Reform, Not Minimalism "Where's The Beef?"

I spent lots of time on National Health Lawyers Association activities in Washington, DC during Ronald Reagan's administration and remember the awesome power and control that President Reagan exercised through the House-Senate conference committee process. It would be hard for the current generation of Republicans to deny their Reagan heritage and cry foul should President Obama emulate Reagan's example with respect to reforming our health system.

But if Obama is going to use his presidential authority and legislative majorities to get the job done, it should be for major health care reform, not the minimalist program spelled-out in today's communique from the White House (Click Title for "Where's The Beef"):

"On Wed, Mar 3, 2010 at 11:45 AM, President Barack Obama wrote:

"Friend --

"Last Thursday's first-of-its-kind summit capped off a debate that has lasted nearly a year. Every idea has now been put on the table. Every argument has been made. Both parties agree that the status quo is unacceptable and gets more dire each day. Today, I want to state as clearly and forcefully as I know how: Now is the time to make a decision about the future of health care in America.

"The final proposal I've put forward draws on the best ideas from all sides, including several put forward by Republicans at last week's summit. It will put Americans in charge of their own health care, ensuring that neither government nor insurance company bureaucrats can ration, deny, or put out of financial reach the care our families need and deserve.

"I strongly believe that Congress now owes the American people a final vote on health care reform. Reform has already passed the House with bipartisan support and the Senate with a super-majority of sixty votes. Now it deserves the same kind of up-or-down vote that has been routinely used and has passed such landmark measures as welfare reform and both Bush tax cuts.

"Earlier today, I asked leaders in both houses of Congress to finish their work and schedule a vote in the next few weeks. From now until then, I will do everything in my power to make the case for reform. And now, I'm asking you, the members of the Organizing for America community, to raise your voice and do the same.

"The final march for reform has begun, and your participation is crucial. Please commit to join with me to take reform across the finish line.

"Essentially, my proposal would change three things about the current health care system:

"First, it would protect all Americans from the worst practices of insurance companies. Never again will the mother with breast cancer have her coverage revoked, see her premiums arbitrarily raised, or be forced to live in fear that a pre-existing condition will bar her from future coverage.

"Second, my proposal would give individuals and small businesses the same choice of private health insurance that members of Congress get for themselves. And my proposal says that if you still can't afford the insurance in this new marketplace, we will offer you tax credits based on your income -- tax credits that add up to the largest middle class tax cut for health care in history.

"Finally, my proposal would bring down the cost of health care for everyone -- families, businesses, and the federal government -- and bring down our deficit by as much as $1 trillion over the next two decades. These savings mean businesses small and large will finally be freed up to create jobs and increase wages. With costs currently skyrocketing, reform is vital to remaining economically strong in the years and decades to come.

"In the few crucial weeks ahead, you can help make sure this proposal becomes law. Please sign up to join the Organizing for America campaign in the final march for reform:

http://my.barackobama.com/commit

"When I talked about change on the campaign, this is what I was talking about: coming together to solve a huge problem that has been troubling America for 100 years and standing up to the special interests to deliver a brighter, smarter future for generations to come.

"I look forward to signing this historic reform into law. And when I do, it will be because your organizing played an essential role in making change possible.

"Thank you,

President Barack Obama"

MY OPINION

America needs reform which will provide: (1) efficient basic accessible, ethical, scientifically appropriate, health care, pharmaceutical product and health insurance coverage for every citizen in America; (2) a health care work force including physicians, nurses and other personnel, which is adequate in number, well-educated, highly competent, and incentivized to provide appropriate high quality health services; (3) a system, including but not limited to, a federal independent agency provider, which provides economically sound medically necessary, scientifically well-founded, and appropriate health services 24 hours a day, 7 days a week, 365 days per year; (4) appropriate incentives for high level mathematical and scientific student and post-graduate training; (5) a respected and appropriately supported system of national public health services which will coordinate and manage health care emergencies including epidemics, national disasters, bio-terrorism episodes, nuclear disasters and other events; (6) national licensing of health care providers; (7) support for local, national and internationally based health care fraud detection, prosecution and punishment; (7) continued support for scientific research; (8) appropriate quality, professional and financial standards for all institutional providers of health services including hospitals, outpatient facilities, research institutions dealing directly with patients; (9) independent objective public health education; and (10) encouragement and support of the development of enforceable ethical standards related to health care, health-related information, and products which purport to effect health care.

Keep Your Eyes On The Ball

During the Reagan era, as a board member of the National Health Lawyers Association (which subsequently morphed into the American Health Lawyers Assocation) I learned of the enormous power vested in House-Senate conference committees, where proposed legislation may be rewritten and the vote for the rewritten, often very different bill than that originally passed by the house or senate, is straight up and down.

Instead of getting excited about the political hoopla surrounding health reform, I suggest my readers keep their eyes on the ultimate conference committee and its rewrite of health reform. That's where deals will be made, the decisions hammered out, and health reform will either be gutted or given the muscle that it needs to work. Take a look at Ezra Klein/Jim Horney's analysis of conference committee functions for insight into this legislative powerhouse.

If Ronald Reagan's Health Coverage Was Cancelled

The story was told to me in the mid-90s with great enthusiasm, by a former executive of a major California-based health insurance company. It seems that a major California health insurer, which had enrolled State of California employees for many years, did a study to find out why writing health insurance for this group was becoming less profitable, and learned that it was experiencing adverse selection: all of the State of California employees who had selected the program were over age 40; the younger employees joined Kaiser which had much lower premiums.

So the insurer did just what insurers still do to employers. It notified California that it was no longer interested in the state's business, and that upon the termination of the contract, it would no longer provide coverage for state employees. The insurer "fired" the State of California.

Though I don't remember the name of the man who told me the story, I remember his grin and the twinkle in his eyes, when he related that among those who lost his coverage was then governor, and soon to be President, Ronald Reagan. The person who told the story said that when the insurer discovered its politically disastrous mistake, it withdrew its health insurance termination decision so that, once again, Ronald Reagan was insured.

I had no independent verification of the story. But it strikes me as quite consistent with health insurers' behavior. So I thought I'd pass it on. Perhaps one of my readers can give us additional details.