Paths Toward Healthcare: Compromise, Consensus or Conflicts?
Hopefully the last post on Healthcare Reform ( Taught/Taut/Taunt Moment: Healthcare Speech, Policy, Politics & Realities) laid out the current dysfunctional dynamics (the vicious cycle) and the potential evolutionary improvements embedded in the President's speech (the virtuous cycle). Moving to a better state of things is about extending coverage in the short-run and getting costs under control in the long-run, and the key to the latter is creating an incentive system that causes all the interested parties to make more sensible choices. In that post one thing we talked about was the macro implications for the health of the economy, now we're going to shift the ground and talk some about the micro-consequences and the sausage-grinding that's been going on since the Inaugural. But our driving mantra is to try and see things as they are, not as the fantasists, ideologists and partisans pretend they are:
"You can't make radical changes in the pattern of your life until you see yourself exactly as you are now."
- Bhante Gunaratana, Mindfulness in Plain English
And on that note, seeing things as they are and finding a way to work with them clear-eyed, clear-headed and dispassionately we'd refer you to an addition to the readings explaining some of the key workings of the Baucus Plan:The Baucus Plan: A Winner’s Curse for Insurance Companies In the context of the prior post's machinery this thing is potentially brilliant. Incremental change that will drive deep structural evolution!
Consequences for the Individual: Unaffordable Insurance
We tried to make clear that the cost trends are going to put the Meditwins out of business with a few years and essentially bankrupt the economy. What many people still don't really grasp is the personal implications. It's not just the country who can't afford insurance but even the supposedly insured. In the last decade family coverage has skyrocketed from $6K/yr to $13K/yr, individual contributions have gone up, as have deductibles and co-pays. At the same time wages and other benefits have been stagnant or worse. As a consequence more firms, large and small, have been dropping, not just modifying, coverage. In other words even folks who think they're insured, at least before an insurance bureaucrat rescinds their coverage, aren't in fact. Or won't be shortly. Without controls in another 10 years costs will double or triple!!! If you think it's unaffordable now or it's going to lead to more people being dropped...well no kidding. And the crisis is here, right now! On top of which fewer and fewer retirees are going to be covered as well; in fact we'd guess none.
Continued ...
Grinding Out the Sausage: Lining up the Interest Groups
People and interest groups don't always make all decisions purely for their own partisan and narrow advantage but that's where the betting opens. Any time you want to get major policy changes thru a requisite is that the major power players have to be brought on board, often on the basis of tradeoffs, a quid pro quo. In this case the major interest groups who killed reform in the early '90s have been remarkably cooperative, supportive and relatively quiet after the speech. The insurance companies, for example, have bought in because the new coverage mandates will create a major new market for them. When you try and figure out what's going on you need to understand the 4P's of political decision making. Who are the Players? What are their Positions and interests? What is the Power of each interest group? What are the specific Policies being proposed and how do they impact the Players?
This graphic starts with the ideal to-be set of policies we think, based on our work synthesizing best ideas and practices together, would be an ideal outcome. The proposals in the speech are close but miss some key elements. A critical one would be bringing employer-based insurance out from behind the tax shelter by eliminating the tax deduction. That would be readily offset by providing roughly equivalent deductions to individual tax-payers. It would also make insurance portable and, likely, more affordable in the long-run. Particularly in combination with an exchange that was open to any qualified insuror. If you'll skim the readings you'll find an enormous effort was made to line up all these Players; a real tribute to the consensus building and political skills of the administration. It turns out that the key players who weren't on our original chart are Political Opponents. Who by resolutely and nearly absolutely refusing to collaborate have hamstrung the proceedings and made the voters, here known as Beneficiaries (Yellow), dazed, confused and scared.
Healthcare is Non-Competitive
The multiple great ironies here are that an exchange would introduce competition, something the Republicans claim to support. A truly Conservative position, and entirely logically consistent with free-market principles, would be to eliminate the employer tax exemptions.
Just in case you wondering Healthcare is NOT a competitive market. There is no state that's not dominated by a very few insurance providers. Some, e.g. Alabama, have a single insuror controlling 90% of the business. We repeat - Healthcare Insurance is NOT a competitive market.
To bring that home it means that the political partisans who are so vehemently and virulently opposing reform are not only violating their own supposed principles and supporting non-free markets. They are also directly harming their own constituencies. We wonder if they have a clue? Somehow, we suspect not. In fact we think that instead of analysis it's a combination of no analysis or knowledge, substituting ideological shibboleths and sheer anger at having been tromped so badly in the last several elections. When you put that together with a voting public which is confused, dazed by all the monumental changes, feeling ignored and disrespected and scared you have a politically exploitable opportunity and people willing and able to do the exploiting.
Political Partisanship vs Interest-group Sausage-Making
We went on long enough in other posts about lizard-brain appeals to the hindbrain (Lizard-brains vs the Public Good: Time to Embrace the Suck,Sausage Eating Lizards: Sonia, Spooks, Death Panels and the Pope) but, in the readings and for the record, you'll find several interesting tidbits worth perusing. Some are fascinating vidclips of the 912 protests, a cynically exploitative manuver in its own right IOHO! One of the more interesting tidbits is an excerpt and URL locator from Newt Gingrich's 1996 GOPAC memo on how to use language designed to appeal to the hindbrain. Sadly the politics of politiking to the hindbrain are metastasizing.
