Aneesh Chopra is the Obama Administration’s Chief Technology Officer. He’ll be giving keynote speech at the Health 2.0 Conference in San Francisco, Oct 6-7.
Above the Fold
After Reform
By
One in six Americans at some point during this year will go without health insurance. Most of them at any given point in time do not need it.
One in ten working Americans are without gainful employment right now. Every one of them wants a job . . . right now.
That as much as anything explains Tuesday’s Senate special election result in Massachusetts, the only state in the union that has a health insurance plan similar to ones passed in the House and Senate last year. Were voters there rejecting their own system? Not according to every poll that asks the question. The Bay State has the lowest uninsured rate in the nation; local residents have learned to participate in the insurance exchange set up under its plan (passed under a Republican governor); and people seem to like it.
So any commentary that seeks to make health care reform the scapegoat for voters choosing Scott Brown, an obscure state senator, over an aloof attorney general Martha Coakley, is off the mark.
Massachusetts hasn’t solved its health care problem. Its costs are still rising at an unsustainable pace, suggesting the reforms in the national legislation won’t solve that problem either.
Martha’s Mistakes
Not one to comment on broader political issues but just can’t help myself today after awakening to the news that Kennedy’s Senate seat has gone to the Republican upstart Scott Brown. Whatever happened to carrying on Kennedy’s legacy for healthcare reform, something Martha Coakley vowed to support and Brown vowed to defeat? Has Massachusetts really gone Red (or just a lighter shade of Blue)?
Reflecting on my own thoughts and vote for Martha, have come up with the following missteps of Martha’s that ultimately led to her losing what was considered a sure thing, Kennedy’s seat in Congress.
1) Assuming the cat is in the bag. Skating to an overwhelming victory in the Democratic primary, Martha naturally assumed that Kennedy’s seat was her’s for the taking. Sure, the Republicans would put someone on their ticket, a sacrificial lamb, but a serious contender, no. Surprise, surprise. Yes, the Republicans put forward a relatively unknown State Senator from a small community, but this unknown Scott Brown proved to be an extremely engaging and aggressive politician. By the time Martha’s political machine realized that they had a serious challenger on their hands, it was too late, his momentum too great.
Report: The Past and Future of Health 2.0
Health 2.0 Advisors is the research and consulting arm of the Health 2.0 family and it will be offering a series of reports, a database of all Health 2.0 organizations, and others consulting services including one day workshops/bootcamps and research services. More will be revealed about that in the coming months, but first we’re thrilled to announce that the first publication from Health 2.0 Advisors is now available.
The report is called The Past and Future of Health 2.0, and it's written by Matthew Holt with contributions from Jane Sarasohn-Kahn, Brian Klepper, Michael Millenson, Indu Subaiya, and Marco Smit. This publication is the primer on Health 2.0. It provides an overview of the history of Health 2.0, a detailed explanation of the state of the art of Search, Communities and Tools, and lays out a theoretical framework for what's ahead. We also lay out in detail implications for organizations that will be impacted by Health 2.0 voluntarily or involuntarily. The contents include:
The Boston Massacre
Tuesday’s Republican victory in Massachusetts means the current Democratic health care bills will not be on the President’s desk in 2010.
Forget the crazy talk of ramming something through—including just having the House pass the pending Senate bill.
I’ve talked to lots of people in the past few months that didn’t like the Democratic effort but conceded that the Dems won the 2008 election on a platform to do health care their way. They would say, “elections matter” and could, albeit begrudgingly, understand Democratic attempts to pass their brand of health care.
But losing Ted Kennedy’s former seat in Massachusetts with the singular issue being health care?
The game has changed. Democrats just can’t any longer spin the polls that for months have been so negative on the Democratic health care efforts.
The conclusion is now crystal clear—the people don’t want this. For goodness sakes—they rejected it in Massachusetts! On the political shocker scale this rivals “Dewey Defeats Truman” and the ’94 elections.
House of Straw or House of Bricks?
A week ago, before the Massachusetts special election, health reformers felt that their house was almost finished. The edifice of health reform had been built painstakingly using blueprints designed by policy and political experts during the past 10 years. It wasn’t a perfect building — like many construction projects, there were concerns that it would cost too much and wouldn’t be aesthetically pleasing — but most agreed that it would provide shelter for those who had been excluded from health coverage: the uninsured and the medically uninsurable. The imperfections could be fixed later. As many said, this would be the foundation and framework on which an even better health system for the U.S. could be built. And the wolves who had ruthlessly blown down health reform houses in the 1990s and before had been kept at bay.
