Tuesday, October 13, 2009

A Snowe (flake) does not a GOP blizzard make

The decision by Senator Olympia Snow (R-ME) to vote "yes" today on the Senate Finance Committee (SFC) package does not mean that there suddenly will be a blizzard of Republican support for the pending health care reform legislation. She was the only Republican to vote for the bill, which was approved by the committee this afternoon on a 14 - 9 vote, with all of the Democrats voting in favor. It may be that she will end up being the only Republican, House or Senate, who votes in favor when the final tally on health care reform legislation is taken later this year. Still, in Washington it just takes a single vote from a member of each party to get the highly "coveted" bipartisan label.

By reporting out its bill, the Finance Committee has joined the Senate Health, Education, Labor and Pensions Committee (HELP) and three House committees in moving President Obama's signature domestic priority a step closer toward a debate on the House and Senate floors, and possibly, enactment. At no other time in U.S. history, going as far back as to 1912 when President Teddy Roosevelt first called for universal coverage, have health care reforms designed to cover (almost) all Americans made it to the House and Senate chambers for a vote.

This doesn't mean, though, that the road ahead is an easy one. The House and Senate leadership and the White House will have to reach agreement on such contentious issues as a public plan option, employer and individual mandates, taxes and fees, offsets/cuts to different stakeholders, the level of subsidies and benefits, and a myriad of other issues, all of which are far from being resolved. The Senate HELP bill and H.R. 3200 would provide higher levels of spending on a host of programs than the SFC bill, which will pose a challenge to Congress in coming up with a common approach that doesn't break the budget.

One of the budget issues that still has to be resolved is how to fund a solution to Medicare physician payment cuts. The House includes a long-term physician payment fix - at a budget cost $250 billion. To keep the price tag down, the SFC bill offers only a one year reprieve from the SGR cuts, with a much lower budget price tag. (The different approach to the SGR is the single biggest reason why the CBO found that the Senate bill pays for itself while H.R. 3200 does not.) The House reportedly is considering taking the SGR fix out of the health reform bill to keep the price tag down and, get a favorable CBO "score," so that it meets Obama's requirement that the bill not add "one dime" to the federal deficit. Even if taken out of H.R. 3200 itself, the House leadership and the White House continue to be committed to getting a long-term solution to the SGR physician pay cuts enacted this year, even if the cost ends up showing up somewhere else in the federal budget and not in the health reform bills. How to do this - in a way that will get the fiscal conservatives in both the House and Senate on board - remains unresolved. But the physician community - including ACP - will insist that Congress find a way to put an end to the cycle of SGR cuts, once and for all.

Finally, I expect we will see more and more interest groups sharpening their knives to kill parts of health care reform that they don't like, which could still result in health care suffering a death of a thousand cuts.

The SFC is far from perfect - ACP has its own list of major concerns about it - but the vote today was historic, in that it moves the United States closer than ever toward the goal of providing all Americans with access to affordable coverage. I hope we all keep our eye on the prize even as we try to change the things we don't like.

Today's question: What do you think of today's Senate Finance Committee vote?


Rich Neubauer MD said...

Having a bill emerge from the SFC is a great move forward for all the reasons you outline. Now the real fun begins as Congress tries to meld the different bills into one. Having ACP at the table at this moment is of utmost importance. All the hard work our Washington staff has done will be worth it if we can make our voice heard on the important issues at this crucial time.

DrJHO7 said...

The SFC vote is a positive, as is Senator Snow's gesture of support. It is historic that our legislature is seemingly moving forward with national health care reform, but what I fear is that their action will be only a gesture.

When my daughter was much younger, my wife and I candidly observed the moth-bitten ear of corn she had "finished" whittling away at, when she had less teeth. By the time the congress committees get done with this thing there may not be too many kernels left on that ear. Indeed, it is already moth-bitten.

No SGR fix, probably no public plan, no cost-containment reigns on big pharma or big insura, no mention of tort reform, weakened and unenforceable mandates that many middle americans "buy" health insurance using "extra money" they'll have from "tax subsidies", regional co-ops that ostensibly increase competition and therefore make premiums more affordable which will probably have no substantial effect on premium and will act merely as marketing instruments for the insurers, expansion of medicaid...

A majority of people and a majority of physicians want substantive health care reform, and God knows our country needs it. However, if we call a spade
"a spade", what we may end up with here is an historic political milestone without substance [kernels], and with huge cracks for most of the uninsured and small businesses and their employees to fall through. What a shame that would be - I hope that I am wrong.

Arvind said...

This is another part of the political gibberish that we keep hearing from Congress. Having tried and failed to talk some sense into our elected Representatives and our Medical societies, and being unable to shake my fellow physicians from a deep inertia, I find myself wishing that Congress pass legislation is is potentially devastating to the physician community, i.e. continue SGR, reduce reimbursements in addition to SGR reductions, remove consultation codes, and continue the "guilty unless proved otherwise" method of RACs.

Once this occurs, physicians will forced (by financial reality) to shut their doors to Medicare beneficiaries, thus creating an absolute crisis in access to care. Since we have stopped accepting new Medicare patients, we advise those calling us for appointments to call their Congressional Reps and complain that they have no access to a specialist that they need so desperately. We feel very sad about this, but have no choice to be honest. This is the only way to demonstrate to this tax and spend Congress that medical care has a real price and medical professionals that have quietly borne the decade-long recession, will no longer accept any left-over thrown at them. Pay us fairly or find other sources to care for your newly insured! Remember, universal coverage is far from universal access. It would be best, Bob, if you could communicate this unequivocally to your Congressional contacts.

Steve Lucas said...

My personal issue is that the whole process will now move behind closed doors. Some political leaders have promised to reinstate items not in the finance bill and bring the resulting legislation to a vote before CBO scoring (a questionable issue by itself), and before open debate.

I am also concerned about the obvious "gaming" of the system as to cost and the willingness of some to increase taxes to unprecedented levels to pay for this legislation. A recent Wall Street Journal article showed how Germany is moving away from its system due to an unsustainable tax burden.

We really need to get this right.

Steve Lucas

Christian McTurk said...

Doctors advocating for mandatory pre-paid health care is a bit self-serving, is it not?
What it really is a shame. More regulation, less patient control over their dollars and their health care.

Costs of health care and insurance will continue to rise, forcing more cuts and rationing from insurers and government. The country is going bankrupt, the dollar is crashing, the deficit is at TWELVE TRILLION DOLLARS!

Defeat insurance mandates and public options!

Allow 100% tax credit for all medical expenses!

Make insurance just that, insurance. Get the government and third party payers out of every little nuance of care!

Stop this train before it's too late. Isn't it bad enough already?