The ACP Advocate Blog
by Bob Doherty
Friday, July 24, 2009
Singing the health reform blues
The headlines in today's newspapers will give health reformers a bad case of the blues:
"Senate Won't Hit August Deadline" (Wall Street Journal)
"Health Reform Deadline In Doubt Process Could Be Slow and More Contentious" (Washington Post)
"For Public, Obama Didn't Fill in Health Blanks" (New York Times)
There is no question that the prospects for fast action on health care reform took a hit with yesterday's announcement by Senator Majority Leader Harry Reid that the Senate will not schedule a vote until after the August recess. In the House of Representatives, completion of the "mark up" by the House Energy and Commerce Committee has been delayed because of in-fighting between "Blue Dog" fiscally-conservative Democrats and more liberal members of the caucus.
From my standpoint, these setbacks mask the fact that substantial progress is being made. The negotiations in the House of Representatives may be more contentious and taking longer than many had expected, but I believe that the Democrats will reach agreement on ways to trim the cost of the bill that will bring most of the Blue Dogs on board, without losing too many liberal members.
The nature of the Senate is such that it always takes a long, long time to get agreement. Even with the Democrats so-called "filibuster proof" majority of 60, the party leadership can't afford to lose a single Democratic vote - this gives each Senator enormous negotiating power, which inevitably slows down the process. Senator Max Baucus, chair of the Senate Finance Committee, continues to report that "progress is being made" on reaching agreement that could win the support of two or three Republicans. (Although any agreement he reaches with Republicans runs the risk of alienating fellow Democrats whose votes will be needed in the end.) If the Senate Finance Committee reaches agreement on a bill, it will still have to be reconciled over the August recess with legislation reported out of Senator Kennedy's Health, Education, Labor and Pensions Committee.
Then the really tough negotiations will take in the fall. The House and Senate versions will have to be reconciled, and then the final product will need 60 votes in the Senate and a simple majority in the House to pass.
Yet despite all of these obstacles, there actually is pretty solid agreement among the Democrats (and even some Republicans) on the many of the core elements of health reform legislation: expansion of Medicaid to cover the poor with the federal government picking up the tab; sliding scale tax credits to help people buy coverage through a purchasing pool or alliance; an individual insurance mandate; improved coverage for preventive services; insurance market reforms to ban cherry-picking by insurers; workforce and payment policies to increase the numbers of primary care physicians; and payment reforms to link payments to the value of care rendered instead of the volume of services. These policies all are closely aligned with ACP's recommendations.
The remaining issues are tough ones: how to pay for health care reform and reduce the cost of the package (taxes and savings); the role of a public plan; and employer-mandates. Yet, I don't think any of those issues are beyond the capacity of Congress and the President to find common ground.
Despite the gloom and doom headlines, the fact is that health care reform has already advanced further in the legislative process than at any time in history, with two of the three House committees of jurisdiction and one Senate committee approving their respective versions (and in the House, all three committees are working together to produce a single bill). Congress never got anywhere near this close when Bill Clinton was president.
Today's question: Do you think the recent developments are bumps in the road to health care reform, or an indication that the whole effort is heading for collapse?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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