Update - There's a reason why I tend to practice cautious optimism - Susan Collins appears to be a solid "No" and Ben Nelson continues to say "No" as well. And the Democratic Left may be unwilling to accept the watered down bill.
Last month I took to this page to argue that health reform would fail to pass. In my original post and one subsequent follow-up I theorized that disagreements within the Democratic Party and between the House and Senate over funding, mandates, taxes, and abortion would ultimately sink health reform - and they almost did. But it is now increasingly likely that health reform will pass and all credit goes to two Senators - Max Baucus (D-MT) and Joe Lieberman (I-CT). Lieberman has become public enemy number one among the Left this week since stating that he would filibuster any bill with a Public Option AND any bill that allowed for a Medicare buy-in. Baucus enjoyed a similar bit of infamy back in September when his Senate Finance Committee drafted health reform legislation that did not include a public option and had watered done the individual and employer mandates. Baucus argued that his goal was to write a bill that could receive 60 votes.
Senate Majority Leader Harry Reid (D-NV) took Baucus' bill and added a public option and has spent the better part of a month trying to reach 60 votes. It seems that Reid has now surrendered. Word out of Washington is that the Senate will strip away the public option, will strip away the recently proposed Medicare expansion and will essentially consider the legislation originally reported by Baucus' committee back in October. Liberal Senate Democrats such as Tom Harkin (D-IA) have stated that they will accept scaled back legislation and the White House has urged Reid to make what ever concessions are necessary to get the bill passed.
Perhaps most significant is the increased likelihood that the scaled back Baucus inspired bill may receive 2 Republican votes – Olympia Snowe and Susan Collins, both from Maine. Snowe supported the Baucus bill in committee and Collins recently praised Lieberman’s efforts to strip away objectionable elements in the bill. So there you have it – the bill that Baucus originally produced has now become the savior of the Democrats' health reform effort and because of the efforts of Joe Lieberman it is likely to pass complete with a Republican vote or two.
If you are wondering why Harry Reid opted to not introduce the Baucus bill in the beginning it is because of the politics of the House of Representatives and the powerful progressive caucus there. Reid needed to prove that a public option could not survive in the Senate, he needed to prove that the Baucus bill was the only acceptable legislation. The last month has made that clear. Given that the House has passed a health care bill the normal process would be for a House/Senate Conference Committee to reconcile differences between the chambers and return a compromise bill for final votes in each. I do not expect that to happen – rather I suspect that whatever passes in the Senate will be introduced in the House and approved unamended, thereby negating the need for a conference. Any other approach would introduce more delay and uncertainty. The White House and Democratic Leaders will exert tremendous pressure on progressive House members to grit their teeth and simply vote for the Senate bill, or risk getting no reform at all.
I would add that abortion remains a hurdle – but I suspect that it is one that will be overcome.
Showing posts with label public option. Show all posts
Showing posts with label public option. Show all posts
Tuesday, December 15, 2009
Wednesday, December 9, 2009
As Progress is Made on Health Reform, Public Opposition Solidifies
Update II: Senate Democrats have reached an agreement and the Public Option is gone. This clears one hurdle, but another has popped up. The Senate rejected Ben Nelson's abortion funding amendment making the math of 60 votes still a difficult equation.
Update: Late word indicates that GOP moderate Olympia Snowe is not a fan of the new compromise that would expand Medicare and Medicaid, this could make it very hard for Democrats to reach 60 votes. Especially if they lose Ben Nelson over the issue of abortion coverage.
News today suggests that significant progress is being made in the Senate on compromise health care reform as Democratic Party leaders seek a path to 60 votes. It is increasingly clear that the Public Option that Majority Leader Harry Reid had included in the bill will be dropped - but progressive members of the Democratic caucus have not simply surrendered, rather they are using the elimination of the Public Option to bargain for new and potentially far reaching concessions. Multiple sources are reporting that the Public Option would be replaced with a new nationwide nonprofit health plan to be administered by the federal Office of Personnel Management (the same agency that administered the federal employee health benefit system). The new national plan would be offered by a private insurance company. Party leaders hope that progressives will find this to be an acceptable alternative to a Public Option run by the government. In exchange for dropping their demands for the Public Option, progressives have pursued amendments to the current legislation in the form a significant expansion of the Medicare program – the nation’s health insurance system for those over the age of 65. Under the proposal currently being discussed, the Medicare program would be opened to Americans over the age of 55. This is a population that can face great difficulty obtaining affordable coverage – especially if they suffer a job loss. Also being pursued is a proposal to open the new national health insurance exchange to more Americans. As originally proposed, the exchange would have been limited to a select few small employers and uninsured Americans, perhaps as few as 15-30 million. Adoption of these compromises would have a far more significant impact on health reform and coverage expansion than would the limited Public Option and progressives would be wise to pursue them.