The really sad part about all this is that it needs to be done, done as proposed or as we'd recommend it'd help all the key players, and the necessary interest groups were lined up very carefully and skillfully. What seems to be standing in the way is political maneuvering for short-term advantage at the expense of long-term benefit. And to the harm of the people and the country and in violation of principles!
Will contradictions in the interest of self-service never cease? Sadder yet a recent poll shows overwhelming support for reform and a pronounced lack of confidence in success, for just these reasons.
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Socionomic Perturbations: the Private Costs vs ....
The Mounting Price of Health Care’s Status Quo No sooner had the provisions concerning health care in the House’s economic stimulus bill seen the light of day than the defenders of the status quo came out, guns blazing. One target is the proposed development of a nationwide electronic health information infrastructure. The other is an initiative for “comparative effectiveness analysis,” which refers to estimates of the cost of different therapies used to reach a particular outcome (e.g., there are multiple ways to treat high blood pressure, and they all cost different amounts). Both have strong bipartisan support. Unfortunately, a defense of the status quo is par for the course in American health policy. If the defense carries the day in the coming debate on health care reform, then the American people have only themselves to blame for the predictable consequences, which are: First, health-spending per capita in the United States will continue to rise 2 to 2.5 percentage points faster than the rest of per-capita gross domestic product, as it has done for the last four decades. Health care then will absorb about 40 percent of G.D.P. by 2040. Second, more and more middle- and lower-income American families will find themselves priced out of needed health care, as the cost outpaces the growth in the wage base that supports the families. They will experience harsh rationing of health care, not by government, but by price and their ability to pay. And, third, the waste most experts impute to our health system would continue unabated, as it thrives on the opaqueness of a heavily paper-based, fragmented health system that shuns comparative effectiveness analysis. Part of the problem is that the defenders of the status quo always skillfully mingle several distinct issues that ought to be treated separately. These issues, much discussed in the well-respected literature, are: 1. Appropriateness: A growing body of scholarly literature suggests that a surprising fraction of the health care given to patients in the United States — and in other countries as well — does not appear to be the clinically most appropriate response to the patient’s medical condition. 2. Cost-Effectiveness: Even if clinically effective and appropriate, a good part of the health care delivered in this country does not appear to be the lowest-cost therapeutic approach to reach a given therapeutic target (e.g., managing diabetes or controlling blood pressure). 3. The Price of Changes in Health Status: As the cost of health care keeps rising, severely straining the budgets of households, businesses and governments, sooner or later we must confront the question of whether there should be an upper limit to the price that should be paid for a given improvement in health status, at least insofar as it is paid for out of collective health-insurance pools in private, commercial insurance or public health insurance programs.
- The Long-Term Outlook for Healthcare Spending
- ‘Cost-Effectiveness Analysis’ and U.S. Health Care
- Pricing Human Life(-Years)
The Baucus Plan: A Winner’s Curse for Insurance Companies On Wednesday, Senator Max Baucus of Montana, chairman of the powerful Senate Finance Committee, released his health care proposal, known as the chairman’s “mark.”At first glance, the mark comes across as a victory for the private insurance industry, which is why it was promptly attacked as a sell-out by liberal pundits (see, for example, this).But the health insurance industry may yet come to see it as a variant of winner’s curse — a term economists use to describe situations in which a winner regrets getting what he wished for.Under the plan, all insurers would have to take all comers asking for insurance in the restructured market for nongroup and small-group health insurance (known as guaranteed issue). Furthermore, although an insurer could vary premiums by age of the insured at a maximum differential of 5 to 1 (that is, the insurance premium paid by the oldest insurance subscribers could be as much as five times the amount paid by the company’s youngest subscribers), the insurer would have to charge all individuals (except smokers) within the same age band the same premium regardless of health status. Actuaries call this community rating.On the plus side, from the insurance industry’s perspective, a mandate on individuals and families to be insured would drive millions of additional customers into the industry’s book of business, many with sizable federal subsidies. It would enhance the industry’s fortunes at a time when the employment-based book of business is shrinking.But the mandate could turn out to be a mixed blessing.Here’s the problem with this plan: The cost-control measures in the Baucus plan alone will not be enough to control skyrocketing health care costs. Whatever the insurance industry may say about its prowess in the market for health services, it has always been relatively much weaker than doctors and hospitals in that market and therefore quite frequently has had to raise its premiums at double-digit rates from year to year. That is especially true of the nongroup and small-group market. But it happens even in the large-group, employment-based market — most recently during 1999-2003.
