Tuesday, March 02, 2010

White House Healthcare Reform Summit: No Losers

The headlines were predictable immediately after the White House Healthcare Reform Summit:

“No Clear Winner in Seven-Hour Gabfest” – Politico

“More Talk, No Deal at Health Summit” – Wall Street Journal

“Obama’s Health Summit Talkathon” – Washington Post

“Bottom Line On Health Care Summit: Dems Push Ahead” – AP

Some news organizations had already issued a comprehensive list of “winners and losers” less than 10 minutes after the summit had concluded. But the real take home message from the White House Summit was there were no “losers.”

Make no mistake, putting on the event itself was a calculation intended to produce political theater that benefited the President and help the administration get some traction for the White House’s top domestic policy agenda item. And Obama did benefit from the public meeting. But so did some Republicans. And so did other Democrats. And so did the viewers who took time to tune in for a few minutes or the full day.

In short, the White House Summit, warts and all, produced the kind of discussion on a national issue of great controversy that many hoped would take place. There were talking points, sure. And there were carefully orchestrated maneuvers, such as House Minority Whip Eric Cantor (R-Va.) repeatedly pointing to the 2,000 page-plus bill, or House Rules Committee Chair Louise Slaughter (D-NY) retelling a story of how a woman had to use her dead sister’s dentures because she couldn’t afford her own. But those were side points to the substantive discussions that occurred in the majority.

Policy Wonk Obama. It’s difficult to find any single person more polarizing to an American public than a current sitting American President. A 50% approval rating is typically good news. Like him or lump him, though, Obama demonstrated a firm grasp of both the large issues, such as the individual mandate to buy health insurance, and the detailed nuances of how the Congressional Budget Office scores premium increases over time. It was at the very least reassuring to see the President know the issues from top to bottom. Put simply, Obama was very good. Moreover, Obama presided over the full meeting, which went roughly six and a half hours. In the end, he gave a defense of the comprehensive he has favored over an incremental approach:

"An interesting thing happened a couple of weeks ago, and that is a report came out that for the first time, it turns out that more Americans are now getting their health care coverage from government than those who are getting it from the private sector. And you know what? That's without a bill from the Democrats or from President Obama. It has nothing to do with, quote-unquote, ‘Obamacare.’ It has to do with the fact that employers are shedding employees from health care plans. And more and more folks, if they can, are trying to get into the Social Security system and the Medicare system earlier through disability or what have you, so that they can get some help ... The reason we didn't do it is because it turns out that baby steps don't get you to the place where people need to go. They need help right now.”

Lamar Alexander: The Right Responder. Republicans could not have picked a better first responder to the President than Lamar Alexander, the Tennessee Republican who is the Senate Republican Conference Committee Chairman. He came off as reasonable, knowledgeable, confident, and respectful. Here’s a snippet from Alexander’s response:

“When I went home for Christmas after we had that 25 days of consecutive debate and voted on Christmas Eve on health care, a friend of mine from Tullahoma, Tennessee, said, ‘I hope you'll kill that health care bill.’ And then, before the words were out of his mouth, he said, ‘But we've got to do something about health care costs. My wife has breast cancer. She got it 11 years ago. Our insurance is $2,000 a month. We couldn't afford it if our employer weren't helping us do that. So we've got to do something.’”

The message, skepticism aside: Republicans aren’t here to say no, we want you to go in a different, incremental direction. Alexander listed six ideas Republicans would be willing to work with Democrats on: A small-business health care plan. Helping Americans buy insurance across state lines. Put an end to junk lawsuits against doctors. Give states incentives to lower costs. Expanding health savings accounts. Eliminate preexisting conditions.

Tom Coburn Speaks, Obama Listens. There are few, if any, members of the Senate more conservative than the Oklahoma doctor Tom Coburn. It was surprising, then, to see on live television Obama listening closely to what Coburn had to say on health care waste, fraud, and abuse, and watch him take copious notes while Coburn spoke. In fact, at the very end of the day, Obama went back to his notes to point out the many point on which him and Coburn agree.

Coburn during his opening remarks:

“You know, when you compare the private sector fraud rates, it's 1 percent compared to Medicare and Medicaid. You know, there's estimates that there's $15 billion worth of fraud in Medicaid a year in New York City alone. So we haven't attacked that. We haven't gone where the money is. And my hope would be that we would look at where the money is. And if truly it's accurate -- and I don't know many people that will disagree that $1 in $3 doesn't help somebody get well and doesn't prevent it, then we ought to be going for that $1 in $3.”

