Monday, February 9, 2009

Health care reform, stimulus, and beyond

With Friday's announcement of an agreement among "centrist" senators, President Obama seems to have the votes he needs (but barely) to get the economic stimulus package passed by the Senate.

Not that this will be the end of the story.

There are major differences between the (modified) Senate bill and the version passed by the House of Representatives. These differences have to be worked out between House and Senate negotiators and then voted on again by both chambers. Concessions to the House could make the package vulnerable in the Senate, where a switch of just one vote could bring it down. Too many concessions to the Senate, though, will be resisted by House Democrats and their allies.

On Friday, ACP weighed in with our priorities for stimulus. How did we fare?

The Senate agreement preserves more than $20 billion in funding for health information technology and more than $1 billion for comparative effectiveness, but eliminates $600 million for primary care training programs supported by ACP. It trims COBRA subsidies for people who lose their jobs. Both the House and Senate provide the same amount of money to prop up state Medicaid programs. Unlike the House, the Senate does not give additional money to the states to extend Medicaid coverage to temporarily unemployed low-income persons. ACP will ask Congress to restore the money for primary care and increase the funding for COBRA and Medicaid.

Although the stimulus bill is the big story today - as it should be, given the amount of money involved and the stakes for the economy - it is only a down payment, at best, on broader health care reforms. Which raises the question: what will President Obama and Congress decide do next?

Jonathan Cohn writes in the New Republic blog about Obama's plans to make health care reform a "central focus" of his first budget. He quotes the New America Foundation's Len Nichols, an economist and longtime reform advocate: "If they put [health care] in the budget, and fully fund it, then they are demonstrating a profound commitment to health care as an integral part of the agenda. And I welcome that."

Me too.

And in other good news for health care reform, the New Health Dialogue blog writes that "Two key Senate Democrats, Max Baucus and Edward Kennedy, jointly and publicly reiterated their commitment to major health reform this year, with or without the help of Tom Daschle."

Today's question: After stimulus, what do you think the President and Congress should do next to reform health care?


Jay Larson MD said...

Not to sound like a one trick pony, but… address the primary care crisis in this country. The documented benefit of primary care and the current primary care crisis has reached PhD (Piled high and Deep) status. Time to grab a shovel and dig out.

Steve Lucas said...

My personal feelings are that Congress should address some of the nut and bolt issues surrounding medicine. I would like to see a continuation of the push for transparency regarding grants and fees paid to doctors and institutions. Often we see institutions at fault for conflict of interest.

Along the same line I would like to see something resembling the UK's NICE. We need comparative studies and real information for both doctors and patients to make informed decisions. The Bush administration gave a going away present to oncologist by basically eliminating any questions as to payment for any drug for cancer.

We can see in the AP piece by Matthew Perrone Drug Firms Accused of Hyping Illness how drug firms have cooped fibromyalgia for their own. Other examples exist of conditions created by pahrma to sell drugs, as sited in the article.

I would like to see the elimination of DTC television and radio ads for medical purposes. Pharma has used "education' as an excuse to bombard the airwaves with only partial truths. Nonprofits fair no better with demands for support for their illness. Finally, the one I find disturbing, our local nonprofit hospitals advertise not only to stop by the ER for a scrape, "because you can never be too sure" to selling elective surgeries, with payment plans, "financial counselors are standing by."

Let's hope the continued debate will result in positive changes in the medical community where doctors become once again a persons medical advisor and compensation levels are adjusted to allow a stable income, while spending the necessary time with a patient.

Steve Lucas