Most pollsters have Obama well ahead nationally and in the swing states, with Gallup reporting he has almost reached a double-digit lead.. And after last night’s debate, which Obama ‘won‘ handily more independents look to be behind his campaign (although if you watched the alternate-universe-dwelling wingnuts on Fox, you might not get that impression).
It is looking very good for Obama, and very bad for the Mav (the bettors have it Obama with a 73% chance of winning).
So, the Senator from Illinois wins. What does that mean for health care?
We’ve established that his big reform plan is not going to happen. And I couldn’t really take Obama at his word when he said last night that health reform would be his second priority after energy. Energy’s big, but health care is bigger.
Here’s what I’d expect we’ll see in 2009-2010 from Congress and the new President.
Expect the new political year to begin with incremental fixes to specific programs – The biggie will likely be Medicare physician compensation. With docs scheduled to see their reimbursement drop by around 20% in 2009, the caterwauling will be heard loud and clear inside the Beltway. Don’t look for a major policy change, but rather something to satisfy the physician community and build a little equity for the future. Where will the money come from?
Do not be surprised if CMS is expressly ordered to negotiate prices with big pharma in the near future. The Part D program is a budget buster, big pharma has few political allies (despite big contributions) and reducing the cost of drugs will save CMS budget dollars that can be spent on physicians.
SCHIP may be next out of the blocks. The expansion of coverage for kids is a central piece of Obama’s platform on health reform, and with a Democratic Congress the chances of meaningful expansion of this program are pretty good. And it won’t just be Democrats voting ‘aye’. After the back and forth battles, marked by confusion and consternation from Republicans who felt Pres. Bush threw them under the bus by vetoing a bi-partisan bill to extend SCHIP earlier this year, enough Republicans are likely to cross the aisle to support funding of a somewhat-expanded program.
Also on the table will be reduced funding for Medicare Advantage, a program that has long struck Democrats as a giveaway to big healthplans. Foolishly. the insurance industry worked hard, and effectively, to block reductions in MA this year. As Bob Laszewski notes, with Congress and the White House changing hands, the bill they stopped this year will look great compared to what they’ll get next. Expect MA subsidies to be slashed, in what could, and should, be seen as a shot across the bow of the insurance industry.
The FDA will also be under the microscope. Despite passage of the Food and Drug Administration Amendments Act of 2007, ostensibly fully funding the FDA and giving it the staff needed to do its job, the FDA continues to stumble. With a Democrat running the Administration, expect increasing oversight, much more post-approval monitoring, and much less tolerance for patent-extending gamesmanship.
What does this mean for you?
Obama is a very smart guy who knows enough to not try to do everything at once. Incremental steps mean progress towards reform – and are easier to accomplish, build consensus. momentum and working partnerships.
Oct
8
Referring to Fox commentators as “alternate-universe-dwelling wingnuts” does not advance the discussion at all, especially with the bias we routinely see in the major networks. I appreciate your thoughts but not the ad hominem remarks that seem to belittle what you have to say.
Your overt and constant bias on the election calls into the question the integrity with which you present other issues. As a person who relied on your information as an objective starting point on real health care issues – you are no longer credible and do little to advance the goal of many Republicians as well – effective reform for the health system. All that is missing from your bog now is creative of exclamation points and smiley faces to underscore your agenda.
You now have one less reader & a new critic of your judgment on consulting matters.
Mickey – thanks for the comment.
The trigger for my observation was a graphic on the Fox screen last night that indicated a large majority of viewers thought McCain won. This was in direct contrast to every other credible reporting organization. Therefore, my conclusion was, and remains, that they were in ‘another place’. I do not see nearly as much bias on other networks as is so routinely evident on Fox. As an example, they persist in their publicity of the Ayers non-issue with little consideration of the much more important, and timely, Keating scandal. Seems to me that is evidence of bias.
I’ve long objected to other outlets (MSNBC for one) kowtowing to criticism from the far right while Fox et al protest vehemently when others criticize their bias. There was an interesting study done on media bias some time ago by the folks at the Columbia School of Journalism; if you’re interested I’ll try to track it down for you.
Was – thanks for your comment. We’ll miss your presence, but feel free to check back whenever you want to see opinion backed up by facts and citations, a policy I embrace wholeheartedly. As for your new status as a critic of my consulting, I’ve never done any consulting for your employer, Quest Diagnostics. If you choose consultants on the basis of their political stance, that’s your prerogative. My clients want results, not yes men.
Paduda
I dont know Joe, I read today that the Zogby,C-Span, Reuters (none of whom I think of as being alternate universe dwelling wingnuts) Poll of Likely Voters has the race at a statistical dead heat. As for the Ayers “non-issue,” even the NY TImes has reported that Ayers and Obama had more involvment and interaction than Obama has admitted to. One must wonder why if it is in fact such a “non-issue” as you characterize it, Obama wants to distance himself from his relationship and involvment with Ayers?