Interestingly, or perhaps distressingly for Democrats, just as progress is being made on reform public opposition is on the rise and public support is collapsing. According to the latest tallies from Pollster.Com a majority of the country now opposes reform and less than 40% is in support. As heated debates remain over touchy issues such as abortion and funding – to say nothing of a needed reconciliation with the House – Democrats in tough re-election fights need the cover of public support - at the moment they do not have it. Only time will tell if that changes as details of these new negotiations emerge.
Update: Late word indicates that GOP moderate Olympia Snowe is not a fan of the new compromise that would expand Medicare and Medicaid, this could make it very hard for Democrats to reach 60 votes. Especially if they lose Ben Nelson over the issue of abortion coverage.
News today suggests that significant progress is being made in the Senate on compromise health care reform as Democratic Party leaders seek a path to 60 votes. It is increasingly clear that the Public Option that Majority Leader Harry Reid had included in the bill will be dropped - but progressive members of the Democratic caucus have not simply surrendered, rather they are using the elimination of the Public Option to bargain for new and potentially far reaching concessions. Multiple sources are reporting that the Public Option would be replaced with a new nationwide nonprofit health plan to be administered by the federal Office of Personnel Management (the same agency that administered the federal employee health benefit system). The new national plan would be offered by a private insurance company. Party leaders hope that progressives will find this to be an acceptable alternative to a Public Option run by the government. In exchange for dropping their demands for the Public Option, progressives have pursued amendments to the current legislation in the form a significant expansion of the Medicare program – the nation’s health insurance system for those over the age of 65. Under the proposal currently being discussed, the Medicare program would be opened to Americans over the age of 55. This is a population that can face great difficulty obtaining affordable coverage – especially if they suffer a job loss. Also being pursued is a proposal to open the new national health insurance exchange to more Americans. As originally proposed, the exchange would have been limited to a select few small employers and uninsured Americans, perhaps as few as 15-30 million. Adoption of these compromises would have a far more significant impact on health reform and coverage expansion than would the limited Public Option and progressives would be wise to pursue them.
Interestingly, or perhaps distressingly for Democrats, just as progress is being made on reform public opposition is on the rise and public support is collapsing. According to the latest tallies from Pollster.Com a majority of the country now opposes reform and less than 40% is in support. As heated debates remain over touchy issues such as abortion and funding – to say nothing of a needed reconciliation with the House – Democrats in tough re-election fights need the cover of public support - at the moment they do not have it. Only time will tell if that changes as details of these new negotiations emerge.
Monday, October 26, 2009
The Need for Real Health Care Reform
A few weeks ago on the PoliProf Blog I cited a study by the McKinsey Global Institute (MGI) which found that the U.S. spends about 31% more per year on health care than would be expected based or our wealth, cost of living, and health. In a $2.5 trillion health care economy that translates into $775 billion in excess spending. Why do we over spend? We have higher administrative costs owing to the fragmentation in our system, but mostly the problem is the manner in which we pay for services. Since every patient and procedure is a source of revenue providers over-provide. Because our insurance frequently has no limit on the utilization of services, we over-consume. My argument then was that only system-wide reform could realize the substantial savings implied by the study.
The findings from the MGI study have just been confirmed by a new study conducted by Thomson Reuters. That study found that the American health care system wastes an estimated $700 billion a year, roughly one-third of the nation's healthcare bill. Among the key findings:
The Reuters story concludes with this "Democratic Senator Charles Schumer said on Sunday that Senate Democratic leaders are close to securing enough votes to pass legislation to start reform of the country's $2.5 trillion healthcare system."
