While Republicans Worry About Dobson's Agenda...

by DemFromCT

...the reality-based community of all ideological stripes has been working on finding solutions to a real problem: what to do with the health uninsured.

At a time when Congress has been torn by partisan battles, 24 ideologically disparate leaders representing the health care industry, corporations and unions, and conservative and liberal groups have been meeting secretly for months to seek a consensus on proposals to provide coverage for the growing number of people with no health insurance.

The participants, ranging from the liberal Families USA to the conservative Heritage Foundation and the United States Chamber of Commerce, said they had made progress in trying to overcome the ideological impasse that has stymied action on the problem for eight years.

The group, which first came together last October, has not endorsed any specific plan, but has discussed a range of options, including tax incentives for the purchase of insurance, changes in Medicaid to cover more low-income adults and the creation of insurance purchasing pools at the state level.

"This effort holds as much promise as any I've participated in over the last decade, probably more," said Kate Sullivan Hare, the executive director of health care policy at the United States Chamber of Commerce.

      

It's way too early to figure if something good will come out of this, but the numbskulls in the House (and, alas, these days, the Senate) who only know how to vote ideologically might do well to read this story.

Historically, such efforts have failed because of profound disagreements over the proper role of government. The group is far from any final agreement, but persists in seeking common ground, even as the problems of the uninsured have been eclipsed on Capitol Hill by Social Security and other issues.

The group also includes top executives from AARP, the A.F.L.-C.I.O., the American Hospital Association, the American Medical Association, America's Health Insurance Plans, the Blue Cross and Blue Shield Association, Johnson & Johnson, the National Conference of State Legislatures, the National Governors Association, Pfizer and the Service Employees International Union.

The group's overarching goal is to agree, by the end of this year, on proposals that expand coverage to as many people as possible as quickly as possible. By meeting in secret, the group has tried to shield itself from political pressures. Some of the proposals under discussion could lead to increases in federal spending or regulation, at a time when the government already faces large deficits and Republicans generally oppose further expansion of government.

Republicans like W don't seem to mind as long as red states benefit. But sometimes a problem is big enough to require some fresh thinking.

Increasingly, business executives say, health care costs hurt the global competitiveness of American companies. "This is a crisis," General Motors said in its latest annual report, noting that its health costs - $5.2 billion last year - had "a tremendous impact" on its profitability.

The Census Bureau says that 45 million people lacked health insurance in 2003, up by 1.4 million from 2002 and by 5.2 million from 2000. The National Academy of Sciences estimates that 18,000 adults die each year because they are uninsured and cannot get proper care. The number of uninsured may rise further as states like Tennessee and Missouri cope with soaring health costs by ending Medicaid coverage for tens of thousands of low-income people.

We don't have time to go over all the issues here (more to come in the next few weeks), but the fact that folks are talking about what is an issue that should be on everyone's plate is a good sign. Of course, it's no accident that this story surfaces just after the centrists in Congress have been asserting themselves. Will it be President (in the mirror) Hagel or President (to the media) McCain who claims this on the R side of the aisle? The dems will have no dearth of sponsors when the time comes.

Remember that the public has taken a dim view of Congress, right now, and that it is Republicans who are in the majority in both houses. If they can't get it done, health care will join stem cells in 2006 (and 2008) as fertile Democratic ground.

Comments

[DHinMI]

What a lineup! That's one of the first encouraging things I've seen about health care in ages. Of course it doesn't mean anytyhing will happen with these numbskulls in charge of Congress and the WH, but it could form the basis for some kind of widely-backed legislation in the future, either by a Dem chamber in Congress or a Dem President.

I'd love to see some practical heath-care legislation move out of a Dem House or Senate in 2007, and put the pressure on the WH and Congressional Repubs, and have an important chunk of corporate America on our side. This is a huge potential wedge issue on the coalition scale, with the Repubs siding with insurance, PhARMA and the small business people and the Dems picking up just about everyone else. I look forward to that fight.

[DemFromCT]

"GM backs Dem for WH"

sweet.

[Mimikatz]

I would think that, depending on how it is played, the Dems could pick up small business as well. They don't like having to pay for health insurance either. Having the gov't pick up health care costs above a certain level (catastrophic care) and requiring those with means to carry a high-deductible policy for mid range care (kind of like mandatory auto insurance) is one possibility. Another issue is having a better grip on what treatments are best to increase efficiencies in the system, which is now comparatively inefficient.

And Remember Robin Cook's NYT op-ed about how genetic screening will force single payer health care because otherwise there is too much potential for discrimination.

[DemFromCT]

In a perfect world, finance reform would be matched by acess reform and quality reform. With all the players at the table, it's possible they'll all be addressed, rather than the shotgun approach done now.

a single payor system, however, may still be out of reach.

[Abby]

Well, it seems like most of the push on healthcare is happening at the state level. Vermont's got a single-payer proposal working its way through the legislature, and I hear that Illinois is tackling the problem.