Obama wrapping up the meeting:

"With respect to bending the cost curve, we actually have a lot of agreement here. This is an area where if I sat down with Tom Coburn, I suspect we could agree on 95 percent of the things that have to be done, because the things you talked about in terms of -- and I wrote some of them down. In terms of reducing medical errors, in terms of incentivizing doctors to coordinate better and work in groups better, in terms of price transparency, improving prevention, those are all things that not only do I embrace, but we've included every single one of those ideas in these bills.”

The Clinton Boogie Man Makes His Point. No one is perhaps as reviled in Democratic circles in the health care reform debate as Tennessee moderate Democrat Jim Cooper. The prominent House Blue Dog member is often blamed in part for the failure of Bill Clinton’s failed 1993-1994 effort because of his opposition. Liberals dislike him, to put it lightly. That’s why what he says publicly is being carefully watched by both sides of the aisle in 2010.

Obama went to Cooper in the afternoon, and the Tennessean gave one of the most thoughtful, persuasive remarks of the day:

“Mr. President, I'm thankful you have appointed a presidential fiscal responsibility commission, with Alan Simpson and Erskine Bowles, to try to force us as a Congress and force the nation to address these fundamental problems, because if you love Medicare, you need to act to save it fast. Every day matters. A report will come out issued by the Treasury Department. It comes out every year. It'll come out in the next few days. It's the only report that uses real accounting to describe America's fiscal problems, and the news is not pretty. It will reaffirm what's been discussed here about Medicare and Medicaid and other vital American programs being deeply in the hole. And the opportunity of costs for delay is extraordinary. So we can face these problems, Mr. President. We can solve them with political will, but the talking points won't do it. We've got to acknowledge the real questions.

And as every business person in America knows, if you can't measure it, you can't manage it. And too many people in the federal government are refusing to measure it, much less take the tough votes that are required, because the reason we have a Medicare Advantage program, Mr. President, as you know, is in 2003, when the other party was completely in charge of everything here, we passed a program that before now was almost completely unfunded and added $8 trillion in one bill to our children and grandchildren.

Now, those benefits if offered should be paid for. So this is a challenge for everybody in both parties, because nobody's hands are clean in this, but let's have a new day, a new beginning. I think we could do this. And this bill is a great place to start, because if you don't think this bill reduces the deficit enough, according to CBO, vote for more savings. If you want to reform Medicare some more, vote for it. Don't just talk a good game.

So I hope the American people are watching, because -- and they're going to be watching after the cameras are turned off, too. And I'm thankful you called this meeting, because this is a moment of truth for our country. And together, we can solve this problem.”

In the end, it’s about philosophy. Maybe no one summed up the critical question at hand better than Texas Republican and ranking Energy & Commerce Committee member Joe Barton:

“Mr. President. I want to commend you for asking us to come here. And I will say that never have so many members of the House and Senate behaved so well for so long before so many television cameras. So if we ever get to a conference committee, we may want you to be the moderator. I do think, though, that there is a fundamental difference in the vision that you and your friends on the majority have put forward and the vision that myself and those of us in the minority have put forward: It's the pivotal role of the government.

We believe that we should use free markets to empower people and give them choices. And for the best of intentions, yourself and most of your allies in the Democratic Party seem to believe that the government, either through a mandate or through a regulatory requirement, knows better and will do better for health care for most Americans.”

Barton encapsulated in his brief remarks the question at the heart of the health care reform debate and it was clear to everyone watching: If you want more government involvement in health care, you’re for them. If you don’t, you’re for us.

(Official White House Photo by Lawrence Jackson)


Anonymous said...

If commercial insurance fraud is 1%, $25 billion still is a very large amount since the total amount spent is $2.5 trillion last year! And half the federal spend is administered by commercial insurers.

And if fraud in Medicare and Medicaid which as you write is half the total coverage but is only a third of the total spend [$800 billion] then physicians are indeed getting paid less for these programs than they are for commercially insured patients.

I don't know if Sen. Coburn meant to imply that physicians are the parties who through waste, fraud and abuse cause $1 of every $3 to be mispent and don't think "hiring secret Medicare shoppers" would discover physicains overcharge Medicare and Medicaid; rather I think they "push the limits on coding" and "churn patients".

Sen. Coburm stated 20% fraud and a look back to the Clinton era shows they discovered that 24% was fraud back then so it shouldn't surprise anyone that it has risen to the same levels or more again.

Settlements of cases filed under the False Claims Act excluding agencies such as the SEC which wasn't covered by this allowing the Madoff case to happen, and many other departments which were only recently added, shows that large corporations [pharmaceutical manufacturers, hospitals, insurers,etc are the ones making settlements and while a few physicians owned businesses are shown to have made settlements they are rare.

So if hundreds on billions of dollars are involved, until the government gets serious about stopping fraud, the only results will be less care for less people until Medicare and Medicaid go bankrupt. States are the "canary in the mine on this issue" as Medicaid will cause them to go bankrupt even before Medicare does!

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