Monday, November 23, 2009

What Next?

Unless there are really big developments (which is doubtful) on the reform front, I am going to take a bit of a breath over the next few days and won't be blogging and won't be writing in the News and Observer this Friday. Here are a few thoughts on what I think are the likely direction of things in the Senate with the bill.

1. Public Option will come out. And the weak public option is not worth having in the first place, I don't think. A strong triggered public option would like be more effective at 'holding insurance companies honest' than the one now written.

2. I think med malpractice comes in. For a certain segment of the population who want reform and who want to see the President succeed and who think the Republicans are just blocking for political gain....they still have uncertainties and things don't pass the BS test for them. Reflexively, they think med mal reform is important and bringing it in will appeal to them, the doctors of the nation, the moderates in the Senate and the Blue Dogs in the House. And the CBO says that a list of changes will reduce deficit by $54 Billion over 10 years....with ~$40 Billion of this being for declines in defensive medicine. And this will be important for any future cost control efforts because without med mal/tort reform, the docs will always say 'what about malpractice?' to any changes. I wrote about it last summer.

3. I assume some abortion compromise will be worked out. Those on both sides are very noisy.

4. An Independent Medicare commission is likely to stay in but be focused on payment reforms (shift from fee for service in Medicare toward other approaches). The questions related to things like changing eligibility age will be excluded from such a commission but will be wrapped up in some sort of Deficit reduction commission that is likely to come about next year....not as part of health reform but more generally next year as Dems seek to move ahead with a Deficit commission to prep for 2010 elections (and it is needed).

5. There will be attempts via health reform debate to cancel the remaining $200 billion in stimulus money and/or support of moderates will get hooked in with that issue.

6. Not sure what will happen on financing. I wonder if the addition of the payroll tax to Senate was result of a 'pre conference conference' with the Senate seems no way on income tax hike, while House was no way on insurance tax. Payroll tax plus pared back insurance tax the compromise? This is also where the med mal may be the only way to bring along some of the moderates.

Also, if something passes the Senate, perhaps the President will say 'this is my bill' and ask the House to treat it essentially as a conference bill, bring it to the floor with a rule that doesn't allow amendments? It is hard enough to get something through Senate about twice?

In the end, I think the key is what the members of Congress and their consitutuents understand the status quo of doing nothing to represent. How bad do they understand the status quo to be? I think pretty bad. As worry about deficits rise, there seems to be some who think we can't afford to do this now. In reality, it is the opposite. Because of what Medicare and Medicaid will do to the deficit inevitably with no change over the next 30 years, we cannot afford not to move ahead with something different. Advocates will have to be better at making this case for reform if it is to pass. The best visual for this reality is the graph that loads with this page.

As the headline of CBOs health care page says, "The federal budget is on an unsustainable path, primarily because of the rising cost of health care and the aging of the U.S. population." This refers to what happends if we do nothing. If we take a step now, we have a reasonable chance of improving this outcome.

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