What you don't have can kill you News that this year’s premium growth for job-based family coverage came in at a relatively moderate 5% was offset by dire forecasts of what an average policy will cost 10 years from now, assuming that the atypical pattern of slower growth we’ve seen in the last few years continues. Sen. Max Baucus finally released the Senate Finance Committee’s health-reform bill, which disappointed many on both the political left and right even as they grudgingly agreed that it qualifies as progress. And a new study found that a whopping 45,000 Americans die every year because they lack health insurance, a number more than twice as high as the previous estimate from 2002. To recap: Premiums for a full year of family coverage increased 5% to $13,375 in 2009, with employees on average footing $3,515 of the bill and employers paying $9,860, according to a report released Tuesday from the Kaiser Family Foundation and the Health Research & Educational Trust
Political Gyrations: Searching For Common Ground
Obama Brings Together Old Health Foes at Summit to Start Work on Overhaul The White House conference today brought together insurers, drugmakers, consumers, hospitals, and lawmakers to talk about how to provide affordable medical coverage to everyone while restraining costs. Expanding insurance would make drugs more widely available, while comparison studies may lead government and private insurers to cover cheaper products at the expense of drugmaker profits. Agreeing on tradeoffs like that may be the hardest part of changing the U.S. system, said Pete Davis, president of Davis Capital Investment Ideas in Washington. “It’s a nice touch to get everyone together for discussions, but health-care reform will quickly return to trench warfare for much of this year,” Davis said in a note to clients today. Obama said an agreement this year is critical for the economy to bounce out of a recession and the government to bring down its deficit. He urged Congress to assemble a package and find additional financing this year. “Today is completely different,” Kahn, a participant, said before the conference. “We want this to happen. There is an expectation that there will be shared sacrifice to make this happen and we are more than willing to take part in the discussion to decide what that’s to be.”
'Professor' Obama lances healthcare poison Juggling the roles of professor, conciliator, salesman and crafty political strategist, President Barack Obama launched his healthcare reform drive with the most mild-mannered open debate. Healthcare might be the most poisoned issue in US domestic politics, separating those who want a bona fide US National Health Service, and others who spit venom at the thought of "socialized medicine." Yet in a collegial, congenial White House forum Thursday, Obama compared a discussion involving the uninsured and the insurers, doctors and patients, and bitter foes who spend their lives throwing punches across the political aisle. Obama's healthcare summit, mixing presidential symbolism and informality in the East Room of the White House, was carried live on cable television, and was a powerful political tool as he stresses bipartisan credentials. The hybrid event had the air of a college seminar, with former law professor Obama directing the free exchange of ideas. It also recalled campaign townhall meetings, with the audience seated around the president, albeit in a more restrained and choreographed style than the hundreds Obama held on the campaign trail. The president also called on Karen Ignani, a representative of American health insurers. "We want to work with you -- we want to work with the members of Congress on a bipartisan basis here. You have our commitment," she said. The health insurance lobby was seen by many critics as the ultimate roadblock to healthcare reform the last time it was tried, in a defeat which severely drained former US president Bill Clinton's political capital. White House officials have only replied vaguely when asked how that defeat impacted their strategy. But the open, televised event on Thursday cut a clear contrast with the former Democratic president's effort, under then first lady and now Secretary of State Hillary Clinton, which was criticized for being closed, secretive and an attempt to impose a solution on Congress.
Health-Care Plan Could Bridge Divide The health-care train is about to pull out of the station in Congress. How far it goes may depend on whether good seats are given to two very different senators, Democrat Ron Wyden of Oregon and Republican Robert Bennett of Utah. For the past couple of years, those two have been trying to do what nobody else in Washington has achieved: redesign America's health coverage in a way that both liberals and conservatives can accept. The fruit of their labor is a fully formed plan -- officially called the Healthy Americans Act -- that would give health insurance to every American in an entirely new way. It seeks to make that politically possible by giving both the left and right a couple of big features they would like, and a couple they wouldn't.Specifically, Messrs. Wyden and Bennett would require that everyone in America have an insurance policy and would give government help to many families to help buy one. That should please the left. But the plans would be offered by private insurance companies. That should please the right. Employers would help pay but no longer would be the main procurers of health insurance. People would do that for themselves. Best of all, the Wyden-Bennett plan is designed to pay for itself in just a couple of years. There's no silver-bullet solution to America's health problems, and this isn't one either. But it does show there are, in fact, ways to build bridges between differing views. A bipartisan group of senators of left and right already has signed onto the act. "There's a philosophical truce that's reachable here," said Mr. Wyden as he and Mr. Bennett shared breakfast in the Senate dining room one recent morning. The most formidable opposition to their approach, said Mr. Bennett, comes from "the status quo caucus" of groups willing to live with the current system, flawed as it may be. But that caucus is shrinking, which is why something might actually happen on health this year. Employers are tired of the rising costs they face providing health coverage. Employees are tired of paying more out of their pocket for coverage that seems to shrink every year. Federal and state governments are tired of seeing their own health bills go up because costs seem to be beyond their control.
Health-Care Dialogue Alarms Obama's Allies As Congress returns to begin an intense debate over reshaping the nation's $2.2 trillion health-care system, prominent left-leaning organizations and liberal House members are issuing a warning to their Democratic allies: Don't cave on us. The early skirmishing -- essentially amounting to friendly fire -- is perhaps the clearest indication yet of the uphill battle President Obama faces in delivering on his promise to make affordable, high-quality care available to every American. Disputes over whether to create a new government-sponsored insurance program to compete with private companies shine a light on the intraparty fissures that may prove more problematic than any partisan brawl. More than 70 House Democrats recently warned party leaders that they will not support a broad health reform bill that does not offer consumers a government-sponsored policy, and two unions withdrew from a high-profile health coalition because it would not endorse a public plan.