The implication from that final line about Schumer and Democratic leaders being close to a deal on reform is that the reform may actually address the problems highlighted in the Thomson Reuters study - unfortunately, that is simply not the case. The current reform proposals being considered in the House and the Senate will not solve the systemic problems in the American health care system - in fact they will likely make the problems worse. The current reform proposals maintain our fragmented system and will even add to the fragmentation. The expansion of Medicaid and the creation of a public insurance option will only add to the plethora of insurance providers with which doctors and hospitals must contend. The reforms will do nothing to address the care-linkage deficiencies that result in the poor management of patients with chronic conditions (asthma, diabetes, heart disease) who consume 70% of our health care dollars. The reforms will not change the fact that our fee for service system makes every patient and every procedure a source of revenue - and therefore encourages overuse. The reforms will not alter our malpractice policies and the defensive medicine that results. Rather the proposed reforms will extend coverage to about 30 million Americans (a good thing), but it will accomplish this by dropping them into an inefficient, expensive, and broken system - the simple result will be even greater costs (a very bad thing).
In his recent book The Healing of America, T.R. Reid writes "Any proposal for reform that continues to rely on our fragmented structure of overlapping and often conflicting payment systems... will not reduce the cost or the complexity of American health care. Any proposal that sticks with our current dependence on for profit health insurers... will not be sustainable." Unfortunately our elected leaders have spent the past few months hammering out deals that will do those very things. While our press and our politics have been obsessed with whether or not reform would have a public health insurance option the real question should have been "will these reforms actually improve the American health care system?" Perhaps no one wanted to ask the question because the answer is so clearly "No."
President Obama has said repeatedly that he would like to be the last president to take on the challenge of health care reform... if he signs into law any reforms similar to the legislation being debated in the House and Senate he will fall well short of that goal.
The findings from the MGI study have just been confirmed by a new study conducted by Thomson Reuters. That study found that the American health care system wastes an estimated $700 billion a year, roughly one-third of the nation's healthcare bill. Among the key findings:
- Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year.
- Fraud makes up 22 percent of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.
- Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste.
The Reuters story concludes with this "Democratic Senator Charles Schumer said on Sunday that Senate Democratic leaders are close to securing enough votes to pass legislation to start reform of the country's $2.5 trillion healthcare system."
The implication from that final line about Schumer and Democratic leaders being close to a deal on reform is that the reform may actually address the problems highlighted in the Thomson Reuters study - unfortunately, that is simply not the case. The current reform proposals being considered in the House and the Senate will not solve the systemic problems in the American health care system - in fact they will likely make the problems worse. The current reform proposals maintain our fragmented system and will even add to the fragmentation. The expansion of Medicaid and the creation of a public insurance option will only add to the plethora of insurance providers with which doctors and hospitals must contend. The reforms will do nothing to address the care-linkage deficiencies that result in the poor management of patients with chronic conditions (asthma, diabetes, heart disease) who consume 70% of our health care dollars. The reforms will not change the fact that our fee for service system makes every patient and every procedure a source of revenue - and therefore encourages overuse. The reforms will not alter our malpractice policies and the defensive medicine that results. Rather the proposed reforms will extend coverage to about 30 million Americans (a good thing), but it will accomplish this by dropping them into an inefficient, expensive, and broken system - the simple result will be even greater costs (a very bad thing).
In his recent book The Healing of America, T.R. Reid writes "Any proposal for reform that continues to rely on our fragmented structure of overlapping and often conflicting payment systems... will not reduce the cost or the complexity of American health care. Any proposal that sticks with our current dependence on for profit health insurers... will not be sustainable." Unfortunately our elected leaders have spent the past few months hammering out deals that will do those very things. While our press and our politics have been obsessed with whether or not reform would have a public health insurance option the real question should have been "will these reforms actually improve the American health care system?" Perhaps no one wanted to ask the question because the answer is so clearly "No."
President Obama has said repeatedly that he would like to be the last president to take on the challenge of health care reform... if he signs into law any reforms similar to the legislation being debated in the House and Senate he will fall well short of that goal.