Dom–You must understand that Obama wants to distance himself for the same reason McCain wants to distance himself from George W. Bush…though on a far, far distant scale.
The whole guilt by association attack line.
Watching the Republican attack machine at work if he were to acknowledge any further association–other than what’s been reported–the Republican’s would pound and pound and pound the ‘association with a terrorist’ line…despite the fact that Mr. Obama was 8 years old at the time of Mr. Ayer’s original actions.
This is a standard political maneuvering and at this time with Serious issues from the economy to military options to healthcare to job loss to energy this is much ado about nothing. A diversion from the critical issues we face.
Jonathan Fuchs
Joseph,
It’s a trust issue and the media who will not do the investigative reporting on Obama that it does on Palen or McCain. I watched all of the major and they neglected to play any positive statements that McCain said, which Obama could not deny. Trusting Obama who has lied about many things, is really the issue now.
Yeah Joe, the FOX News poll showed that 86% of their viewers thought McCain won. Wow.
The neo-cons have done an amazing job of swaying public opinion. The mainstream networks are on constant defense against looking like a “liberal media” because the republican party has campaigned so hard to coin the term. So now anytime the “mainstream” media discusses actual issues, they’re being liberals. And there is so much junk out there about both McCain and Palin (wacky church videos, questionable associations, firing troopers, etc) that you have to go to youtube to see them (which is the way it should be). If there were actually a network for liberals like conservatives have FOX…. can you imagine the crap they could talk about all day?
Instead, there are actually a large number of people out there (a lot of my family included) that think Bill O’Reilly and Rush Limbaugh are the only reliable news sources. Because of these “news sources,” conservatives got so much traction on Bill Clinton for an affair that they actually impeached him. Yet, look at the state the country was in and compare REAL ISSUES that really affect people to what this president has been doing. You could go on forever… outing CIA agents for political reasons, warrantless spying on americans, etc, etc, etc. But you never hear about those because the mainstream media is afraid to discuss them out of fear of being labeled liberal. So the “issues” we have the pleasure of hearing about are: “is Obama secretly a terrorist?”
Seriously?
The country is in the toilet, I don’t have a house, a job, or any money in my IRA, but as long as the President isn’t cheating on his wife I’m happy.
If Obama wins and health care becomes a right –
“…I think it should be a right – FOR EVERY AMERICAN…” (Wonder what the every American part means?
Hallelujah! I can’t wait to sign up and get my wife a boob job and get me some viagra for free !
“In a country as wealthy as ours…” Um, has anybody been actually watching the news or paying attention to the nation’s finances lately ? (No – FOX, CNN, ABC etc aren’t airing the severity of this of course.)
http://news.kontentkonsult.com/2008/10/top-five-financial-issues-for-us-in.html
http://www.usnews.com/blogs/new-money/2008/10/09/maxing-out-the-national-debt-clock.html
http://finance.yahoo.com/
“…The question is how much of the claim cost will the Feds assume…”
https://www.joepaduda.com/archives/001309.html
Oh, and Lassie has a tumor – can we get coverage for the four legged friend of the family too ? I mean dogs are American’s too…
Thanks for your article and I hope you’re right about Obama’s picks for his early health battles. The ones you mentioned (negotiating drug prices, eliminating MA overpayments, and expanding SCHIP) would lay the groundwork for a more thoughtful and longer-term effort for fundamental health care reform. 2015 will be the 5oth anniversary of Medicare, and single payer would offer both an efficient and affordable way to expand coverage to all as well as fix the problems in the Medicare program over the long term. The greatest advantage would be a national single payer’s ability to reduce Medicare’s costs, making the program sustainable for those retiring soon and in the next generation. While Medicare has the lowest insurance overhead of any insurer, it still has to pay 25-30 percent higher prices for physician and hospital care than necessary (simply due to the fact that doctors and hospitals today have to keep huge administrative staffs to deal with our complicated and fragmented insurance system). Having one payer would allow hospitals to cut administration as a share of revenues from 25-30 percent of today’s hospital bill to 10 percent, with similar reductions (and sighs of relief) in doctors’ offices. Raising physician reimbursements is important but helps little when an increasing share gets eaten up by having to hire more staff to deal with private insurance bureaucracy, billing patients for cost-sharing, etc. Thanks again for your article. (P.S. National health insurance usually doesn’t cover cosmetic surgery or pets, sorry).
At a panel discussion months ago in New York City Nobel Prize winning economist, Paul Krugman, said that a universal national health plan will require funding and that one, perhaps the only, opportunity for the federal budget to fund a national health plan will occur in 2010 when the generous tax cut provisions expire. If these tax cuts are not renewed the additional tax revenue will make it possible to finance a universal national health plan.
At this conference Krugman made it clear that increasing compensation to physicians under a national health plan is possible and would not represent a significant amount of money, overall.