Harry and Louise ride again THE final nail in the coffin of Hillarycare came when Harry and Louise appeared on television. Hillary Clinton’s effort to introduce a government-run health system over a decade ago fell apart when two worried, middle-aged Americans were shown equating reform with bloated bureaucracy. That ad was paid for by the health-insurance lobby. Now Barack Obama says that reform is a priority again. He argues that the recession only adds urgency, as there is no way to tackle long-term deficits without fixing health care. Kathleen Sebelius, his new nominee for the post of secretary of health and human services, this week pointed out to a Senate committee that nearly half of all recent home foreclosures have resulted, in part, from families being hit by health expenses not covered by insurance. So it would be rum indeed if the latest reform efforts were also shipwrecked by the insurance lobby. At first the industry made noises of general support, and its lobbyists joined various bipartisan efforts to broker a deal. But relations are turning frosty again. Senator Jay Rockefeller, head of the Senate’s Commerce Committee, dragged a leading insurance boss into a hearing on March 31st to face allegations of overcharging. So is the “greedy” insurance lobby getting ready again to skewer reform? The industry’s foes certainly think so. Such folk want a muscular government-run insurer to compete against the rapacious private insurers, and so get costs under control while expanding coverage. Boosters of “public provision” think that if Medicare, the government health scheme for the elderly, were opened to all comers, it could squeeze savings out of hospitals just as Wal-Mart does from its suppliers. That seems plausible; but look closer, and it turns out the insurers are not being unreasonable. For one thing, although Wal-Mart is a giant it does not also regulate itself and impose price controls (as a federal insurance scheme could). A recent study by the Commonwealth Fund, a think-tank, calculates that a strong government insurer could suck away 65m-70m customers from private rivals. Experience with Medicare offers one reason to treat Ms Pelosi’s proposal with caution. Denis Cortese, head of the Mayo Clinic, a respected hospital chain, worries that any new government insurer would underpay hospitals for care, forcing a shift of costs on to private insurers. These, in turn, would be forced to pass on that cross-subsidy as higher rates for corporate clients. Various studies have shown that this is what is happening today. Dr Cortese estimates that Medicare underpaid his outfit by $840m last year alone.
Health Care's Tomorrow Over time, certain ideas become irresistible. They start out as problematic. Later, no one can remember why. Consider Tuesday's bipartisan ceremony at which President Obama signed the Edward M. Kennedy Serve America Act. Thirteen years ago, Republicans in Congress tried to kill Bill Clinton's AmeriCorps program. This year, Republicans and Democrats joined together to pass the largest expansion of service opportunities in decades. Tomorrow isn't always defined by yesterday. Bear that in mind as you hear reports about this or that snag, controversy or disagreement over the effort to pass comprehensive health-care reform. Because of its defeat in 1994, there will be a temptation to treat every dispute -- notably the recent reports of contention over the inclusion of a government-run option in a final bill -- as the first step toward the collapse of the process. The "public plan" idea is a good one, and the issue is important: If the government makes it possible for everyone to buy health coverage, one option among many should be a government-run health insurance plan akin to Medicare. The genius here involves both politics and policy. Many liberals believe our entire health-care system should be scrapped in favor a government-run single-payer plan along Canadian or British lines. The problem is that single-payer is not only politically impossible; it would also cause significant disruptions in the existing system. The public-option idea is a clever halfway house. It would allow the United States to move gradually toward a government-run system if -- and only if -- a substantial number of consumers freely chose to join such a plan. The market would test the idea's strength. Private insurers hate the idea because they think the public plan would undercut them in the marketplace. This argument is, in some ways, self-refuting. If the private insurers are right that the government would actually provide health coverage more cheaply than the private companies, why shouldn't that option be available? Since the government would be ponying up to help people buy insurance, wouldn't this save taxpayers money in the long run? But negotiations over health care will involve give-and-take. What if including a robust public plan has the effect of dooming a bill that gets affordable health insurance to everyone? Should public-plan advocates block any bill that doesn't contain their idea, as originally conceived? Of course not.