Tuesday, October 20, 2009
Deciphering Public Opinion on Health Care Reform
As Harry Reid (D-NV), Chris Dodd (D-CT), Max Baucus (D-MT), Rahm Emanuel, and Olympia Snowe (R-ME) continue to hammer out the Health Reform compromise between the Senate's HELP and Finance Committees there is a picture emerging with regard to public opinion toward health reform – and at first glance it makes little sense. The most recent data from Pollster.Com (see chart below) show that public support has begun to drop (after a mini-rally last week) and opposition is on the rise. A recent ABC News survey found that 48% opposed “the proposed changes to the health care system being developed by Congress and the Obama administration,” while 45% supported such changes. A Fox News survey found that 54% opposed “the health care reform legislation being considered right now,” and only 34% supported it. According to Rasmussen Reports 54% opposed “the health care reform plan proposed by President Obama and the congressional Democrats,” and 42% supported.
Taken together these polls suggest considerable opposition – but beyond these topline questions the picture becomes murkier. When ABC News asked “Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans” an overwhelming 57% indicated support – odd given that such a proposal is being considered as part of the changes being developed by Congress – the same changes that only 42% of respondents supported. When Fox News asked whether respondents would prefer “the current health care system or the health care plan proposed by the Democrats in Congress” the current system was favored by a 51% to 34% margin. The Rasmussen survey found that a majority of respondents believed that health care costs would increase and quality decrease if the current reforms were enacted.
So what can we make of this? There appears to be clear opposition to the health reform plans in general, support for maintaining the current system, a lack of faith in the ability of the proposed reforms to control costs or maintain quality, but also clear support for the creation of a public option. I see two possible explanations – one being that many Americans don’t know what the “public option” is and therefore their response to questions regarding support or opposition must be taken with a grain of salt. A recent post by Mark Blumenthal at Pollster.Com gives credence to the theory that the public does not understand the term. As he points out, a recent PEW study found that 56% of the public correctly linked the term “public option” to health, meaning that 44% of the populace does not recognize the term. He also points to a randomized internet survey where only 37% of the adult population could correctly identify the public option when presented with three choices (by random chance you would get 33%). So perhaps the public simply does not get it. There is one other possibility that gives the public a bit more credit. When Fox News asked respondents whether they supported reforming “the entire health care system” or reforms to provide “health insurance to those who don't have it,” covering the uninsured was preferred by a 50% to 27% margin. With that answer, current public opinion makes much more sense.
The current proposals in Congress would represent system-wide changes, though largely incremental in nature, they are more akin to the “Comprehensive Incrementalism” defined by the Washington Post's Ezra Klein. It would appear that most Americans are opposed to the proposed comprehensive incrementalism, but support efforts to cover the uninsured – such as a public, or government-sponsored health insurance option. So when ABC News asked whether respondents would support “a plan that includes some form of government sponsored health insurance for people who can't get affordable private insurance, but is approved without support from Republicans in Congress; or a plan that is approved with support from Republicans in Congress, but does not include any form of government-sponsored health insurance for people who can't get affordable private insurance?” it should not be surprising that “government sponsored health insurance for people who can't get affordable private insurance” was preferred over bipartisanship by a 51% to 37% margin. This is roughly the margin that preferred covering the uninsured over system-wide reform in the Fox poll. By no means does it suggest that the public would prefer Democrats to “go it alone” on overall health care reform, nor does it suggest public support for current proposals would be higher if those proposals contained a public option. It does tell us that Democrats are correct when they say that the public supports a public option, and Republicans are correct when they say that the public opposes the health reform proposals currently being considered in Congress.
Taken together these polls suggest considerable opposition – but beyond these topline questions the picture becomes murkier. When ABC News asked “Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans” an overwhelming 57% indicated support – odd given that such a proposal is being considered as part of the changes being developed by Congress – the same changes that only 42% of respondents supported. When Fox News asked whether respondents would prefer “the current health care system or the health care plan proposed by the Democrats in Congress” the current system was favored by a 51% to 34% margin. The Rasmussen survey found that a majority of respondents believed that health care costs would increase and quality decrease if the current reforms were enacted.
