Tuesday, February 9, 2010

Lets Make a Deal

The Republican leadership has responded to the White House invitation for a health reform summit on Feb. 25 with a list of demands or they won't show.

The President should agree to no reconciliation IF they agree to let a final bill have a straight up or down vote in the Senate. You know, majority rules. So, no reconciliation if you won't filibuster. Easy.

He ESPECIALLY should agree to have the CMS actuary come and testify/present. Based on what the acutary has written of late, his presentation will go something like this.
1. The current health system is unsustainable.
2. If we do nothing, we will spend $33.3 Trillion on health care in the next 10 years.
3. If the Senate bill becomes law we will spend $33.6 Trillion on health care in the next 10 years, and 36 Million people (what actuary said) will be insured in 2019 who will otherwise be uninsured.
4. We really need to do something.
5. If you want to really slow cost escalation in health care you will need to do two things: (1) reform the tax exclusion of employer paid insurance; and (2) Begin to apply cost effectiveness research/some means of reducing expenditures in Medicare that are either non-productive or where the costs are greater than the benefits.
6. Now do something.

Then I would ask the Governors to come and ask them a simple question. "If you are opposed to an individual mandate, how do you think we can got more people covered?" Especially invite the Governors from the 5 states with the LEAST insurance regulation and ask them why they haven't lead the way in terms of the proportion of their population that is insured? And finally ask them whether they think we as a society should reconsider the legal requirements, as well as the cultural and moral intuitions that underlie the fact that people who are uninsured actually get care, and whose costs are then quietly socialized? If we are not going to come up with a financing mechanism for uncompensated care, why should providers have to provide care?

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