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

Thursday, July 16, 2009


Regardless of the Blue Dog pushback and all the other slings and arrows lodged at health care, some potentially big news has come down in the past 24 hours.

First, the Congressional Progressive Caucus has produced the names of 50 members who will not vote for health care without what they call a "robust public option." Robust is in the eye of the beholder, of course, and the one the House proposed would only cover 9 million or so people, which may not be enough to reverse incentives in the industry, but they drill down pretty far into the meaning of robust:

Enact concurrently with other significant expansions of coverage and must not be conditioned on private industry actions.

Consist of one entity, operated by the federal government, which sets policies and bears the risk for paying medical claims to keep administrative costs low and provide a higher standard of care.

Be available to all individuals and employers across the nation without limitation

Allow patients to have access to their choice of doctors and other providers that meet defined participation standards, similar to the traditional Medicare model, promote the medical home model, and eliminate lifetime caps on benefits.

Have the ability to structure the provider rates to promote quality care, primary care, prevention, chronic care management, and good public health.

Utilize the existing infrastructure of successful public programs like Medicare in order to maintain transparency and consumer protections for administering processes including payment systems, claims and appeals.

Establish or negotiate rates with pharmaceutical companies, durable medical equipment providers, and other providers to achieve the lowest prices for consumers.

Receive a level of subsidy and support that is no less than that received by private plans.

Ensure premiums must be priced at the lowest levels possible, not tied to the rates of private insurance plans.

In conclusion, the public plan, like all other qualified plans, must redress historical disparities in underrepresented communities. It must provide a standard package of comprehensive benefits including dental, vision, mental health and prescription drug coverage with no pre-existing condition exclusions. It must limit cost-sharing so that there are no barriers to care, and incorporate up-to-date best practice models to improve quality and lower costs. All plans, including the public plan, must include coverage for evidence-based preventive health services at minimal or no co-pay. All plans, including the public plan, should be at least as transparent as traditional Medicare.

I now think that the public option will be a feature of whatever gets signed by the President. The House is providing a progressive firewall, and most of the objections of the Blue Dogs and others are over other aspects of the bill. What's more, the American Medical Association, scourge of universal health care for decades, has blessed the House bill, which is remarkable.

And that makes it a pretty big deal. No, the AMA is not as powerful, nor as representative of the medical community, as it once was. But an unqualified endorsement for the most liberal plan out there has large symbolic value, given the role AMA played in killing health care reform for most of the 20th Century.

So what's in it for the docs? The medical community came into this debate with two big concerns. One is the financial and emotional burden of malpractice lawsuits. The other is the annually scheduled reduction in Medicare payments, known as the Sustainable Growth Rate (SGR) formula, that the AMA and other physicians lobbies end up fighting every summer when it's about to take effect [...]

Changing the SGR is expensive, probaby $200 to $300 billion over the course of ten years, depending on the details. And that's on top of the cost of expanding insurance coverage. But, to be clear, the SGR adjustments were becoming a farce. If they are part of a package that includes payment reforms designed to improve quality and reduce health care costs over the long run, it'd be money well spent.

Nobody in Washington supports legislation without getting something for themselves, but I agree with Cohn that this looks like a decent enough deal.

And now, the Senate Finance Committee thinks his committee will have a deal on his bill by the end of the day.

Senate Finance Committee Chairman Max Baucus (D-Mont.) said Thursday that he hopes to have a bipartisan deal on a health care reform bill by the end of the day.

He made the remarks after huddling for about two hours with five Finance Committee members most closely involved in the negotiations. It was the first time Baucus acknowledged a time frame for reaching an agreement.

“We are meeting very aggressively today,” Baucus said of the bipartisan group, which plans to meet again at 1:30 p.m. “We will keep meeting all day long. I hope we can reach some kind of agreement by the end of the day, but having said that, it depends on what kind it is.”

If the Finance Committee can get a bill reported out, suddenly the chances of a bill become much greater. What form that bill will take, of course, is open for debate.

Labels: , , , ,