As the reformers stood on the top floor last week, deciding on the final touch-ups and planning for the housewarming, someone pulled the rug out from under them. The upset election of Scott Brown to fill the late Sen. Kennedy’s seat changed the political calculus. It would not be possible for the Senate to pass a bill including the final modifications, since a unified Republican minority of 41 would be able to block consideration of the bill. It turned out that under the rug was a hole in the floor, and suddenly the reformers were on the next floor down. The reformers might have to leave the top floor unfinished (the modifications that were needed to get House approval), but they could still have a pretty solid building if they could reach agreement.
The Silver Lining
Massachusett’s voters’ stunning rejection of Democrat Martha Coakley, in favor of a not-very-impressive Scott Brown, should be exactly the splash of cold water that the Democratic party – and Congress as a whole – needed. The defeat can be understood in two ways: one large and one fairly small.
First, the large one. This will probably send reform back to the drawing board. Health care is too much in crisis and too pressing to be pushed completely off the table until certain issues – including both access AND cost – are addressed.
Second, this election marks the loss of a single critical Senate seat, but it is also very loud warning shot. The mandate received at the end of 2008 was a resounding call to throw out the Republicans who for more than a decade had ridden roughshod over American values. Yesterday, the Democrats, in one of their most secure strongholds, received the same message. Whatever people in DC think, rank-and-file Americans – not those on the right or left, but the swing voters in the middle who actually determine election results – are very unhappy with the gaming that’s been vividly displayed over the last year under the guise of health care reform.
The distaste expressed yesterday probably has little to do with the specific provisions of the bills, except for the largest generalities: that they expand coverage while avoiding a commitment to changes that could significantly reduce cost. But along the way, voters have witnessed — with an immediacy and transparency that has only been available as a result of the Web — lawmaking in its worst tradition. There was the White House’s deal making with powerful corporate interests like the drug manufacturers even before the proceedings began. And the tremendous lobbying contributions by health care and non-health care special interests in exchange for access to the policy-shaping process. Or the outright bribery of specific Senators and Representatives in exchange for votes. Last week’s White House deal with the unions that exempted them from the tax on “Cadillac” health plans until 2018 must have seemed like a perfectly OK arrangement to the people in the center of all this activity, but to normal people who read the paper, it was emblematic of the current modus operandi: If you have power and support the party in power’s muddled agenda, you get a special deal.
The most tempting mistake now for the Democrats would be to dig in. President Obama’s most appealing characteristic — the one that got him elected — was his embrace, his embodiment even, of approaches that would revise the traditional kinds of politics we’ve seen for the last year throughout the health care reform process. Of late, the most telling complaint about this Presidency so far has been disappointment that, once in office, he seemed to cave in so easily.
Undoubtedly, many Republicans are now rejoicing over the Democrats’ loss and the possible defeat of any health care reform legislation. That’s unfortunate. The health care crisis is real and remains unaddressed. The pressures it creates, particularly for powerful interests like business, will force Congress to return to it and develop meaningful solutions. Hopefully (though probably unlikely), Congress and particularly the Democrats, will be chastened and wiser. There’s a big opportunity here to make lemonade.
There is a new, bipartisan movement in Congress, highlighted on NPR two weeks ago, that would revisit the rules around the relationships between special interests and lawmakers. This is an issue that trumps and is more important than all others, because if every policy is ultimately shaped by those with enough money to buy Congress’ favor, then our democracy will be unable to hold.
The silver lining in yesterday’s election was that it was a mild, if critical, reminder that, whatever DC thinks, America’s center is just as displeased with the current governance as it was with its predecessors. Faced with a much larger rejection in the 1994 elections, President Clinton went on TV, took full responsibility, and then spent his time rebuilding. The good news is that today is a new day, and that, if they’re interested in what’s good for America over the long term rather than simply themselves over the short term, Congress has the ability to start again in ways that could please the American people and actually work to our collective advantage.
Brian Klepper and David C. Kibbe write together about health care technology, market dynamics and reform.
Obama & Company
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…
A vote for single payer, austerity-style
I spent summer 1984 in Boston and generally found it an oppressively hot place. I’ve spent a few winter days there and found it an oppressively cold place. I’ve always thought that, given the absence of passport controls, if you lived there and could move to California and didn’t, you were probably crazy. And yesterday the residents of that fair state proved me right.
As I said earlier this week, it now appears that health care reform is dead. I just can’t see a scenario in which there are 60 votes to pass anything. I also don’t see the Dems having the cojones to go to reconciliation or to cram the current Senate bill through the House quickly. Instead (as Bob Laszewski says below) the moderate Dems will run for their lives away from health insurance reform—although I just don’t understand what Bob thinks “reform” would have meant if it had really required 6–10 Republican Senators.
So my prediction is that we end up with nothing.
Thinking the unthinkable–no Health Care bill?
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.