So what can we make of this? There appears to be clear opposition to the health reform plans in general, support for maintaining the current system, a lack of faith in the ability of the proposed reforms to control costs or maintain quality, but also clear support for the creation of a public option. I see two possible explanations – one being that many Americans don’t know what the “public option” is and therefore their response to questions regarding support or opposition must be taken with a grain of salt. A recent post by Mark Blumenthal at Pollster.Com gives credence to the theory that the public does not understand the term. As he points out, a recent PEW study found that 56% of the public correctly linked the term “public option” to health, meaning that 44% of the populace does not recognize the term. He also points to a randomized internet survey where only 37% of the adult population could correctly identify the public option when presented with three choices (by random chance you would get 33%). So perhaps the public simply does not get it. There is one other possibility that gives the public a bit more credit. When Fox News asked respondents whether they supported reforming “the entire health care system” or reforms to provide “health insurance to those who don't have it,” covering the uninsured was preferred by a 50% to 27% margin. With that answer, current public opinion makes much more sense.
The current proposals in Congress would represent system-wide changes, though largely incremental in nature, they are more akin to the “Comprehensive Incrementalism” defined by the Washington Post's Ezra Klein. It would appear that most Americans are opposed to the proposed comprehensive incrementalism, but support efforts to cover the uninsured – such as a public, or government-sponsored health insurance option. So when ABC News asked whether respondents would support “a plan that includes some form of government sponsored health insurance for people who can't get affordable private insurance, but is approved without support from Republicans in Congress; or a plan that is approved with support from Republicans in Congress, but does not include any form of government-sponsored health insurance for people who can't get affordable private insurance?” it should not be surprising that “government sponsored health insurance for people who can't get affordable private insurance” was preferred over bipartisanship by a 51% to 37% margin. This is roughly the margin that preferred covering the uninsured over system-wide reform in the Fox poll. By no means does it suggest that the public would prefer Democrats to “go it alone” on overall health care reform, nor does it suggest public support for current proposals would be higher if those proposals contained a public option. It does tell us that Democrats are correct when they say that the public supports a public option, and Republicans are correct when they say that the public opposes the health reform proposals currently being considered in Congress.
Friday, October 2, 2009
There's a Public Option and Then There's a Public Option...
The Senate Finance Committee defeated two efforts to add a public option to Baucus authored health reform bill, but proponents have note ceded defeat. In fact, many are being heartened by recent statements from Harry Reid that “We are going to have a public option before this bill goes to the president's desk.”
What does this mean? Will Reid ensure that the public option is retained when the Senate Finance and Senate Health, Education, Labor, and Pension committee bills are merged? Does it mean that he will ensure that the public option survives the House/Senate conference process? Does it mean that he plans to use reconciliation to pass the bill and has sufficiently prepared for all of the challenges that would present?
Or does it mean that Reid is choosing his words wisely? Moments after his initial comments were made public his office offered a follow-up: “Sen. Reid believes that health insurance reform must include a mechanism to keep insurers honest, create competition and keep costs down… the public option is the best way to do that… we don't know exactly what that option will look like.”
I’d suggest that it won’t look like a federal public option, rather it is more likely to come in the form of the amendment drafted by Tom Carper (D-DE). Carper’s amendment would:
So states could participate in the co-ops created in the Baucus bill as a substitue for a national public option, open the state's insurance plans, or create a state based public option... This is hardly a significant change and arguably "allows" states to do things that they can already do. So I would advise tempering any excitement over Reid’s comments.
What does this mean? Will Reid ensure that the public option is retained when the Senate Finance and Senate Health, Education, Labor, and Pension committee bills are merged? Does it mean that he will ensure that the public option survives the House/Senate conference process? Does it mean that he plans to use reconciliation to pass the bill and has sufficiently prepared for all of the challenges that would present?
Or does it mean that Reid is choosing his words wisely? Moments after his initial comments were made public his office offered a follow-up: “Sen. Reid believes that health insurance reform must include a mechanism to keep insurers honest, create competition and keep costs down… the public option is the best way to do that… we don't know exactly what that option will look like.”
I’d suggest that it won’t look like a federal public option, rather it is more likely to come in the form of the amendment drafted by Tom Carper (D-DE). Carper’s amendment would:
give states the authority to increase competition in health insurance markets by implementing one of the following mechanisms listed below. This would allow a state to offer a state public option; however, both the executive and state legislature would have to agree.
The state would have the option of implementing one of the following mechanisms:
1. Participate as grantees in the CO-OP program and apply for seed funding.
2. Open up that state’s employee benefits plan.
3. Create a state administered health insurance plan with the option of banding together with other states to create a regional insurance compact.
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