Industry leaders meet with reform chief DeParle After two hours of hearing from more than 30 healthcare industry leaders, Nancy-Ann DeParle, director of the White House Office of Health Reform, encouraged participants to “stay with us” as the federal government works to reform the nation’s ailing healthcare system. In the end, the discussion did not identify any clear next steps for DeParle’s office. Rather, it highlighted problems that have plagued healthcare for years—including high costs, chronic disease and coverage—and centered on a few solutions that have been mentioned before, such as preventive care, health IT, comparative-effectiveness research, and integration of healthcare with the broader community. “We have a high-class problem now,” DeParle said at the conclusion of the healthcare stakeholders discussion in Washington. She then acknowledged an earlier comment from participant Jennifer Bordenick, chief operating officer and interim CEO of the eHealth Initiative, who said “The devil is in the details” when she talked about reform and HIT implementation. “The great news is that we are in the details,” DeParle said. “Congress is working, and you’re all at the table, helping.” The roster of attendees included physicians, nurses, public health advocates, industry leaders, IT professionals and policy wonks, many of whom applauded the current administration for focusing on reform. “What’s evident in this room is the passion and the significant amount of common ground in the issues,” said Paul Diaz, president and CEO of post-acute provider Kindred Healthcare in Louisville, Ky., who added later: “It’s important to link coverage and payment. There is so much dislocation between Medicare, Medicaid and the private plans.” Healthcare stakeholders meeting at White House
Aide Guides Health Overhaul With Light Touch The cost-cutting pledge to be announced by health-care groups Monday is an example of the White House strategy that health czar Nancy-Ann DeParle has pushed: keeping potential opponents on board.Influenced by the failure of President Bill Clinton's health plan 15 years ago, Ms. DeParle, who worked in the Clinton White House, has met in recent weeks with doctors, nurses and small-business owners, as well as nearly 60 members of Congress. The goal is to seek broad support for President Barack Obama's ambitious plans for a health-care overhaul -- or, at least, ensure that big players don't declare war on the Obama program. One thing Ms. DeParle hasn't done is publicly get into the nitty-gritty of what the overhaul of the health-care system should look like. That's Congress's job, she says. Some lawmakers are hoping for a little more White House direction. Senators are expected to lay out some details this week on their plans to broaden health-care coverage. It is important that the White House isn't "waiting to see what we do and deciding to see if they like it or not," said Sen. Christopher Dodd (D., Conn.). Ms. DeParle, recalling the criticism of Mr. Clinton's highly detailed plan that failed in Congress in 1993-94, said it is "much better to have the president lay out the principles." Meanwhile, she is working behind the scenes with lawmakers who are crafting the details, and she helped pull together the industry effort to reduce the rate of health-care spending growth. Ms. DeParle's style reflects significant experience in the private sector, a relative rarity in the upper ranks of the Obama administration. For the past two years, she was a managing director at CCMP Capital Advisors, a New York private-equity firm, where associates say she demonstrated a skill for building consensus on tricky issues. Ms. DeParle said many large questions on the health-care bill are unanswered, but some broad ideas have shifted. As a candidate, Mr. Obama pushed for introducing a public health-insurance plan to help expand coverage to all Americans and create more competition, and he likened that plan to Medicare. Now, the administration has backed away from structuring the plan like Medicare, which reimburses doctors and hospitals at lower rates than private plans. "One thing I've learned is that there are a lot of different models out there" for a public plan, Ms. DeParle said.
Obama Lauds Offer to Cut Costs Volunteering to "do our part" to tackle runaway health costs, officials from leading groups in the health-care industry met today with President Obama and offered to squeeze $2 trillion in savings from projected increases over the next decade. Obama, calling the meeting "remarkable," noted that some of the groups making the offer "were among the strongest critics of past plans for comprehensive reform." Some were involved in the "Harry and Louise" ad campaign that helped derail health care reform efforts during the Clinton administration. What prompted the meeting, he said, "is a recognition that we can't continue down the same dangerous road we've been traveling for so many years, that costs are out of control, and that reform is not a luxury that can be postponed, but a necessity that cannot wait. The pledge comes amid a debate over how, or whether, to overhaul the nation's health-care system, and Obama administration officials predicted that it will significantly increase momentum for passing such changes this year. The groups aim to achieve the proposed savings by using new efficiencies to trim the rise in health-care costs by 1.5 percent a year, the officials said. That would carry huge implications for the national economy and the federal budget, both of which are significantly affected by health-care expenses. Representatives from half a dozen health industry trade groups made the formal offer today in their White House meeting with Obama. "I don't think there can be a more significant step to help struggling families and the federal budget," a senior administration official said in a conference call with reporters last night. The official spoke on the condition of anonymity because the offer remained tentative. The trade groups making the pledge represent a broad spectrum of health-care interests, including the American Medical Association, the Pharmaceutical Research and Manufacturers of America, the American Hospital Association, America's Health Insurance Plans, and the Service Employees International Union.
Blue Double Cross That didn’t take long. Less than two weeks have passed since much of the medical-industrial complex made a big show of working with President Obama on health care reform — and the double-crossing is already well under way. Indeed, it’s now clear that even as they met with the president, pretending to be cooperative, insurers were gearing up to play the same destructive role they did the last time health reform was on the agenda. The story so far: on May 11 the White House called a news conference to announce that major players in health care, including the American Hospital Association and the lobbying group America’s Health Insurance Plans, had come together to support a national effort to control health care costs. The fact sheet on the meeting, one has to say, was classic Obama in its message of post-partisanship and, um, hope. “For too long, politics and point-scoring have prevented our country from tackling this growing crisis,” it said, adding, “The American people are eager to put the old Washington ways behind them.” But just three days later the hospital association insisted that it had not, in fact, promised what the president said it had promised — that it had made no commitment to the administration’s goal of reducing the rate at which health care costs are rising by 1.5 percentage points a year. And the head of the insurance lobby said that the idea was merely to “ramp up” savings, whatever that means. Meanwhile, the insurance industry is busily lobbying Congress to block one crucial element of health care reform, the public option — that is, offering Americans the right to buy insurance directly from the government as well as from private insurance companies. And at least some insurers are gearing up for a major smear campaign. On Monday, just a week after the White House photo-op, The Washington Post reported that Blue Cross Blue Shield of North Carolina was preparing to run a series of ads attacking the public option. The planning for this ad campaign must have begun quite some time ago. The Post has the storyboards for the ads, and they read just like the infamous Harry and Louise ads that helped kill health care reform in 1993.
