Health Care in Congress

With almost two and a half months until President-Elect Obama takes the Oath of Office, the U.S. Congress is already ramping up a number of plans to address the health care crisis.

Robert Pear of The New York Timesreports:

Without waiting for President-elect Barack Obama, Senator Max Baucus, the chairman of the Finance Committee, will unveil a detailed blueprint on Wednesday to guarantee health insurance for all Americans by facilitating sales of private insurance, expanding Medicaid and Medicare, and requiring most employers to provide or pay for health benefits.

President-Elect Obama's aides have stated that he welcomes congressional efforts and has encouraged that body to take the lead on this high priority issue. Sen. Baucus, who we have been following here for some time, calls for universal coverage as the final goal. He is not the only one drafting proposals of this nature, however; several others from his own party have ideas in the works as well.

Other Democrats with deep experience in health care are also drafting proposals to expand coverage and slow the growth of health costs. These lawmakers include Senator Edward M. Kennedy of Massachusetts and Representatives John D. Dingell of Michigan and Pete Stark of California.

While each proposal is going to be unique, Mr. Pear says that they will all be "broadly compatible," with the President-Elect's stated positions on the subject. The Baucus plan would go one step further with its universal coverage goal; President Elect Obama's approach would only mandate coverage for children.

It looks like we will be seeing a plethora of options presented soon, a huge step forward as we move towards Health Care Reform Now!

SOURCE: "Senator Takes Initiative on Health Care" 11/11/08
photo courtesy of Kimberlyfaye, used under its Creative Commons license

The AMA on EMRs

Technology is a repeated refrain in the ongoing national health care dialog. The virtues are well known, especially to readers of this blog. Studies have been enacted by numerous foundations and organizations that show the massive savings of both money and time that electronic medical records (EMRs), properly implemented, can provide. By the same token, the discussion of EMRs also brings up a consistent set of issues that are of concern to medical providers: cost of implementation, privacy issues, and technical standards.

Thanks to the online edition of AMedNews, we can take a look at the American Medical Association's views prior to the hard copy's release date of July 7, 2008, addressing this triple header of concerns.

On standards:

As work continues to develop a national strategic plan for health IT, including any coordination of the multiple government initiatives already under way, it is essential that doctors have a strong voice. It is physicians, after all, who will be expected to invest heavily in making the system work.

The AMA also stresses that physicians with small practices should be given a voice in this discussion since they comprise the majority of medical practices in the United States. This push for standards, compatibility and systems thinking is one that is at the core of George C. Halvorson's approach. Involving the actual physicians in the crafting of these standards is extremely important. After all, they will, as pointed out above, be footing the bill.

On privacy:

To boost confidence in an integrated network, the Health Insurance Portability and Accountability Act's privacy and security rules that apply to physicians, as well as other health care professionals and health plans, should be extended to any party that works with confidential health care records. This would include workers' compensation carriers, researchers, life insurance issuers, employers, marketing firms, health IT and personal health record vendors, and health information exchanges.

Doctors, says the AMA, do not need to see an expansion of their HIPAA obligations. The organization states that this would slow down transmission of patient data as new restrictions are implemented. Instead, their proposal hinges upon expanding the privacy strictures of HIPAA to apply to anyone handling this confidential data.

On implementation:

Physician reimbursements already are under intense pressure, and the Congressional Budget Office itself has released a report doubting estimates of extraordinary, health IT-related savings. It's no surprise that many practices, especially small ones, find it justifiable to avoid health IT investment. Meaningful grants, loans and other financial incentives are essential for giving physicians the financial security they need to accept and accrue the benefits of health IT.

With the cost of implementing EMRs quoted at $37, 000 per practicing physician (and that is a starting number that does nothing but increase), these sort of incentives seems to be in order. It would be a nice change from the perverse incentive standards of the modern day medical profession.

The article goes on to relate the AMA's position as it attempts to influence the U.S. Congress, which even now is deliberating the proper ways to push expansion and implementation of health information technology. Go take a look and see for yourself what your opinion is of their stance.

SOURCE: "Removing health IT barriers: The AMA advocates that federal legislation to encourage technology use should incorporate physicians' ideas, particularly in regard to technical standards, privacy and financing." 07/07/08
photo courtesy of Daquella manera, used under its Creative Commons License

Congress Gets a Shot in the Arm

It would seem that the United States Congress is getting themselves mobilized to make an impact on health care. How much of these efforts end up being substantive and how many ephemeral is a question answerable only by the passage of time.

Ben Bernanke's recent statements about health care taking up a quarter of the federal budget were only one facet of the mobilization beginning on several fronts within those hallowed halls.

