The ACP Advocate Blog

by Bob Doherty

Monday, February 22, 2010

"We can work it out"

"Life is very short, and there's no time
For fussing and fighting, my friend.
I have always thought that it's a crime,
So I will ask you once again.
Try to see it my way,
Only time will tell if I am right or I am wrong.
While you see it your way
There's a chance that we may fall apart before too long.
We can work it out,
We can work it out."

Lennon/McCartney, 1965

After a year of deferring to Congress, President Obama today released his own health care reform proposal (although it largely borrows from the bills already passed by the House and Senate).

The proposal is part of a coordinated effort by the White House to say to GOP opponents that "we can work it out" . . . but only if they are willing to see it his way. The White House's web site lists 14 Republican ideas that it says are included in the Obama proposal, in the president's budget, and/or in the bills passed by the House and Senate. It also says that "the president remains open to other policies as well. And the purpose of the Bipartisan Summit is to review all ideas and ensure that the best ideas are included in the plan."

The GOP isn't buying it.

Roll Call reports that the President's plan has ignited a partisan backlash. House minority Leader John Boehner (R-OH) and Senate minority leader Mitch McConnell (R-KY) each released statements to make it clear that they will not budge from opposition to Obama's plans. McConnell accuses the president of "completing ignoring what Americans across the country are saying."

Is McConnell right? The "By the Numbers" blog written by Washington Post pollsters suggests that Obama may have stitched together proposals that have "broad, but often malleable, public support." Large majorities, they report, support creation of a new health exchange to give people the same insurance choices that members of Congress have, ending discrimination against persons with pre-existing conditions, enacting reforms to reduce the deficit, closing the Medicare Part D doughnut hole, requiring large employers to provide coverage, financing the changes by raising taxes on higher income persons, and requiring plans to cover adult dependents to age 26 - all features of the President's proposal (and, for that matter, the bills that have already passed the House and Senate).

How does Obama's proposal differ from the bills that passed by the House and Senate? The Kaiser Health News "Blog Watch" has a good summary of the changes he proposes. The proposed changes include increasing the subsidies for people to buy coverage, providing more funding to states to expand Medicaid coverage (applied to all states - no special deals), increased penalties on employers who don't buy coverage, delaying and raising the ceiling for a tax on Cadillac plans, and getting more money out of Medicare Advantage plans. One of the biggest - and controversial - changes is a new proposal to create a new "Health Insurance Rate Authority" to "provide needed oversight at the Federal level [over health insurers' premium increases] and help States determine how rate review will be enforced and monitor insurance market behavior."

In the end, I don't think the changes proposed by President Obama will win over any GOP support. But by embracing changes that have broad "but malleable" support from the public, and daring Republicans to see it his way (or, presumably, get out of the way), he may have charted a way for the Democrats to finish the job, presumably using the "majority rules" reconciliation route.

Today's question: Do you agree with the changes proposed by President Obama? Do you think it will help get health care reform over the finish line?

4 Comments :

Blogger Harrison said...

It is necessary for the President to move forward on health care legislation.
His proposal is a move forward.
He cannot count on the Republican party for anything other than opposition.
The sad thing about that is that there should be at least one or two Republican senators who have majority constituents in favor of the President's proposal. One or two who see that passing such a proposal would help their states.
The Democrats have senators who side with the Republicans often for just that reason. They do not pick the party's need to oppose and show unified strength over the interest of those they represent.

That is sad.

It is to be hoped that the public debate this week will be helpful.

I'm not holding my breath though.
It will be about posturing.

The Republicans will work to find a way to turn the President's rhetorical skills and clearly superior knowledge of the subject against him.

I hope that the Democrats are able to use the reconciliation process and allow the majority to rule at least on this issue.

Harrison

February 22, 2010 at 5:47 PM  
Blogger Arvind said...

I am sorry to say this, but this is probably the worst post I have read from you. Aren't we talking the same things ad nauseum?

I did not see any new proposal from the President. How do we expect any different response from any one? If he has the guts and is willing to take responsibility, he should just go ahead with it. But stop blaming the minority for the failure of the majority.

Interestingly, I make it my job to spend 1-2 minutes with each and every patient discussing health reform. Almost 90% of my patients have told me that we need serious tort reform in our country, and at least 40% of these folks are Democrats. So far not even one patient has yet to tell me "we need strong lawyers to represent my interests". So how does the President respond to this - he remains completely silent in his proposals. And why am I not surprised?

February 22, 2010 at 10:12 PM  
Blogger Steve Lucas said...

I am always concerned when I hear the word malleable. It means we can change things after we get the bill passed. There is a reason Democrats are not willing to pass this bill on their own: Their continuants don’t like the scope and size of the bill.

If this bill was not about politics then there would be tort reform. My wife is an attorney and what I find interesting is lawyers complain that the people entering the profession want to arbitrate not litigate. This has not stopped the very high profile cases from casting a long shadow over medicine, and in fact, our everyday lives.

I don’t hold out much hope for a repackaged bill changing minds.

Steve Lucas

February 23, 2010 at 9:06 AM  
Blogger Rich Neubauer MD said...

I honestly don't know if the current strategy will work to enable final passage of health care reform, but I hope so.

The strictly partisan Republican opposition continues to be highly unattractive, while the lack of unity in the Democratic members continues to be difficult to swallow and smacks of governance by plebiscite.

Once again just to point out that those who have the most to loose are average citizens if nothing happens with health care reform.

February 23, 2010 at 12:16 PM  

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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.

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