Massachusetts is working on it too. There's a push from a group called Health Care for All which has allied itself with the Greater Boston Interfaith Organization. The GBIO just committed itself to gathering 40,000 signatures to get this on the 2006 ballot as an initiative. The hope is that this will force the legislature to act. For more info, see HCFMA's blog.

[DemFromCT]

thanks, Abby. I suspect single payor systems might be done at the state 'laboratory' level first before it becomes acceptable at the federal level.

[praktike]

"a single payor system, however, may still be out of reach."

It looks to me like this is an effort to head off single-payor at the pass.

[DemFromCT]

praktike, it may be, but if some other good ideas come out of it, and if single payor gets a hearing (even if rejected), it'll be progress where before there was none... just a lot of uninsured Americans; more every year.

The corporations, I think, are more open to ideas than ever before. GM alone has a $5 billion annual problem. And if the corporations buy in, we have the next change in health care, just as they pushed HMOs to control (their) costs.

I'd prefer single payor, but I am curious what will come out of this.

[Abby]

Michael Porter has been trying to tackle this too. I think he may be associated with the Leapfrog Group. Michael Porter would like to see universal coverage, but his main goal is to improve value. He's less concerned with just cutting cost in the short term.

He is very much against single payor, because he thinks that it will cut out innovation. He likes competition, but he seems to believe that what we have now is not good competition, but just cost-shifting. He fears that a single-payor system will just impose price controls, and that that would be bad. If we could convince someone like him, then I think we'd be close to winning the debate on single payer.

I think that in Porter's world, your health plan would be like an advocate, helping you to find the best care for your particular disease.

Does anyone know how we can counteract this innovation canard? (And while Medicare is pretty great in a lot of ways, it's not always great about covering the most effective treatments, particularly for diabetics. I'm not sure what to do about that. Everyone's thoughts are most welcome.)

To clarify, HCFAMA is not backing a single-payor system at this time. They figure that their proposal would cover about 400,000 out of 500,000 currently uninsured. Thhey would pay for it by raising the cigarette tax by 50¢. Massachusetts has voted down a progressive income tax, and I don't think that the legislature can raise income tax rates without amending the constitution. I'm not sure about that though.

[RonK, Seattle]

Not sure I like the sounds of this. Practike may be right, a scheme to head off single payor. [Single apyor isnot an immediate option either, but we should be wary of anything that puts us farther off course.]

All the "solutions" seem oriented to driving money into the insurance system, which is where aggregate return on aggregate expenditure goes to die.

Any of several proven universal coverage systems -- fundamentally single payor, with or without fee-for-co-pays and luxury policies around the edges -- would cover everybody, improve outcomes, and reduce public expenditures.

Any of several diversionary policies would increase costs and strengthen entrenched interests ... and that sounds like where this initiative is going.

[Tom Geraghty]

By meeting in secret, the group has tried to shield itself from political pressures.

Now, where have I heard that before?

[stumpy]

"He (Porter) is very much against single payor, because he thinks that it will cut out innovation. He likes competition, but he seems to believe that what we have now is not good competition, but just cost-shifting."

I thought the whole idea about health care was (and is) a competition between us, the public, and sickness and results of injury. What game does Porter think we are playing?

[DemFromCT]

chinese ideogram Danger = crisis + opportunity.

This can turn out very good, very bad or somewhere in the middle. RonK's and stumpy's comments suggest the concentration is only on finance reform (which we don't know... It's clearly the driving force but there may be room for access reform and quality reform as well). The difference (hopefully) between the energy task force and Hillary's project is that there's public input into the process rather than a done deal at the end.

Keep an ear out for more... we know less than we need to about this.

[DemFromCT]

oops... RonK takes me to task on my chinese ideogram analogy for two separate reasons: the third error (inversion) being due to not enough coffee. But see below:

"you are repeating myths, not facts, about Chinese characters. First, Chinese characters do not represent an ideographic writing system. Second, "crisis" does not equal "danger" + "opportunity".""

The user links to this article, which seems authoritative enough. The author has me cheering:

A whole industry of pundits and therapists has grown up around this one grossly inaccurate formulation. A casual search of the Web turns up more than a million references to this spurious proverb. It appears, often complete with Chinese characters, on the covers of books, on advertisements for seminars, on expensive courses for "thinking outside of the box," and practically everywhere one turns in the world of quick-buck business, pop psychology, and orientalist hocus-pocus.

The author actually goes even further than I would:

Those who purvey the doctrine that the Chinese word for "crisis" is composed of elements meaning "danger" and "opportunity" are engaging in a type of muddled thinking that is a danger to society, for it lulls people into welcoming crises as unstable situations from which they can benefit. Adopting a feel-good attitude toward adversity may not be the most rational, realistic approach to its solution.

I encourage accuracy in blogging and am happy to admit to error (especially if it means linking to Mark Schmitt... a bonus, there). Nonetheless, the myth (let's posit that that's what it is) endures because it is apt.