Sens. Ron Wyden (D-Ore.) and Robert F. Bennett (R-Utah) are sponsoring the first bipartisan proposal for universal coverage to come out of the Senate. The proposal would scrap employer-based health insurance replacing it with a state-run system where insurance companies are mandated to offer basic coverage to all applicants and compelling those not covered by employer-based plans to buy in.

Tom Daschle has just released a new book in which he argues in favor of a Federal Health Board similar in structure to the Federal Reserve. This probably will be one of the thrusts of the legislation he is currently working on along with fellow Democrat George Mitchell and Republicans Bob Dole and Howard Baker. The four former Senate Majority Leaders plan to introduce their legislation in November. (For an in-depth interview about the book and Sen. Daschle's stance on health care take a look at the interview that he did with Ezra Klein for the American Prospect.)

Via The Washington Post:

"We have a broad consensus that we aren't getting nearly as much as we should for the money," said Mark B. McClellan, President Bush's former director of the Centers for Medicare and Medicaid Services who now heads the new Engelberg Center for Health Care Reform at Brookings. "There's an unprecedented level of agreement that something can be done and that something must be done."

Let us keep our fingers crossed and our eyes open.

SOURCE: "Writing New Prescriptions For Change" 06/17/08
photo courtesy of yanivba, used under its Creative Commmons license

Rockefeller, Congress, and Healthcare: The Quote Heard 'Round The Net

One of the big topics in the blogosphere right now is the article by Manu Raju on The Hill that talks about Congressional Democrats crabwalking on the issue of health care reform:

Congressional Democrats are backing away from healthcare reform promises made by their two presidential candidates, saying that even if their party controls the White House and Congress, sweeping change will be difficult.

It is still seven months before Election Day, but already senior Democrats are maneuvering to lower public expectations on the key policy issue.

Considering the profile of the health care debate in the current election, this is news that, unsurprisingly, seems to be spreading like wildfire across the Internet. The most often quoted part is this statement:

"We all know there is not enough money to do all this stuff," said Sen. Jay Rockefeller (D-W.Va.), a Finance Committee member and an Obama supporter, referring to the presidential candidates' healthcare plans. “What they are doing is … laying out their ambitions."

Ezra Klein at The American Prospect has his doubts about the veracity of this report, and that quote is one of the reasons:

That scans oddly for two reasons. The first is money. Obama's aides say the plan would cost between $50 billion and $65 billion a year. Assume they're lowballing, and the real number is $80 billion. That's some cash, to be sure but it's not a level of outlay that tends to make Senators balk. We're spending far more on Iraq, on tax cuts, and a host of other projects. The money could probably be found fairly easily -- and it's certainly not hard for Senators to say it could be found fairly easily. So that looks strange.

When viewed in relation to other governmental expenditures it does seem like a comparatively small sum. Klein goes on to analyze the quote itself and the reporter who provides it:

The second oddity is "all this stuff." A health care bill contains a lot of stuff, to be sure, but it's generally referred to in the singular. It's a bill. It's big, and you can either do it or not do it. Moreover, the only proof we have that he was talking health care is that the reporter says so. It sounds to me like Rockefeller is saying something much broader and more mundane: That if you look at the domestic agendas of Clinton and Obama, there's not enough money nor political will to do all of it. You're not going to get health care and tax cuts and energy policy and housing reform and education and poverty and everything else you promised in the campaign. And even if you could muster the will, you can't find the funds. That leads to the question of priorities, but that's no surprise.

Jonathon Cohn of the New Republic's response is dismayed:

This is pretty discouraging stuff. Rockefeller is a longtime advocate for universal coverage; his moral commitment to the issue is not in question. And Baucus, whose comments were much less negative but still not enthusiastic, chairs the Finance Committee--through which any universal coverage bill must go.

Still, this isn't the last word on the subject. I just got off the phone with Andy Stern, president of the Service Employees International Union, who in recent years has done as much to promote the cause of universal coverage as any single person in politics. And he is not at all happy.

"I thought it was embarassing," Stern said. "I think it showed an incredible lack of appreciation for what most Americans are confronting every day in this health care system. ... What was said in this aritcle is not the kind of leadership that I think Americans are expecting after this election."

Whatever the context of the quotes was, it sure is generating a lot of discussion. I am sure that by the time this is posted there will be a vast array of opinions being voiced from blog pulpits and news outlets everywhere. Go check out these articles and render your own opinion. Our comments section welcomes you!

SOURCE: "Dems hedge on Health Care" 04/23/08
SOURCE: "Is Congress Backing Off health Care Reform?" 04/24/08
SOURCE: " Stern to Congress: Don't Chicken Out on Health Care." 04/24/08
photo courtesy of The Gold Guys /Lumax Art, used under its Creative Commons license

Medicaid Battle: Congress vs. The Veto

A battle over proposed cost saving measure proposed by the Bush administration is brewing in the U.S. House of Representatives. With a veto threat already on the table, things are looking interesting as another face-off between the two branches of government begins.

