Monday, July 20, 2009

The Sausage Factory Road To Health Reform

News flash: Anyone who says the health care bills now in Congress are doomed to failure. Or those who proclaim health reform is on the horizon. I say bunk. I have read portions of the versions of the House and Senate bills until the words became blurred as if viewing the world through cataracts.

Frankly, I gave up in despair. I came to the only sane conclusion possible: Wait until the House and Senate bills are voted and sent to conference for reconciliation. Then and only then can they be dissected with some order of coherence. Actually, that is precisely the method the White House gurus seem to be taking unless they panic and give away the store before the August recess.

The health care reform bills are a text book case of the messy process making legislation much like the making of sausage, something you don't want to see done but bound to eat it in its final product.

As a result, President Barack Obama is taking the lead ramrod role of cheerleader encouraging Congress to get it done. “We’ve talked this problem to death — year after year,” Obama said Monday to a group of doctors and nurses. “Unless we act and act now, nothing will change. The need for reform is urgent and indisputable.”

The president said that the “status quo” in the nation’s health-care system would only get worse and coverage costs would continue to soar. He said he would not sign a bill that did not reflect a commitment to slow costs over the long run -- and "deficit neutral" to coin a Washington phrase.

Democrats are weakening their resolve by urging a 70-day delay in the Senate for health reform passage, in order to gain Republican support. House Speaker Nancy Pelosi said her chamber's version is on schedule for a vote before the August recess.

So far, Obama has been reluctant to be specific, preferring to paint with broad brush what he wants. On the few occasions he has targeted congressional proposals, it has antagonized Democratic leaders. One specific was his displeasure with a tax on health insurance premiums of employers providing coverage for workers. He has been mum on the House proposal to provide federal funding for abortions for poor people. Nor has he addressed the nation's governors' concern of proposals to mandate more benefit coverage through Medicaid without additional federal funding.

The National Governors Association, meeting last weekend in Biloxi, Miss., said the recession is draining their budgets of revenues and cannot afford additional Medicaid costs when they face an aggregate deficit of $200 billion over the next three years.

In the House bill, Medicaid would be expanded to cover all nonelderly people with incomes at or below $29,300 for a family of four. The federal government would pay all the costs for those who were newly eligible. Medicaid would also cover newborns, for up to 60 days after birth, if they did not have insurance from other sources.

The Congressional Budget Office projects that 11 million more people would receive coverage through Medicaid under the House bill, and that it would increase federal Medicaid spending by $438 billion over 10 years. Medicaid thus accounts for about 40 percent of the cost and 30 percent of those who gain coverage.

Many governors expressed frustration. “There’s a concern about whether they have fully figured out a revenue stream that would cover the costs, and that if they don’t have all the dollars accounted for it will fall on the states,” said Gov. Bill Ritter Jr. of Colorado, a Democrat.

In a draft of the bill in the Senate Finance Committee, the federal government would pick up the extra costs for perhaps five years, but states would eventually have to pay their normal share. On average, the federal government pays 57 percent.

As I said, the legislative process is a meat grinder. I have touched on only a few of the proposals and, believe me, there are dozens. On the whole, the scheme favored by Congress is taxing those with earnings of $300,000 and more to pay the brunt of the additional costs that will come with universal health care coverage. Less prevalent is actual reforms other than a national patients' data base and reimbursement of doctors for quality rather than quantity of procedures. Stay tuned.

No comments: