In case you missed the media extravaganza from Blair House on Feb 25, John Goodman sums up the most important lesson: “Under no circumstances do you want to give any of these guys power over your health care.”
Obama himself spoke for 119 minutes, longer than the 110 minutes used by Republicans from whose ideas he purportedly wanted to learn. (Other Democrats spoke for 114 minutes.) But as Obama said, he can go overtime: “I’m the President.”
Out of the 40,000 letters the president receives everyday, “I get 10 letters…for me to take upstairs to the residence and read every single night,” Obama said. Sometimes five of the letters will be about healthcare.
In addition to the platitudes, sad stories, and “I” statements, Obama’s opening remarks contained a key truth: “Almost all of the long-term deficit and debt that we face relates to the exploding costs of Medicare and Medicaid. Almost all of it. That is the single biggest driver of our federal deficit. And if we don’t get control over that we can’t get control over our federal budget.”
So the Plan dumps 15 to 18 million more people into Medicaid, and extends the “Cornhusker Kickback” to all the states. The vote of Sen. Ben Nelson was reportedly bought by exempting Nebraska from the state share of increased Medicaid costs in perpetuity.
While Sen. Lamar Alexander stated that 50% of physicians refuse to see new Medicaid patients because of low fees, one survey showed the rate is only 28%.
The Plan still promises to cut half a trillion dollars out of Medicare over 10 years, despite filling in the “doughnut hole” in prescription drug benefits.
Two-thirds of hospitals already lose money on Medicare patients, and virtually all lose on Medicaid, writes Len Nichols, Ph.D., in the Feb 24 New England Journal of Medicine. Still, we should “be not afraid.” Although without comprehensive reform, we will face draconian price controls, benefit cuts, and ruinous interest rates within a decade, reform will fix the problem, despite expanded coverage.
“Only government can rewrite the rules of private insurance markets” or “lead locally dominant providers through payment reform.” The answer, Nichols believes, is comparative performance databases and reformed incentives.
State reform can only go so far, since insurers can leave the state. Also, thousands of smaller firms as well as big companies now self insure under ERISA to avoid state insurance mandates and premium tax payments. “Affordable health care is a national problem that demands a national solution,” writes Sara Rosenbaum, J.D., in the Feb 24 New England Journal of Medicine.
So what would be the effect of proposed federal insurance rules? Obama said premiums would go down; Alexander said they would go up. The CBO weighed in with a 28-page analysis. The answer seems to be: “It depends.” Large group plans, small group plans, nongroup plans? Income level (i.e. subsidy level)? “Bare-bones plan” (probably to be outlawed), “Cadillac plan (prepare to be taxed), or just-right plan?
One of the unbridgeable gaps appears to be abortion funding. Nancy Pelosi claims the new Plan doesn’t cover abortion, but Rep. Bart Stupak (D-MI) and others claim that it does. Layers of accounting gimmicks mean that everyone will be paying a monthly abortion premium.
Before the reconciliation process can be use to bypass a filibuster, the House has to pass a bill acceptable to the Senate. Abortion coverage may be the factor that defeats that maneuver. The key vote may then be not Scott Brown’s but Democrats who supported the Stupak Amendment in the House.
Goodman concludes that none of the speakers at the summit have any idea how to control costs, improve quality, or ensure acceess to care. The Republicans’ blank sheet of paper idea is the best one we have heard.