Jim Abrams gives us the scoop in his article for Time Magazine:

Passage of the legislation in a vote scheduled for later Wednesday would send it to the Senate Finance Committee, where Chairman Max Baucus, D-Mont., is reviewing options for suspending the regulations, his press officer said.

The governors of all 50 states, state Medicaid directors and others oppose the rules, Energy and Commerce Committee Chairman John Dingell, D-Mich., told the House. "They know the devastating effects these rules would have on local communities, upon hospitals, and upon vulnerable beneficiaries." Dingell's committee approved the bill earlier this month on a 46-0 vote. [Emphasis added. -GW]

So far during the current administration Congress has only been able to successfully override one veto from the President: a water projects bill last November. While this does not bode well for Congress in the coming conflict, this issue is far from dead in the water. Legislators, state governors, health care providers and more are coming together in favor of the moratorium because they fear the administrations plans will simply cost shift the burden to the poor and the state governments.

Once again, the Executive branch and Legislative branch of our government are locking horns, this time on one of the top issues of the current electoral season.

The White House, in a statement Tuesday warning of a veto threat, said the bill would "thwart these efforts of the federal government to regain fiscal accountability and integrity in Medicaid." Health and Human Services Secretary Mike Leavitt, in a letter to lawmakers, said it "puts billions of dollars of federal funds at risk, and may turn back progress that has already been made to stop abusive state practices."

But the proposed changes have met opposition from states, health care providers and advocates for poor who say they will shift costs from the federal government to the states and create new hardships for the needy. "Some of these regulations already have become effective and current state estimates of the impact could be as high as four times the administration's $13 billion estimate," National Governors Association chairman Tim Pawlenty, D-Minn., and other governors wrote lawmakers this month. Timely action to impose the one-year moratorium was "critical to avert significant disruptions in coverage for vulnerable populations," they wrote.

So it looks like the fiscal side of American health care rears its head once again. With 48 million people participating in Medicaid over 2007 the impact of this legislation will be felt far and wide. The Time article paints the cost of Medicaid programs at $352 billion, $200 of which was supplied by the federal government, an amount guaranteed to make the public sit up and take notice.

When was the last time you can recall the governors of all 50 states in the U.S. agreeing on something?

SOURCE: "House Challenging Medicaid Rules" 04/23/08
photo courtesy of euthman, used according to its Creative Commons license

Attempt to Overturn SCHIP Veto Goes Up In Smoke

President Bush's veto stands. After a long and acrimonious war of words the results are now in. Williams Neikirk, a senior correspondent for The Chicago Tribune recounts the closing round of the current congressional battle:

The measure fell 13 votes short of the two-thirds requirement to override the veto. The vote was 273-156, as 54 Republicans voted with Democrats to pass the bill, compared with 53 GOP members who voted for the bill when it first passed. Only two Democrats voted to sustain the veto compared with six who voted against the bill originally....

The bill killed Thursday would have cost an additional $35 billion over the next five years and made children's health-care insurance available to more middle-class families. The expansion would have been financed with a 61-cent-a-pack increase in the federal tobacco tax, raising the levy to $1 a pack.

John Godfrey of Dow Jones Newswire gives us some specifics about the tax on CNNMoney:

Companies that would have been affected include R.J. Reynolds Tobacco Co., a wholly owned operating subsidiary of Reynolds American Inc. (RAI); Philip Morris USA, a subsidiary of Altria Group (MO); and Carolina Group (CG), which is a unit of Loews Corp. (LTR).

The $35 billion raised by the tobacco tax increase over five years would have offset the cost of expanding the State Children's Health Insurance Program. The bill's supporters said that by 2012, the expansion would have allowed the program to cover nearly 10 million children.

House Speaker Nancy Pelosi, D-Calif., already has promised to have the same bill back on Bush's desk within two weeks. Asked whether the bill might include an alternative funding source, Pelosi said simply, "no."

Smoking and health, two subjects often found intertwined. It is interesting to note how little this aspect of the legislation has been touched upon over the last few weeks of constant media coverage. To some it is not only a very relevant concern, but also an emotionally charged issue.

Take the following excerpt from a letter to the Yale Daily News by Jose Abrego, a student in the Ezra Stiles College, as an example:

Consider the ramifications of raising the tax on tobacco by such a ridiculous rate. Nearly all of the tobacco farmers in my province in the Dominican Republic would have their contracts frozen. The same goes for other countries in Latin America.

