions will potentially add some $200 billion a year to federal expenditures, make only miniscule reductions in Medicare cost trends, and impose play-or-pay provisions and a new surtax that could hurt smaller businesses just as they try to recover from the recession.

So, is there anything that can be done to fix HR 3200 so that it would provide affordable universal health care coverage without increasing federal deficits or halting the recovery from the recession?

Rantology: Sympathy for the blue devils?

Jul 22, 2009• 21

By Matthew Holt

I do have some vague sympathy for the Blue Dogs, the group of mostly red-state Democrats who have to pretend that they care about fiscal responsibility. They, like me, think that we shouldn’t be increasing taxes on the non-health sector to pay for universal coverage. Unlike me they think that we should be reducing any commitment to universal coverage by reducing the level at which subsidies for people mandated to buy health care coverage cut off—which will leave us in a situation with lots of people who forgo coverage because they can’t afford it. I of course think that we should be finding the money to cover the uninsured from within the 16% of GDP we already spend on health care and then ratchet that overall number down, but then again I don’t have to get elected to Congress.

But I do have one modest question. Where were the dogs/devils’ concerns about the deficit when George Bush was borrowing for the future to pay for income and dividend tax rebates for the very wealthy, by invading Iraq and hiding the accounting, and by creating the boondoggle that was the Medicare Modernization Act. Now it’s late at night and I’m not going to go chasing voting records from 2001–3. But I sure have my guess….

More on the politics of health care reform:

Op-Ed: Reform- Why have our objectives been abandoned?

Jul 22, 2009• 23

By DR. ALBERT WAXMAN

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…