In two more days President Obama is scheduled to lay out his plan on moving forward with high priority healthcare reform legislation, following the largely partisan full day summit led by him on February 25th in Washington, D. C. with leading Democrat and Republican congressional leaders. I thought the President did a good job in trying to gain an uphill bipartisan consensus, but it became quite clear that, while there was some general agreement on a number of issues, the Republicans insisted on scrapping the pending bills, as well as the President's own recent proposal based for the most part on the Senate bill, and starting over from scratch as a condition for their support of a mutually satisfactory reform bill.
The Republicans must have known that the President and Democratic leaders would not be willing to go along with starting over after a year of meetings, hearings, filibustering and negotiations. However, based on recent public opinion polls generally unfavorable to Democrats, and their optimism for Republican prospects in the November mid-term elections, they were apparently very willing to take the risk involved. So it was in large part a strategic political decision by the Republicans. To be fair, their decision was also due to real concern with the affordability and scope of the Democrats' comprehensive plan.
There's no doubt that right now President Obama has his Chief of Staff Rahm Emanuel, Speaker Pelosi, and Majority Leader Reid pressuring members for support, and counting and recounting expected votes in the Senate and House for the President's plan, tweaked a little to incorporate some Republican summit input. There's no question that it's critical for the President to have a satisfactory bill passed within the next two to three months that he can sign into law. He would greatly prefer a bill that has a level of bipartisan support. He would also prefer to avoid, if possible, what most members of Congress and political pundits consider inevitable, achieving approval by the controversial process of reconciliation where all that's required is majority vote.
Democrats' priorities are cost controls, comprehensive reform, care affordability, healthcare insurance industry reforms, and especially wider coverage for uninsured and underinsured Americans. Republicans' priorities are cost controls, more limited lower cost reform, no increase in any taxes, and keeping our federal deficit and national debt as low as possible as a consequence of the approved legislation.
The President's and Speaker Pelosi's apparent two biggest challenges on the vote counting is to keep the House's liberal members in line, though these Representatives object to many parts of the Senate bill, and to win the votes of the 25 more moderate "Blue Dog" Democrats who voted against the House bill last year. The latter will likely prove the more difficult challenge.
Some additional thoughts:
1. It's a "no-brainer" that the final legislation should focus a great deal on eliminating fraud, abuse and obvious inefficiencies in our current system to the greatest extent possible, keeping in mind that this should have broad bipartisan support and the claim by Republican leaders that these activities account for as much as one-third of all healthcare spending.
2. In support of their push for more limited reform, and less government regulation, one of the Republican leaders stated that the U. S. already has the best healthcare system in the world, implying that very little reform is really needed. This is highly debatable, (given also the high level of fraud, abuse and inefficiencies) considering that 11-15% of our population is uninsured and a much higher percentage is either uninsured or underinsured, while in almost every other developed country everyone is insured. Moreover, the infant mortality rate in the U. S. is twice as high as in Italy, Austria,and Norway, and 50% higher than in Switzerland, France and Germany. Additionally, there is the fragility of our insurance coverage, due to the risks inherent in pre-existing conditions and losing or changing jobs, which are not a problem in most other developed countries.
3. The final bill should also allow purchases of insurance across state lines, in order to create more competition and thereby lower premium costs. I also think there should be agreement on some level of tort reform, as recommended by Republicans, to lower liability insurance costs for hospitals and doctors, thereby lowering costs to patients and premium costs billed by insurance companies.
4. As the world's wealthiest country, we should be able and willing to at least provide a limited, basic healthcare coverage to the most needy 5-10 million of our 35-40 million uninsured, especially the children in this group, without having a serious longer term negative impact on our deficit or national debt levels.
Frankly, all of the above points are relative "no-brainers" and a high majority of members of Congress, adequate to get the final legislation approved, should be able to agree and do what's right for the country, moving us in a positive direction towards one day hopefully actually having the best healthcare system in the world.
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Jeff responded that he thought I had made "all good points." His main concern is controlling costs. He had read that a bag of IV fluid costs patients $250, while it sells to the hospital for just $12. Also that while sutures cost patients on average about $200that they only cost the hospital $10. He had found that there are all sorts of examples that are even more egregious. Jeff added that we therefore need to get an explanation why these patient costs are so high. Where is all that money going?
I told him there are many other important questions that have not yet been answered satisfactorily. Among the most important is getting details on the claim by the Republican speaker at the recent summit that fraud, abuse and clear inefficiencies account for one out of three healthcare dollars spent! If correct, that's huge! Do Democrats agree to that high of a figure? What's the evidence that this very high level of activity is going on, what's the breakdown, and, if it's correct, why has it been tolerated and not successfully been acted on before???
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