What worries me about this whole issue is that the tax increase guaranteed that hundreds of thousands of farmers across Latin America would suddenly find themselves unemployed. For Third World nations that are already neck-deep in a sea of poverty, this bill promised to drown them outright. Why didn't any of the major news networks report on the number of jobs that Bush saved in Latin America? Or the number of children that will continue to eat because their parents are employed? Isn't the media's job to present the news to us impartially - or at least pretend to do so?

SOURCE: "House Fails to Foil Health-Care Veto: Defiant Democrats Vow Revised Bill" 10/19/07
SOURCE: "House Failure to Override Veto Good News for Tobacco" 10/18/07
SOURCE: "Letter: Media Ignores Benefits of Health Care Veto" 10/18/07
photo courtesy of SuperFantastic on Flickr, used under this Creative Commons license

The Veto Heard Round The World

President George W. Bush on Wednesday issued his expected veto of $35 Billion in children's health care funding. In short order the commentary and criticism of this move have rippled through not only our own national news, but across the the global media as well. Here is a quick World Tour of reactions to this fourth veto of President Bush's career:

The first stop on our world tour is Korea, where we pick up a copy of The Korea Times and read about the SCHIP legislation:

The bill has problems. It is expensive, $35 billion over five years; the use of a cigarette tax to finance it is questionable; and it may indeed cover some families who could afford private insurance.

But it is not, as some overheated opponents charge, socialized medicine or anything like it. Some Republicans charge that SCHIP is the first step toward "HillaryCare," but even if that were in the back of the Democratic candidate's mind, it would be beside the point.

Then we head over to nearby China to see what The Xinhua News Agency has to say:

The veto of Bush was seen by analysts as a high-risk gamble that might impair his party's efforts to compete with democrats for the next presidency and the dominance in Congress.

Lets shift perspective to Western Europe, how are they viewing this? A quick glance at The Economist (UK Edition) unearths the following:

Up with children, down with smokers: it was, in other words, an easy sell. But Mr Bush balked for several reasons. He said that expansion would mean shifting the programme's focus away from poor children. Better off parents might be tempted to drop their private coverage in lieu of the government option, nudging the country down the dangerous road to nationalised care. Mr Bush objected to the tax increase. And although this White House is not known for fiscal restraint, it thought the expansion would cost too much. Mr Bush had previously said that a $5 billion spending increase would be about right.

Getting a bit closer to home we find the Dominican Republic rejoicing at the veto. Why? As Dominican Today reports, it has saved their industry:

Tobacco farmers of the country's north region (Cibao) yesterday heard with joy the news that U.S. president George Bush's vetoed a bill passed by Congress, which threatened to decimate the Dominican and Central American tobacco industries.

The president of the Cibao Tobacco Harvesters Federation, Jorge Mercado, said the U.S. president's decision would reactivate the north zone's tobacco industry, mainly in Santiago province. "The veto of the law represents hope and relief for more than 300 harvesters in this region who have lived off the production of tobacco for centuries."

Agriculture minister Salvador Jiménez, quoted by the newspaper Diario Libre, said if the bill had been signed into law the country would've lost some 54,000 jobs.

Stay tuned.

SOURCE: "Veto of Child Health Bill" 10/04/07
SOURCE: "Bipartisan Tension Tightens as Bush Vetoes Program" 10/04/07
SOURCE: "Why Did George Bush Veto a Popular Health Care Bill?" 10/04/07
SOURCE: "Bush Veto Saves The Dominican Tobacco Industry" 10/04/07
photo courtesy of Bluedharma used under this Creative Commons license

Wyoming Senator Helps Advance Health Care Reform

In the Casper Star Tribune today, Tom Morton writes about the chairman of the Senate Committee on Health, Education, Labor and Pensions, Edward Kennedy, a Democratic Senator from Massachusetts. The senior Senator from Wyoming, Republican Mike Enzi, previously held the position. Kennedy is entrusting Enzi "to grapple with the finer points of health care reform," according to Morton.

[...] instead of promoting a single comprehensive health care reform bill that could die by a thousand cuts, [Enzi is] promoting 10 different bills, he said.

They include allowing small businesses to band together and cross state lines to obtain group health insurance; allowing individuals to buy into group programs; and fostering coordinated health care technology.

The latter bill would save upward of $160 billion a year, he said. Individuals would have their records on a card that would eliminate the need to fill out multiple forms and inform physicians of previously performed tests to avoid duplicate testing [...]

The committee has been soliciting input from experts, "and has encouraged them to incorporate each other's ideas as it crafts legislation."

SOURCE: "Enzi, Kennedy Join Forces to Reform Health Care" 08/21/07
photo courtesy of "scol22, SXC"