The health reform battle is escalating. And the President is moving to the head of the pro-reform forces. According to a piece in the NYTimes,
“Ultimately, as happened with the recovery act, it will become President Obama’s plan,” the White House budget director, Peter R. Orszag, said in an interview. “I think you will see that evolution occurring over the next few weeks. We will be weighing in more definitively, and you will see him out there.”
Till now, President Obama has stayed above the fray, talking in generalities about the economic imperative of health care reform, the need to automate the cottage industry that is the health care system (my characterization, not his), and the flaws in the current system. That’s not to discount the significant ‘reform-type’ initiatives that passed early on in this very young administration, including S-CHIP, initiatives that would have been plenty important if expectations weren’t so high. But high they are, and Obama has clearly decided it is time for the President to start doing some of the heavy lifting.
This is where it is going to get very interesting.
Way back in February 2009 the President put forth a health care reform ‘plan’; actually it was more of a list of things to get done, and avoided addressing the key issue – how are we going to pay for reform, and what medical care should we be paying for (a nice way of saying ‘cost control’). Now he’s getting a bit more specific, but avoiding any lines in the sand in an effort to gain some bipartisan support.
What’s interesting is the disagreement between Senate Republicans and the President/most Democratic Senators is centered around the public plan option. I just don’t see this as a huge issue, and continue to wonder why the GOP, AHIP et al are so bothered by the idea of competing with a government-sponsored option.
I’m wondering if the Dems keep promoting the idea more as a bargaining chip than anything else, as it pales in comparison to changes in reimbursement for physicians, pharma, devices, and facilities in terms of overall importance.
That’s where the real battle is going to be fought.
Jun
8
Will private insurance plans have access to the same taxpayer-provided funds which the public option will receive?
If not, the public option will be in an unfair position. There will be no “competition” as long as the government is the unfair player.
I still, frankly, don’t see public plan option as the make-or-break policy plank for healthcare reform. Its most useful purpose, I think, is to be the distracting shiny object for all the birds to peck at while the real work goes on elsewhere.
And in a stealthy way, I think the most important piece of the puzzle is already under way. Sen. Rockefeller has introduced a bill that would turn MedPAC into the “healthcare Fed” that Daschle and others think will take healthcare out of the hands of Congress, and therefore the lobbyists, and allow real cost containment. And isn’t that what we all really need? I mean, a public plan that pays too much for too many services that are ineffective is only 5 percent better than a private plan that does the same and adds on 5 percent EBITDA. 5 percent improvement ain’t gonna do it.
Under Rockefeller’s plan, MedPAC — which would gain the authority to set Medicare provider reimbursements and become part of the executive branch — would produce a rate package after considering public input, and submit it to Congress for a simple-majority up-or-down vote. No amendments and no filibusters allowed. Rates would automatically take effect in the absence of a Congressional override.
I like that the average person, and even quite a few well-informed people, have no idea what Rockefeller’s bill means. It keeps the Frank Luntzes of the world from developing opposing sound bites, talking points and narratives.
I don’t know if we’ll be in the land of milk and honey if it passes, but I’m pretty sure it’s the right tool to do the job.