Monday, March 22, 2010

Ten things about Health Reform

20090105_obama_pelosi_33It happened.  And the ink will go onto the paper in the next 24-48 hours marking the end of one of the most historic and contentious legislative battles in recent history.  But the fun is just beginning.

I’ve been asked all day: “what do you make of the health reform vote?”  This is the first chance I’ve had to sit in front of a computer (this post seemed worth specifically not pecking out on my blackberry), and so… here are ten things worth knowing about health reform:

  1. The winners and losers have faces and names.  When Massachusetts passed its universal coverage legislation a few years ago, a jubilant Mitt Romney stood arm in arm with an equally jubilant Ted Kennedy and everybody claimed victory.  The opposition voice was faint, miniscule.  And now that some are pointing to the fact that health care costs have risen sharply as a result in Massachusetts and the early promises of containment haven’t proven out yet, nobody has gone on the offensive.  There’s nobody to say I-told-you-so at the first sign of trouble.  In the current case, there are clear proponents (the President and Speaker of the House are tops on that list) and if/when trouble comes (as it always does), the opponents are going to point fingers.  The vitriol of the debate may wane in the coming days and weeks, but with the November elections looming, look for finger pointers to come out en masse.
  2. The selling game.  Typically, the best selling efforts come before passage.  But again, with elections coming, the President and Democratic leaders are going to hit the podiums, town halls, airwaves, twitter boards and blogs touting the benefits of this legislation.  They have roughly seven months to prove their point and they will get started soon.  Today in fact.
  3. Something is better than nothing.  This was a major political and philosophical distinction in this battle.  Proponents said that the bus is headed for a cliff and we need to do something, anything, to divert.  Some opponents said there is no cliff coming, but most agreed that trouble looms without passage of major reform.  BUT, they said, that this particular diversion is not the one we need.  Ultimately, I think that your own position on this fundamental question is as important as personal politics in terms of whether you support or loathe the weekend’s turn of events.
  4. Who will this benefit right away?  Described on NPR as the IPP (Incumbent's Protection Plan), White House officials and top Democrats are already out touting the immediate benefits of the new law.  What happens this year?  Dependent children can remain on their parents’ insurance plans until age 26, seniors can get help for drugs in the Medicare program, and people with health problems who are uninsurable can now quality for coverage.  The question is whether this group is large and loud enough to sway public opinion.  (Remember, the biggest provisions, including the creation of health insurance exchanges, don’t happen until 2014… an eternity from now.)
  5. Republicans aren’t done yet.  The Senate still needs to vote on the amended portions of the original Senate bill which the House passed.  Though they don’t have the votes or parliamentary muscle to derail, the debate will continue.  Some are claiming that Republicans have a few tricks up their sleeves and that this is not yet over.  Doubt they’re right.  But…
  6. Republicans aren’t done yet.  Ok, so there might be an overtime in this playoff game after all.  If the Republicans are able to muster up enough sway to change some of the language, that might force this to go back into the House for further debate, something Democrats want to avoid at all costs.  Democrats need 60 votes (which they no longer have) to avoid any and all parliamentary challenges and though the prospects of House reentry seem slim, it’s worth watching… just-in-case.
  7. Doing the right thing.  32 million uninsured Americans will now have access to reasonable health insurance coverage.  32 million of these Americans could access the health care system today via safety net providers, the most notable and expensive of which is called the hospital ER.  Without basic primary care coverage and preventative services, these individuals often end up in care when diseases have progressed and/or more expensive treatments are necessary.  Not only does this improve quality of life for these individuals, but it should (should) over time save money.  It’s the right thing to do.
  8. But it’s complicated.  And expensive.  The expansive health bill is poorly understood.  Comments by Massachusetts Reps Lynch and Capuano last week punctuated the fact that the legislation is complex, highly nuanced and implications are poorly understood.  And while most applaud the coverage offered to uninsured Americans, many wonder how we’re going to pay for it all.  I defer to the point made in #7 above, however… that this should save us in the long-run.
  9. Who does this benefit?  The bill is long on provisions for providing coverage to under and uninsured.  It’s fairly short on specifics on how rising health care costs will be controlled.  Proponents argue that the mechanisms are now in place to solve this problem and that that will be the true measure of success of this plan.  Time will tell, but it’s worth noting that some of the big health care stocks (pharmas, insurance companies) are up on Wall Street today.  Up because of relief that the uncertainty in the industry is gone… or up because of a long-term belief that these companies will benefit from the bill?  Hmmm…
  10. He staked his Presidency on this.  That may prove to be an overstatement… but perhaps not.  Politics aside, you have to be impressed with President' Obama’s sheer will and drive in moving this forward.  Again, politics aside… please.  I cannot recall a time when a public leader was so willing to place his own reputation, future prospects and perhaps even legacy out on the line in such a manner.  Clearly, he believes that this is in the best interests of the United States and the majority of its citizens.  Clearly, he understands the consequences, noting a few weeks ago that “that’s what elections are for” when confronted with the suggestion that there was a heavy opposition to this bill.  As always, history will record how all this turned out, but here in the moment, without the benefit of any historical perspective, I suggest that this President’s tireless and risky upward climb on this issue and the fact that we have today a new health care package nearly ready for implementation is testimony to what one person can do to change an entire nation.  Amazing.

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