Senator Burr

Senator Richard Burr (R-NC), my senior senator put out the following statement yesterday about the Senate bill. Pretty standard Republican stuff this year, government takeover, saying the bill will explode the deficit when in fact the non-partisan CBO has said it will reduce the deficit by $130 Billion over 2010-19, and by $650 Billion from 2020-2029. As I say, this has been typical of Republicans this year--block and oppose anything--which is of course their right. But, it is very disappointing coming from Senator Burr, given that he has provided a bill of his own to the debate, The Patients' Choice Act (he is a co-sponsor of the bill).

I thought it would be worthwhile to review the Patients' Choice Act in the context of what is in the current legislation and Senator Burr's statements. I wrote about the Patients' Choice Act in the News and Observer on July 24, 2009. Here are other blog posts about the Act. Several big picture points.

*The Patients' Choice Act calls for repealing the tax exclusion of employer paid health insurance. The excise tax on high cost health insurance plans that is a part of the Senate finance bill is a de facto limiting of this tax exclusion. As Senator Burr and others (rightly) argue, ending the tax exclusion would help slow health care cost inflation. The tax on high cost health insurance plans is after the same idea. The tax proposed in the Reid bill is a much smaller tax increase than the repeal of the tax exclusion proposed by the Patients' Choice Act.

*The Patients' Choice Act had autoenroll procedures whereby person's would be automatically signed up for the lowest cost insurance plan available in an exchange, or health insurance market to be set up at the state level. This is an example of a 'implicit individual mandate' but the Act knew that if you are going to make risk pools work, you have to get people into them.

*Whatever else the Reid bill is, it is certainly not a government takeover of health care. It mostly leaves the system as is for the 160 Million people with employer based insurance, and the 105 Million people with Medicare and Medicaid [expands Medicaid]. It then creates insurance markets to try and cover others. The tag line 'government takeover' is ridiculous and not based in fact.

*All of the bills being discussed this year (including the Patients' Choice Act) have had as a central feature the setting up of insurance markets that were designed to help consumers be better shoppers of health care. The Patients' Choice Act (PCA) was much, much weaker on insurance market reforms than the Senate bill, and concerns over affordability which are raised over the Senate bill, would have been acute with the PCA because the subsidy provided was far, far below the cost of current policies.

*Probably the worst aspect of the Patients' Choice Act was its de facto block granting of the Medicaid program, which would have been a huge shift of costs to the states.

*The Patients' Choice Act was the first bill this year to have a fairly strong independent group to apply cost effectiveness research to coverage decisions. It is now being called an Independent Medicare Advisory Commission. Here is a detailed blog post about this from this past summer. So, I certainly don't expect to hear Senator Burr riffing on these ideas in the Senate bill since they were in his bill first. Title VIII of the Patients' Choice Act (pages 206-215) have some very detailed language about commissions to set standards, apply cost-effectiveness research, and even to penalize physicians who don't follow guidelines.

*Fiscal responsibility. It is hard to know how responsible the Patients' Choice Act would have been because it has never been scored by the CBO so far as I know. I wrote in July that it should be scored soon....but it never was, again, so far as I know. Is this because the CBO was too busy and couldn't do it? I am not sure. It is an advantage to be able to say you have a bill but not have it scored.

Like I have said in the past, I give Senator Burr credit for introducing a plausible bill. Not my preferred approach, but he made a reasonable attempt. As a citizen of North Carolina, I would certainly prefer him to seek to improve the bill instead of simply oppose. If he thinks the status quo is better than the Senate bill, he should vote against it and make the case to the people of North Carolina that he was standing up for us. I certainly don't agree. However, I am willing to listen. I would like to hear him make the case without resorting to the rhetoric contained in his statement of yesterday.