Barack Obama's health plan takes shape If Congress were to take a vote on a health reform bill today, Democrats and Republicans would find a surprising level of agreement — so much so that the broad outlines of a consensus plan already are taking shape. Sick or healthy, rich or poor, all Americans would be guaranteed access to health insurance. In fact, they’d probably be required to purchase it — perhaps through mandates in the law that would include stiff tax penalties for anyone who tried to opt out. Newly created insurance marketplaces would make finding a plan as easy as shopping for cheap airfare. People could keep their coverage, even if they switched jobs. And they might be able to choose between private insurers and a government-backed plan. But here’s the catch — none of this would come free, with the wealthiest Americans likely to face higher taxes to help pay for coverage for all. It’s hard to believe that only three months ago, health care advocates worried that President Barack Obama would drop the health reform issue from his first-year agenda. Now, with an August deadline to pass a bill, a compromise that once seemed unimaginable is considered quite possible, both sides say. Congress this week begins a two-month sprint to pass legislation overhauling the health care system — an aspiration that has eluded generations of American politicians. The task is exceedingly complex and faces the legislative equivalent of an Ironman triathlon, tested at every stage by monied interests, political alliances and an estimated 13-figure price tag.
- Health groups outline plan to cut costs
- Gregg gives health reform a go
- W.H. makes economic case for reform
- House Dems draft sweeping health bill
Obama to Forge a Greater Role on Health Care After months of insisting he would leave the details to Congress, President Obama has concluded that he must exert greater control over the health care debate and is preparing an intense push for legislation that will include speeches, town-hall-style meetings and much deeper engagement with lawmakers, senior White House officials say. Mindful of the failures of former President Bill Clinton, whose intricate proposal for universal care collapsed on Capitol Hill 15 years ago, Mr. Obama until now had charted a different course, setting forth broad principles and concentrating on bringing disparate factions — doctors, insurers, hospitals, pharmaceutical companies, labor unions — to the negotiating table. But Mr. Obama has grown concerned that he is losing the debate over certain policy prescriptions he favors, like a government-run insurance plan to compete with the private sector, said one Democrat familiar with his thinking. With Congress beginning a burst of work on the measure, top advisers say, the president is determined to make certain the final bill bears his stamp. “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.” On Saturday, while Mr. Obama was traveling in Europe, he used his weekly radio and Internet address to make the case that “the status quo is broken” and to set forth his ambitious goals.
Political Gyrations: Running the Sausage Machine
Dems answer Obama's call for action on health care Democratic leaders wrestling with health care legislation are confronting a host of knotty issues such as medical malpractice, abortion, illegal immigrants and Medicaid, all the while predicting passage of sweeping health care legislation within a few months. "That's the legislative process," House Speaker Nancy Pelosi said as she and other Democrats shifted from praising President Barack Obama's health care speech this week to the less glamorous task of trying to negotiate a bill that will pass muster with a host of opposing factions. "As issues emerge, let's drill down on the public option, let's drill down on what this means to small business, let's drill down on what this means to seniors," Pelosi, D-Calif., said Thursday. Increasingly, events in the Senate Finance Committee appeared pivotal, precursor to likely votes in both the House and the Senate by early October. Sen. Max Baucus, D-Mont., has said he will convene the committee the week after next to vote on legislation that would meet Obama's goal of expanding access to health care, providing consumer protection to those with coverage and slowing the growth of medical spending overall. Still unclear was whether Baucus would get a bipartisan deal after months of negotiating with two other Democrats and three Republicans on his committee — the so-called Gang of Six. If he doesn't, Baucus has said he'll go it alone, but a bipartisan compromise is still in play, with another meeting set for Friday.
