Is Health Care Reform Possible?

On Tuesday, President Obama released his overview of the FY2010 budget. The real budget, complete with 8 point font that makes us wonks go blind will be out in April. This coming Monday, he’s addressing lawmakers and others regarding the need for health care reform. All in all, an initial heavy focus on health, especially if one considers the early legislative victory that was SCHIP reauthorization. Working inside the beltway means I attend a number of health care conferences, roundtables, and news events. Just before Obama’s speech, I went to a morning session with a Senate-side staffer and that same afternoon I went to the Commonwealth Fund’s release of their brand-spankin’-new report on High Performance Health Care (executive summary here for those without time or inclination to read all 122 pages.)

By the end of the day, I felt like I had whiplash.

The morning session had some hard political realism. No matter how much we want health care reform there are several political realities in the way:
• The giant, gaping maw that is the federal budget. Yes, doing nothing will be even more expensive but arguments that spending money upfront is more cost effective, long-term, have largely fallen on deaf ear. Delayed gratification isn’t a phrase most in Congress.
• The filibuster. Stuff can get passed House-side. Stuff will probably get passed out of Senate Finance where Chair Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) work well and have genius staffers. But on the floor? It’ll mean getting several Republicans to vote “yea.”
• Legislation that needs to get done before health care reform: At the end of the year, payments to physicians under Medicare will drop 4.5% unless Congress acts.

Still, it is looking like Senate Finance will, at least, produce a piece of legislation in June.

Summer bills are hard. By June Congress has a month until July 4 recess then only three weeks until August recess. And did I mention that they’re supposed to have the entire FY2010 appropriations cycle complete by October 1? And that Justice John Paul Stevens will be 89 this April and may be thinking of retirement (meaning a summer of nominations hearings in an effort to seat someone – maybe Elena Kagan – before the start of SCOTUS’s fall term).

I left the morning session feeling grim and went off to my afternoon session...

While I think the Commonwealth Fund's take on comprehensive health care reform is brilliant, and their focus on quality outcomes incredibly important, I am deeply skeptical. They want to create a health care exchange that expands existing models such as SCHIP and Medicaid and eliminates the two-year wait for the disabled to receive Medicare. A new public plan to cover those without health insurance also would be created.

The new plan and expansions would be funded via employer contributions -- either directly providing health care or contributing to a share fund, a $2 increase in the federal tobacco tax, a 1 cent p/12 oz tax on sugar soft drinks, and a 5 cent p/ 12 oz can of beer (other alcohol proportionately taxed). So what’s the problem? Well, tobacco revenue might be a declining source of revenue (economist disagree). Even if it isn’t, there are sticky ethical issues involved. I feel a bit queasy when I read the sort-of-celebratory language by Campaign for Tobacco Free Kids:

“Tobacco tax revenues are much more predictable than many other state revenues. Year to year, state tobacco tax revenues are more predictable and less volatile than many other state revenue sources, such as state income tax or corporate tax revenues, which can vary considerably each year because of nationwide recessions or state economic slowdowns. In sharp contrast, large drops in tobacco tax revenue from one year to the next are quite rare because of the addictive power of cigarettes.”

Besides that, does anyone remember the very recent fight on tobacco revenue? It was incredibly difficult to raise the tobacco tax a mere 62 cents to pay for SCHIP, nevermind $2. User fee taxes on products like soft drinks and alcohol tend to play well but both industries are lobbying powerhouses.

Also in the “very recent history” category is the language around competitive effectiveness. The economic stimulus included language on it and it created a lot of blow back.

And no one – not the Hill, not NGOs – seems to be addressing the tremendous and growing shortage of primary health care professionals – we’re short some half million nurses. Even if we could pass national reform, where are we going to come up with enough folks to treat the 40-some-odd million folks who would suddenly need a medical home?

And no one is addressing long term care. Which is completely stupid given, I dunno, the largest generational retirement is beginning now.

Really, what I’d like is just to have a single payer system. Of course, I'd also like to win Powerball. Maybe if we can do like Obama says – everyone gives something to get a bill done – then it’ll happen. But a decade in this town isn’t leaving me feeling very optimistic.

Photo Credit: Paul Keleher on Flickr. Creative Commons License.

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