As featured on p. 218 of "Bloggers on the Bus," under the name "a MyDD blogger."

Wednesday, February 04, 2009

Bredesen? End Of Health Care Reform As We Know It

Getting back into the talk about who will run HHS, the name Phil Bredesen has come up, which makes me stumble around as if I've been punched in the face.

As governor, Bredesen presided over some drastic cuts to TennCare, Tennessee's once innovative effort to reform Medicaid. I wrote about these in my book, Sick: was a Democratic governor who would succeed in enacting the most sweeping cuts: Phil Bredesen of Tennessee. Bredesen knew a thing or two about health care: before getting into politics, he had made his fortune by founding a company called HealthAmerica—one of the fi rst commercial HMOs to cash in on managed care during the late 1980s. This experience, plus his confi dence in his own intellectual abilities (he had a physics degree from Harvard), convinced him that he could wring new efficiencies from Tennessee’s Medicaid system, just as his HMO had generated financial savings—and hefty profits—in the private market.

A lot of what Bredesen proposed to do—such as reducing fraud by providers and recipients, and improving the use of information technology—made sense. But when those quick fixes didn’t bring the TennCare budget under control, he unveiled a more straightforward plan: he would simply slash the program. More than 100,000 people who had qualified for TennCare because they were “medically needy” would lose their coverage altogether. Those allowed to remain in the program would have to make do with more limited benefi ts. The biggest change would be in the coverage of prescription drugs. “The sad reality is that we can’t afford TennCare in its current form,” Bredesen said. “It pains me to set this process in motion, but I won’t let TennCare bankrupt our state. This is the option of last resort.”

While Bredesen undoubtedly faced tough circumstances, he didn't exactly distinguish himself by coming up with creative solutions--or fighting for people who, after all, were among Tennessee's most vulnerable citizens. As liberal advocates protested planned cuts, he fought bitterly with them, threatening even more draconian measures if they wouldn't buy into his programme.

That's not the only reason Bredesen worries me, though. Another concern is characterological. He is typical of the top figures in the health industry I've met over the years: Self-made entrepreneurs a bit too convinced of their own brilliance, completely unaware that the strategies for making private insurers profitable don't help--and often hurt--the sicker, poorer people whom insurance should ideally protect. Their biggest fans are often people who know a ton about health care at the macro level, but haven't spent much time observing it on the ground--where reality is often messier than the statistics suggest.

Ezra Klein has more. I mean, Democrats are already telling America to forget about single payer (hopefully team single payer will have something to say about that), but under Bredesen, you'd basically have to forget about even decent incremental reform.

One bit of good news on that incremental front: the House passed SCHIP today for a second time, and as this bill is in line with the Senate version, it will in all likelihood be signed into law tonight. This is actually pretty good incremental reform, not the kind you'd get with Phil frackin' Bredesen.

...wait, I found somebody worse than Bredesen for HHS. Jim Cooper. The guy that killed the 1994 reform. Think "bigger giveaway to special interests".

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