- Details Lacking on Obama Plan
- Charm, But No Ideas
- After Obama's Speech, It's Back to Wooing the Skeptics
- Health care bill coming soon
Oh, Mr. Wilson What's more memorable: a president's rehearsed assertions from the podium or a bunch of congressmen booing the leader of the free world? Otherwise, jeers, eye-rolling and further expressions of disapproval are practically de rigueur for opposition leaders. The queen of disapproving glances isn't Nancy Pelosi, who glared at Wilson, but Hillary Clinton, who listened to George W. Bush's State of the Union addresses with the sort of expression one usually associates with sailing the Drake Passage. And who can forget Sen. John McCain's dozing through Bush's 2007 State of the Union? Or Democrats booing and heckling Bush throughout his 2005 address? The list goes on. This is not to excuse Wilson's behavior, which caused him to become an overnight Twitter sensation. His offense sets a new low bar. But as a nation, we have entered a political era of uninhibited belligerence. The civility we insist that we prefer has been in short supply at town hall meetings, several of which Wilson conducted. A review of his Twitter log during the August break reveals a busy slate of meetings with angry crowds -- 1,500 people in Beaufort, 1,000 in Hilton Head. No one is more surprised by Wilson's implosion, meanwhile, than those who know him to be polite, humble and deferential. (Disclosure: A nephew works in his office.) A former aide to Strom Thurmond, Wilson apparently acquired the late senator's knack for constituent service. Few are quicker with a congratulatory letter or a note of sympathy. Wilson's actions Wednesday, in other words, seem vastly out of character and, perhaps, evidence of what the ladies back home might call "a case of the nerves." Wilson's psychoanalysis will have to fall to others, but further public persecution is unnecessary. Rob Miller, a Marine captain and Iraq war veteran who is Wilson's opponent for reelection, reportedly has increased his coffers by $500,000 since Wilson's one-man siege. Obama escaped the assault both unruffled and unscathed. Though he may have stolen the show, Wilson may have lost his audience.
The Dime Standard On Wednesday night, Barack Obama delivered the finest speech of his presidency. The exposition of his health care views was clear and lively. The invocation of Teddy Kennedy was moving and effective. The rumination at the end about the American character and the role of government was the clearest summary of Obama’s political philosophy that he has yet given us. Best of all for those of us who admire the political craft was the speech’s seductive nature and careful ambiguity. Obama threw out enough rhetorical chum to keep the liberals happy, yet he subtly staked out ground in the center on nearly every substantive issue in order to win over the moderates needed to get anything passed. Finally, people in the administration and moderates in Congress would like to beef up the “game changers.” These are the wonky but important ideas like bundling hospital payments and increasing price transparency that might lead to a more efficient system down the road. In short, the president can read the polls just like anybody else. He has apparently recognized the need to pull back to get something passed. He is, characteristically, trying to rise above old divisions in search of a pragmatic sweet spot. He has opened up many opportunities for intelligent Republicans and moderate Democrats to constructively offer amendments to improve the bill and bring it closer to fiscal sanity. Which is not to say that this is effective health reform. The only risible parts of the speech came when Obama said that parts of the system work (they don’t; they’re unsustainable) and when he said he would be the last president to take on health care (we still await a president willing to take on fundamental perversities in the system). For whatever reason, President Obama has decided not to be that president. He has decided to expand the current system, not fix it. His speech on Wednesday, and the coming legislative changes, make it much more likely he will achieve his goal.
My Comment: a more balanced column with great political insight. I'm almost afraid to point it out but there's more radicalism in the proposal principles than anybody has yet figured out. One could parse the planks into two parts. Incremental fixes to the system (forbidding rescinding, capping out of pocket, extending coverage, etc.). The radical part is the combination of a standards board and exchanges - which is incrementalist in the short-run and a very clever market-oriented way to fill in the holes. But in the long-run the two together introduces a new whole forcing function that has the strong potential to start controlling treatments, reimbursement rates and moving toward a fee for treatment model from the fee for service that lies at the root of the perversities you point to. All that said there's another dimension to this that you should consider - the President appears to me to be trying to find middle ground that's pragmatic. And compromising liberal principles to seek compromise. The Republican party appears to be dead-sight against all compromise in the interests of a political victory and has "just said NO" to every initiative since Jan20th. The great irony here, given my analysis, is that the heart of the proposal is radical free-market mechanisms that could restore competition to a non-competitive market, serve the interests of the country, help their constituents and help their constituents. Yet the party appears to be sacrificing their own principles in pursuit of political victory.
GOP embraces conservative groups’ protest With tens of thousands of conservative protesters expected to gather in Washington on Saturday for a "Taxpayer March on D.C.," Republican officials are attempting to capitalize on a movement that lately has galvanized anti-Obama activists more effectively than the party's elected leaders in Washington.Searching for ways to compete with Democrats after two consecutive electoral drubbings, Republicans have moved past earlier uncertainty about the protesters, who organized nationwide rallies this summer that have threatened Democratic health-care plans and eroded President Obama's standing with the public.Several key Republican lawmakers, including House GOP Chairman Mike Pence of Indiana, have helped to drum up support for the march and are slated to deliver speeches to the crowd.But top Republican strategists and many party observers also worry about the impact that the most extreme protesters might have on the party's image, including those who carry swastika signs or obsess over the veracity of Obama's Hawaiian birth.Mark McKinnon, a former adviser to Sen. John McCain (Ariz.) and other Republicans, said there is an "opportunity for Republicans" to tap into legitimate fears about an overreaching federal government. But he said that "right-wing nutballs are aligning themselves with these movements" and are dominating media coverage."It's bad for Republicans because in the absence of any real leadership, the freaks fill the void and define the party," McKinnon said.Saturday's march is sponsored by the same loose-knit coalition of groups that helped to organize health-care protests over the summer and anti-tax rallies in the spring. They include the Tea Party Patriots, ResistNet and Freedomworks, a Washington-based organization headed by former House majority leader Richard Armey (R-Tex.). The march has also been heavily publicized by Fox News host Glenn Beck as part of his "9-12 Project."
