Congressional Democrats tried to take a big bite out of private Medicare last week in an attempt to pay for an 18-month fix to the upcoming July 1 10.6 percent reduction in Medicare physician payments.
The effort, led by Senate Finance Chair Max Baucus (D-MT) got only 54 of the 60 votes he needed to end debate and move the issue to a floor vote. While getting that floor vote would almost have certainly meant passage of the bill in the full Congress, President Bush would have vetoed any attempt to cut the payments to private Medicare plans and the Dems would not have had the votes in either chamber to override.
Now, Baucus and Senate Finance Committee ranking member Chuck Grassley (R-IA) will have to find a more modest way of fixing the doc problem––likely for just six months. The docs are not going to suffer a Medicare payment cut this summer.
All of this was expected and is what I have been saying for months would happen.
OK, maybe it’s a stretch but bear with me.
I heard a senior exec from a big health plan say the other day that it’s hard to believe we will ever see the end of health insurance distributed primarily through the workplace in favor of an individual-based health insurance system. In fact, much of the health insurance industry is lining up behind staying with the system we know best and the one who has been our customer all these years–the employer.
That is understandable. As someone who came up through the ranks looking at the employer as the customer and individual health insurance as a minor product subset I have the same reaction.
But I will tell you that this idea of moving away from third-party employer pay and to a system of individual responsibility — or moving from defined benefit health insurance to defined contribution health insurance — has been coming on us for some time now.
Two years ago lawmakers in Massachusetts made the state the first in the nation to mandate that residents purchase health insurance. The proposal quickly caught on, inspiring similar efforts on the state level and eventually becoming the blueprint for the national health reform efforts of Democratic presidential candidates Sen. Barack Obama and New York Sen. Hillary Rodham Clinton.
More than a year into the experiment the first returns are in. And reviews are mixed. Not surprisingly, the program is costing far more than backers had initially predicted. On the other hand, the ranks of the uninsured in the state have dropped sharply. (See Matthew’s podcast with Jon Kingsdale, executive director of the Massachusetts Connector, the agency created to administer the program, for more on the back story.) The Massachusetts experiment is clearly not something to be dismissed — nor is it something to
defend for the sake of argument.
In brief, the Massachusetts health care reform law appears on its way to:
- Covering two-thirds of those who did not have health insurance on the day it was enacted — about 400,000 people by the end of 2009.
- Covering most of those who were uninsured in households with incomes below 300 percent of the federal poverty level–below which the plan pays all or most health insurance premiums.
- Offering health insurance plans to middle-income people that are still largely unaffordable for those families making less than $110,000 a year –– people for whom the state has generally canceled the individual mandate that they must buy coverage.
- Racking up costs well above what was first estimated. The plan looks to be coming in 38 percent higher than originally estimated for its first year and the Governor is now estimating second year costs 50 percent higher than the original estimate –– from $725 million to $1.1 billion for the 2008-2009 fiscal year.
- Developing an annual cost trend for the program’s insurance programs, Commonwealth Care and Commonwealth Choice, in the 10 percent to 15 percent range.
So, lots more people, particularly lower-income residents, are covered but the program’s costs are unsustainable.
Health care reform will be hard to do after the November election. I’ve even called it a long-shot.
Polls clearly show the voters split evenly between the Democratic and Republican approach to health care reform. I can’t tell you who will win the presidency, but I am willing to make the bold statement that it will be a close election and neither very different approach to health care reform will enjoy any kind of mandate.
So finding common ground between these very different approaches will be more than tricky.
But we may already have an outline.
Sen. Ron Wyden (D-OR) and Sen. Robert Bennett (R-UT) have crafted a health care reform plan that gives both sides the most important things each are looking for.
Thanks to a very high Google ranking this has been the most popular ever post on THCB. And it's an excellent analysis by Robert Laszewski. who writes The Health Policy and Marketplace Blog. However, it was written during the Democratic primaries in 2008 and is of course out of date. THCB suggests that you checkout a few other intriguing posts too.
For more recent posts on health care reform, try a smattering of these:
and of course enjoy Bob's analysis too!:
Barack Obama’s health care plan follows the Democratic template—an emphasis on dramatically and quickly increasing the number of people who have health insurance by spending significant money upfront.
The Obama campaign estimates his health care reform plan will cost between $50 and $65 billion a year when fully phased in. He assumes that it will be paid from savings in the system and from discontinuing the Bush tax cuts for those making more than $250,000 per year.
By contrast, the McCain Republican strategy for health care reform would first emphasize market reforms aimed at making the system affordable so more Americans can be part of the system and he claims that there would be no additional upfront cost.
Obama breaks his health care reform plan down into three parts saying that it builds “upon the strengths of the U.S. health care system.”
The three parts are:
1. Quality, Affordable & Portable Health Coverage For All
2. Modernizing The U.S. Health Care System To Lower Costs & Improve Quality
3. Promoting Prevention & Strengthening Public Health
Obama claims that his health care reform plan will save the typical family up to $2,500 every year through:
* Health information technology investment aimed at reducing unnecessary spending that results from preventable errors and inefficient paper billing systems.
* Improving prevention and management of chronic conditions.
* Increasing insurance industry competition and reducing underwriting costs and profits in order to reduce insurance overhead.
* Providing reinsurance for catastrophic coverage, which will reduce insurance premiums.
* Making health insurance universal which will reduce spending on uncompensated care.
Will Obama be able to cut the typical family’s health care costs by $2,500 a year?
Well, yes and no.
Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog.
John McCain’s campaign reinvigorated, I am reposting my earlier analysis of his health reform plan.
McCain very rightly points to health care costs as the biggest issue, "We are approaching a ‘perfect storm’ of problems that if not addressed by the next president will cause our health care system to implode."
Therefore, his focus is on the health care costs that make health insurance so expensive that individuals can’t afford it for themselves, employers can’t afford to provide it to their employees, and government can’t afford a wider safety net for the poor. He also reminds us that costs can’t be improved without dealing with quality in tandem. so expensive that many