Wednesday, January 20, 2010

"I'm not dead ... yet"

One of my favorite movie scenes is from "Monty Python and the Holy Grail," when an unfortunate soul pleads with the designated collector of corpses (this being after the plague, mind you) that "I'm not dead ... yet." The collector responds by whacking him on the head ... until he is, in fact, quite dead.

This scene comes to mind as I blog about yesterday's stunning GOP upset of the seat-that-used-to-be-held-by Ted Kennedy. If the election of Republican Scott Brown didn't quite kill off health care reform, some Democrats are quite willing to complete the task.

Ezra Klein blogs for the Washington Post that, "a Democratic Party that would abandon their central initiative this quickly isn't a Democratic Party that deserves to hold power. If they don't believe in the importance of their policies, why should anyone who's skeptical change their mind? If they're not interested in actually passing their agenda, why should voters who agree with Democrats on the issues work to elect them? A commitment provisional on Ted Kennedy not dying and Martha Coakley not running a terrible campaign is not much of a commitment at all." Steve Pearlstein, also writing in the Post, argues that the Massachusetts vote was not a referendum on health reform: "There are lots of reasons other than derailing health reform why normally liberal Massachusetts voters may have wanted to send an angry signal to the state's political establishment. For Democrats in Washington, the danger now is not that they will ignore the election returns, but that they will misread them and sound a premature retreat from a historic and game-changing opportunity."

Yet there is no denying that even if the Massachusetts outcome didn't kill health care reform, it has put it on a death watch. Many of Brown's supporters came from independents who, according to pre-election polls, were highly motivated by their opposition to the health care reform bills. But Massachusetts already has near-universal coverage - broadly supported by its voters - so it is hard to view the election as a flat-out rejection of reforms that they themselves enjoy. And, as I wrote in yesterday's blog, there is no denying that the public lacks confidence in the government's ability to deliver on the promises of better care at lower cost to them.

Politico reports on several options available to Democrats to continue to move forward on health care reform, but there is a clear divide among rank and file members in both chambers on how or if to proceed. And, as I write this, CNN is reporting that President Obama may offer a scaled down version of health care reform - bans on pre-existing conditions exclusions and expanding Medicaid to cover all of the poor and near-poor - as a potential fallback.

I understand all of the focus on the politics of health reform, and I suppose that if I were a Democratic member of Congress, that is the main thing I'd be thinking about. But I am reminded that the reasons for health care reform are just as valid today as they were yesterday: tens of millions of Americans lack access to affordable health insurance coverage, many more have difficulty paying their bills, quality is uneven, and costs are rising faster than we as a country can afford. These were true when Obama took office one year ago today - when, by the way, there were only 58 Democratic Senators (Specter of Pennsylvania hadn't yet switched parties, and Franken's win over Coleman in Minnesota was being contested in the courts) - when the popular refrain was "Yes, we can." Now, with 59 Senate votes, some Democrats are saying "no we can't" to health care reform?

In September of last year, I blogged about the plight of a Missouri bartender I met at an ACP chapter meeting:

"She said she has some serious health problems that require expensive medications, which are only partly covered by the health insurance plan offered by her employer. Her company plan also covers her 19 year old dependent daughter with a serious mental health condition. Her husband, an independent contractor who can't find coverage on his own, also relies on his wife's plan for coverage. She said that even with the insurance, her premiums and out-of-pocket health care bills are so high that 'I don't know how we'll make it.' She was planning to take a day off from work to plead with state Medicaid office to cover her daughter, even though she had already been advised over the phone that her daughter wouldn't qualify."

I wrote that, "I hope we don't lose sight of this Missouri bartender, and the millions of working American families, who can't afford health care and are looking to Washington for help. None of the bills making their way through Congress are perfect - far from it. But I believe the litmus test of whether the results are worth it is whether our Missouri bartender and her family can get good coverage at a price that they can afford."

I still believe this. The voters in Massachusetts elected Mr. Brown, knowing that he promised to be the 41st vote against health care reform, and their choice needs to be respected. But Massachusetts has near-universal coverage, is it too much to ask that a Missouri bartender - and the tens of millions like her - have the same? The current Congress and President can still bring home the Holy Grail of health care reform, but only if they - and we the voters - want it bad enough.

Today's questions: What advice would you give to President Obama and Congress? Give up on health reform? Move forward with the basic framework that has been passed by both chambers? Or pass as scaled down version?


Jay Larson MD said...

National health care reform has had more twists and turns than a roller coaster at a 6 Flags amusement park.

If health care reform does not pass, the issues it was trying to address will only get worse. Health insurance will be more inaccessible to millions of Americans. More families will go into bankruptcy due to an unexpected catastrophic illness or injury. The greed in the system will only get worse. Health outcomes will continue to fall behind other countries. General outpatient internal medicine will die (of course this probably will happen even with health care reform). Patients will continue to be treated as widgets.

These issues are difficulty to appreciate for the 80% of the population that only consume 20% of health care resources. Once they are part of the 20% that need health care, they have a totally different perspective.

What President Obama and Congress do is up to them, but there are consequences to inaction as there are will action.

Arvind said...

The message from MA yesterday was "we don't want the same health care debacle that happened to us spread to the rest of the country". The other message was "we don't like back-room, closed-door political deals that don't involve us - we the people".

I don't want to advise the Dems since they can think for themselves. But the President would do us all a favor by going back to the drawing board, talking to people at the community level - both providers and consumers of health care - about what really ails the system.

Insurance coverage is "the problem" not the solution. The problem of "access" must be solved before the problem of "cost". The playing field must be evened out. The recognition that that good quality health care must to appropriately compensated, and doctors must be allowed to be healers rather than wheeler-dealers; and that small medical practices constitute small businesses and must have a stake in the reform, is critical.

Fundamentally, the President must get out of his comfort zone of being a "government first & only" man, and rely on patients and their physicians making logical choices. But first there must be a freedom to choose!

Jerry M said...

If the Democrats go ahead and pass the bill it would be political suicide. The meaning of the Massachusetts election is fairly clear. Martha Coakley was well liked in a state that reveres the Kennedys, was ahead by double digits and did not make obvious gaffs and Scott Brown was clear in his opposition to the present health bill and the turnout was good so it can’t be apathy. The people do not like the bill and the methods of obtaining votes.

What should happen is that they should start over. Do not threaten medicare, make private insurers market to individuals rather then employers by making insurance tax deductible with group rates and market across state lines and of coarse reduce health care costs and unnecessary care by including meaningful tort reform.

Above all, most people in the USA have insurance and are afraid that what the complex bill will do is make their insurance more expensive and restrictive.

Steve Lucas said...

My personal belief is that there are many issues in the current health reform bill that both parties and the public agree on. The problem of preexisting conditions being one. Another issue, bending the cost curve.

There are items the public and doctors agree on that are not covered in the bill. Tort reform being one.

The one issue both parties missed was the blatant grab for pork. Statements such as if your Senator did not get something in the health care reform bill, maybe you need a new Senator do not go down with a public struggling with high unemployment and a national debt out of control.

My advice would be to go back, gain bipartisan support for those items with broad public support, and pass that bill. Start working on those issues that need additional support and refinement.

Most importantly, pass all of these bills for the good of the country. Skip the pork.

Steve Lucas

Rich Neubauer MD said...

The current turn of events mostly just makes me very sad. The country needs health care reform and at this juncture taking at least a significant first step toward that would put us on the journey. If we don't start that journey, the status quo will inexorably worsen for many of our citizens.

Congress needs to wake up to their obligation to govern. If this effort fails, it will be a blot on Democrats and Republicans alike, even if the democratic party takes the blame.