Tuesday, January 19, 2010

Is Health Care Reform Over?

The Scott Brown win over Coakley in Massachusetts portends the end of the health care reform. The Senate is unlikely to play the game of delaying certification (though Republicans would with a straight face). Election year politics would make further delay difficult. Using the reconciliation process would mean another long perilous set of activities where the bill would have to be re-cut. Democrats are unlikely to end the filibuster rule. From a healthcare executive who has met with members of the House, there is significant opposition to the Senate bill.

That means more acrimony and indecision leading to a likely end of the move to fix an out of control system. The Democrats method of self-flagellation and delay hurts their ability to push things through. Republicans simply see blood and are playing the role of the opposition, regardless of logic.

Watch any of the Sunday news shows and what do you see? Republicans criticizing the President. That's become their job in this highly partisan environment. It's almost understandable. The Democrats are the surprising ones. They attack the bill for not doing enough here or there. They call it a flawed bill that's "better than nothing." They find a hundred holes rather than understanding that no one cares about their little nit or nat. It's hardly confidence building. People do not want a "passable" bill that reorders a huge system that brings a level of certainty for 80+% of Americans. They want to know they are getting huge significant value.

The battle over the public option was a play towards single payer - something that people were not ready for. Obama had very little time to push through the change agenda. The mandarins in Senate allowed delay to upend their ability to get things done.

Meanwhile, costs will keep exploding. My company saw 2 years of 40% quote increases even though we went the high deductible, HSA route. This was the consumer-driven healthcare initiative that leading experts were recommending. If I had a whole bunch of blue collar workers, it would have destroyed our cost structure. Health reform should be a Republican issues as well as a Democratic one. It is about American competitive and greater certainty for our population.

Meanwhile, the hidden secret is that there is universal healthcare in pockets of America. In San Francisco, for example, SF Health Plans integrates federal, state, local, and small business funds to provide universal healthcare to children and low income adults in a high quality, cost-effective way. They contract with local providers on a capitation or per person basis. The incentive is to provide quality care without upselling unnecessary tests or care. The more people are covered, the greater that can be treated in a preventative manner, and the fewer people going for emergency care. This reduces the need for health providers to drive up costs for commercial insurance.

The Senate healthcare bill would enable plans like San Francisco's to grow and make American competitive. The real question is whether Obama and Democrats will accede to Republican demands on a do-over or will they try to push this bill through the House. Already, Republicans have delayed or taken illogical positions over the bill. For example, last year the Grassley and Snowe group delayed negotiations. McCain started railing against cutting Medicare a year after he discussed "Medicare reform."

There's a great section in Winik's book, The Great Upheaval, about the French revolution. During that time King Louis XVI introduced a whole set of reforms that gave property rights and freedom of speech and representation to the Third Estate. He tried hard to compromise between what was an absolute monarchy and the growing movement towards representative democracy. Many times, decisions took a long time, exacerbating mistrust and tension between the haves and have-nots. Instead of being hailed as a great king, it was seen as a sign of weakness. Times were tough with bread shortages and repression of the populace. Revenue collection was problematic at a time when France was up to its eyeballs in debt over funding the American Revolution.

While no one is saying that there will be riots in the streets, there is palpable anger on the far right and left. With partisanship during tough economic times, the type of rapid change that Obama would like to make is difficult. While a number of Republicans would have voted for with a few Democrats voting against the Senate package, compromise in this environment is seen as weakness. Obama has already indicated that they need to start over. This means the status quo will remain.

Will this lead to the end of Obama's ability to make great change? After one year, is his ability to govern over? I'd love to hear what you think.


Andreas said...

This is a good summary. The GOP will roadblock and the Dems won't push it through.

Today's joke: The Republicans secured a 41-59 majority in Massachussets today.

Rajiv Parikh said...

Great joke Andreas - a 41% minority in 1 house has veto power in a 3 headed representative democracy.