Some Interesting Vidclips
Language: A Key Mechanism of Control (Newt Gingrich's 1996 GOPAC memo): As you know, one of the key points in the GOPAC tapes is that "language matters." In the video "We are a Majority," Language is listed as a key mechanism of control used by a majority party, along with Agenda, Rules, Attitude and Learning. As the tapes have been used in training sessions across the country and mailed to candidates we have heard a plaintive plea: "I wish I could speak like Newt." That takes years of practice. But, we believe that you could have a significant impact on your campaign and the way you communicate if we help a little. That is why we have created this list of words and phrases. This list is prepared so that you might have a directory of words to use in writing literature and mail, in preparing speeches, and in producing electronic media. The words and phrases are powerful. Read them. Memorize as many as possible. And remember that like any tool, these words will not help if they are not used. Often we search hard for words to define our opponents. Sometimes we are hesitant to use contrast. Remember that creating a difference helps you. These are powerful words that can create a clear and easily understood contrast. Apply these to the opponent, their record, proposals and their party. Often we search hard for words to define our opponents. Sometimes we are hesitant to use contrast. Remember that creating a difference helps you. These are powerful words that can create a clear and easily understood contrast. Apply these to the opponent, their record, proposals and their party.(intolerant, liberal, lie,limit(s),machine,mandate(s),obsolete,pathetic,patronage,permissive attitude).
- Good through government Sept. 10: Rachel Maddow talks about the message of liberalism in President Obama's health care speech before a joint session of Congress.
- Health fight threatening 'fabric of our nation'? Time's Joe Klein joins the Morning Joe gang to discuss the potential impact of President Obama's push for health care reform.
- Pawlenty: Rep. Wilson's outburst 'inappropriate': Republican Minnesota Gov. Tim Pawlenty joins the Morning Joe gang to discuss President Barack Obama's health care address, as well as the short-term future of the legislation. And then goes onto defend death panels, illegal coverage and the excess growth of government.
- Rep. Joe Wilson interviewed on Sean Hannity on Fox. In which he stands by his position.
- Rep. Wilson's YouTube Campaign Ad: in which he further reiterates his positions.
- Joe Wilson becomes national joke: Countdown takes a look at the week that was for Rep. Joe Wilson, R-S.C., with the late night circuit reacting to his now infamous "You lie," outburst
- Thousands protest spending in D.C: Thousands of people marched to the U.S. Capitol to protest President Obama's health care plan and what they say is out-of-control spending. WRC's Derrick Ward reports.
- Right wing fringe finds acceptance in GOP: Mike Lux, CEO of Progressive Strategies, joins msnbc's Rachel Maddow to discuss the Republican Party's mainstream of the most extreme anti-government elements of their political base
Americans Back Obama’s Health Goals Even as They Doubt Success Americans overwhelmingly approve of President Barack Obama’s goals for remaking the U.S. health- care system even as they express skepticism he can achieve them, according to a Bloomberg News poll.More than 8 out of 10 people support covering the uninsured, curbing costs, creating an insurance-purchasing exchange, and preventing insurers from dropping coverage or refusing to accept people with preexisting medical conditions. Majorities say employers should have to offer insurance and individuals should be required to have coverage.Americans are less sure of the plan as a whole. At least half say they don’t think Obama can fulfill promises such as passing legislation that doesn’t add to the federal budget deficit, preserving the Medicare trust fund and producing savings to help pay for drugs for Medicare patients.Three of four poll respondents support an employer mandate and 59 percent back the idea of requiring everyone to get health insurance, just as they’re obliged to have auto insurance to drive.The poll also shows that Obama may have succeeded in using the speech to Congress to dispel some allegations spread about Democratic proposals. Majorities reject as distortions or scare tactics assertions that have served as talking points for opponents.More than 6 out of 10 respondents say they don’t believe that Obama would set up “death panels” to decide who gets care or that government money would be used for abortions. Similar percentages reject the idea that Obama plans to ration care or cover illegal immigrants.When asked if health care would become “socialized” under the White House proposals, 52 percent reject the notion; 43 percent say it was a legitimate concern.More than 6 out of 10 poll respondents say the current health-care system has some problems that need to be fixed. Another 25 percent say it’s “badly broken” and 11 percent describe it as “really pretty good.”Insurance companies are by far the biggest culprit for problems, participants in the poll say. Still, only half the respondents view health insurers unfavorably; more than half have unfavorable views of pharmaceutical companies.Americans are happier about Medicare, the government program for the elderly, and their own providers, according to the poll. Almost 8 out of 10 have a favorable view of Medicare and even more approve of doctors and hospitals.Even so, a slight plurality says it’s better to pass health-care overhaul legislation that may have some flaws and unexpected consequences than to do nothing at all. And 54 percent say Obama is doing more to reach out to Republicans than vice versa, compared with just 22 percent who say the Republicans are trying harder to find common ground.
