Wednesday, September 9, 2009

Health Care Reform Will Happen - And other predictions

Once Obama got elected, I knew it would happen. I knew we would get healthcare reform. This is not said out of some partisan bias. I have simply observed the last 8 years of largely republican rule where the only healthcare reform that occurred - Medicare Part D, was a confusing morass that is more a giveback to pharmaceutical companies than a benefit for seniors. It encompasses everything that is bad about government today.

While the republicans "support" tort reform, I never saw tort reform come to a vote and get signed by W. It simply wasn't a priority.

For the democrats, health care reform is a priority. And the new president is acutely aware that he will be a one-term wonder if he does not enact dramatic changes. Passing comprehensive healthcare reform-something that hasn't been able to happen for >60 years-would be change.

I have heard the naysayers amongst friends, colleagues, bloggers and twitterers. The issue is too political; too locked into lobbyists' interests and influence. The democrats are weak. They'll cave in to pressure. While these arguments aren't untrue, the cynics forget one thing. The healthcare crisis isn't about poor people anymore. When your trauma center closes down and you-a rich person-has to be sent to a facility farther away with less resources, you suffer. When you can't find a neurosurgeon to treat your aneurysm, the rich person suffers. When your ambulance is diverted from your favorite institution because of Hospital overcrowding, the rich person suffers.

And for the average joe with "good" health insurance, rates are skyrocketing, out of pocket costs are increasing, and when you get a serious illness, maximum coverages are reached quickly. Approximately 40% of insurance claims are denied. You were supposed to feel safe having insurance coverage. There is no safety.

Now that the majority of the population is facing this healthcare crisis, there is a mandate, and the president is acutely aware that his support came from people wanting change. If he doesn't get health care reform, the advantage his party has will fall to pieces just as the advantage the republicans' had did.

So my prediction:
The only two people who determine healthcare reform are Max Baucus and President Obama. There are others who might have some influence if they are acting in good faith, such as Olympia Snowe. But most other republicans are simply trying to weaken a democrat initiative so that moderate dems won't vote for it, and those republicans wouldn't vote for it anyway. If republicans won't vote for a bill for political reasons, then they won't have a vote in what it looks like.

Thus, if you want to know what healthcare reform will look like, read the BaucusFramework.pdf. In my next blog I will discuss this further, but read this, then compare it to the Baucus Whitepaper. There are some differences, such as the public option issue. However, the whitepaper is his real views. The framework is his compromise. I think Baucus is making a political move to hide his intention for a public option, and then slip it in at the last moment.

As far as tort reform, Baucus supports it, and Obama supports it as long as there are attempts to maintain quality in the system. Obama NEEDS it if he is to exact cost savings that will make it succeed. So in some manner, there will be tort reform. Maybe not along the lines of what I would like and have suggested, but something will happen on that front.

The cynics will say I'm naive and deluded. I think they aren't looking at the big picture, because if they did, they would see that this is the year. By 2010, we will have healthcare reform passed. It likely won't translate into immediate results as it will take years to enact. But it will happen.


  1. Dr. Brenner,

    I appreciate your passion for reform. I share the passion, as well. I come from the other side of the spectrum of the provider. I know insurance, as you know your profession.

    Health reform, as you put it, is more about insurance than anything else. More to the point, it is about the eventual usurpation by the federal government of at least $820 billion that represents reserves on claims on the total $2.8 trillion premiums in force for health insurance today. That is the prize. Health reform is the tool used to get it.

    80% of the cost of insurance is spent to pay doctors, hospitals, pharma and other providers. Insurance premiums are a symptom of the cost of care, not the driver of the cost of care.

    Further, state and federal laws are the impediments to competition among insurance companies. State laws enable the insurance monopolies. States govern insurance. The federal government has little, if any, purview.

    Yes we need reform. Yes Mr. Obama should have the votes to enact if his party delivers to him. So you need not worry that reform should come to pass.

    This reform, however, is not the right reform and will be virtually inneffective....unless you are the recipient of an $820 billion windfall from the private sector.

  2. Scott, I find it difficult to see how the profits of insurance companies being astronomical and CEO's making millions of dollars a year and over a billion in short periods of time for one, how that is anything but good. The insurance companies only want to insure those who don't really need insurance. If they were not just money grubbing evil folk then this wouldn't have happened anyway.

    If it were up to me I'd just legislate them virtually out of business, if not completely out of business. Why compete with them as a government when you have the power to shut them down?

    If there is no health care reform you will regret it down the road at some point in time unless you are really, really, really, really, etc., really lucky.

  3. "reform" will pass and accomplish nothing. insurance companies will find loopholes around whatever is passed. tort reform? puh-leez.

    i'm not crazy about the happy hospitalist but i think his eight steps to where health care is headed in this country is probably pretty accurate.

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