None of the current health care bills/measures/concepts are likely to pass the Senate. And that means health reform is not going to happen.
As I’ve noted ad nauseam, the current efforts don’t do enough to control costs, and without cost control there won’t be moderate Democratic, much less bipartisan, support. And they certainly won’t get by OMB boss Peter Orszag. We’re left with measures to pay for the new entitlement by increasing taxes on the wealthiest Americans, a funding source that President Obama has ‘set aside’ for overall deficit reduction.
If rich folks’ contributions go to health care, there won’t be a deficit reduction. And if health reform as currently conceived passes, we’re going to have expanding, not decreasing, deficits.
As an object lesson, remember Part D – the legislation that dealt only with prescription drugs for seniors – compared to universal coverage, a relatively modest effort. It also left us with an $8 trillion unfunded liability. (note that the current GOP deficit hawks were the ones who passed Part D; perhaps they now see the error of their ways…)
(Let us not forget that the Bush/GOP tax cuts were written and passed with a sunset provision; Bush and the GOP Congress are responsible for their termination, not the current Congress/Administration)
The resistance by the Blue Dogs and Orszag is necessary and appropriate. We don’t need, and can’t afford, health reform that merely perpetuates the dysfunctional, corrupting, and hugely inefficient system we have today.
To date, the Dems have not found the political will to make the changes we need. The ‘concessions’ by hospitals and pharma and the insurance industry are far too modest, include too many concessions by the Administration/Congress, and don’t recognize – or address – the core issues. Congress’ refusal to consider taxing health benefits – at any level – is unhelpful and unrealistic.
It also didn’t play well in the health care industry, where they perceive their efforts to commit to cost reduction, however modest, as an honest effort to contribute to the solution. There’s a sense that all have to feel some pain, and the outright refusal by Congressional Dems to consider taxing health benefits at some level makes a mockery of ‘shared sacrifice’. Instead, they’re looking to jack up taxes on the wealthiest Americans – a relatively small – and these days not-too-popular group.
President Obama has yet to (really) weigh in on health reform. He’s dipped into and out of the discussion, sticking primarily to goal-setting and photo-op’ing. If reform is going to happen, the following will have to occur:
1. Meaningful, score-able cost reduction.
2. A way to pay for the additional coverage that can garner 60 votes in the Senate.
So far, we haven’t gotten close to either. Now’s the time for the President to step into the fray and push the hard choices.
Clearly the current bills are DOA. If we do get health reform, it won’t look much like any of the bills currently under consideration.
And that’s good – very good.
Jul
13
Joe– You have nailed it, as usual. I would only add that health care reform simply reflects in one area the cost/revenue dilemma of essentially all governments in the US now. In a way, we are all Californians– stuck between large tax increases and/or draconian service cutbacks and/or the abandonment of any new initiatives– of which health care is just the largest and most obvious. We have run out of tomorrows in which to dump our metasticizing debts and unfunded obligations. Either we get it right with health care and it really does pay as it goes, or we send a very large signal to the nice people who are holding our IOUs that we ultimately have no intention of honoring them. I think there is much more than just health care on the line in the current debate. Is our government funtional enough to actually deal with the multiple economic crises in which we find ourselves or do we continue to live in a fantasy world of high velocity political spin and accounting gimmicks until the sky really does fall in? Which it will.
Health reform should start with every member of Congress having the same health care coverage that they pass for the rest of the population. If its good for one, its good for all.
Health reform can occur to the extent that we can measure and value premiums paid, as compared to cost of services and reasonable outcomes. We are not there.
Cite the Institute of Medicine 100 Initial Priority Topics for Comparative Effectiveness Research. A committee convened by the IOM developed the list of priority topics at the request of Congress as part of a $1.1 billion effort to improve the quality and efficiency of health care through comparative effectiveness research outlined in the American Recovery and Reinvestment Act of 2009. The committee’s report provides independent guidance — informed by extensive public input — to Congress and the secretary of the U.S. Department of Health and Human Services on how to spend $400 million on research to compare health services and approaches to care.
Health experts and policymakers anticipate that comparative effectiveness research will yield greater value from America’s health care system and better outcomes for patients. Despite spending more on care than any other industrialized nation — $2.4 trillion in 2008 — the United States lags behind other countries on many measures of health, such as infant mortality and chronic disease burden. Comparative effectiveness research weighs the benefits and harms of various ways to prevent, diagnose, treat, or monitor clinical conditions to determine which work best for particular types of patients and in different settings and circumstances. Study results can help consumers, clinicians, policymakers, and purchasers make more informed decisions, ultimately improving care for individuals and groups.
This research is not done. So how are we going to expect a health care solution that is fair, unbiased and cost effective if the research has only been prioritized and not yet started or completed?
We need reform, but we need a road map for success… not ready-shoot-aim politics.
Mitch,
I think you are giving Congress and the Administration too much credit in ready-shoot-aim. It seems to me to be, “Fire at will!” and whatever hits the target (whatever that is) will do the job. Just as long as “something is done”.
Best regards,
Mike