Thursday, February 25, 2010

The Health Care Summit: Analysis and A Way Forward

A very interesting day indeed. On the substance, both sides scored points and put forth thoughtful and credible arguments about how to move forward on health reform. Before going any further, let's stop and celebrate that point alone. How refreshing! Real dialogue and debate on meaningful issues. Sure, there was some posturing and demagoguery, but no talk of death panels (at least not that I heard) or other misinformation and distortion that has been spewed about over the past year. That alone is a big win for our country.

In the end, score it a tie on the substance. Few will be moved from their positions by the substantive arguments. But here's the interesting thing. This public debate has not been about the substance. The irony is that the public hates the bill, but likes everything in it. The debate, sadly, has been more about process and size and scope. The public is incredibly confused and, given the economic climate, quite scared about what they perceive (correctly) to be a massive change that may cost a lot of money. And that has been fully and effectively manipulated by Republicans in saying it is too big and we should start over. (It is also quite cynical because you have to be from Mars to not know that their true goal is to cause a massive failure by the President, then criticize him for wasting everyone's time and not getting anything done while he had a majority, all in the hopes of gaining seats in November).

And this leads to my reason for believing that politically, today will prove to be a huge win for the President. First, he demonstrated to the country he is serious about these issues, wants to engage in real dialogue to try to forge a compromise, and showed courage to put himself out there to the World to debate the substance of such important topics (could you imagine George W. Bush doing this?). And as usual, he was quite articulate and came across as very sincere. The public likes him and this will add greatly to his credibility on this issue. Whether or not they agree with everything that is in the bill, they will believe that he really does want to do the right thing for the country and for them (and they will likely respect and reward that, notwithstanding their concerns with the bill, in the same way the country did not like many of Bush's policies after 9-11, but nevertheless respected and rewarded him for wanting to do everything he could to protect them. I believe this is the main reason Bush won the election in 2004).

Second, the Republicans were in a bit of a bind. They have been saying all along the entire legislation is crap. Yet today they engaged in a serious debate about issues in these bills and actually reached agreement in several areas, thereby giving validity to at least certain portions of the bills. The fact is that many provisions of the bills were put in at the request of Republicans. So they have now conceded (implicitly or otherwise) that there are some substantive and serious provisions in the legislation. And given the fact that the President took the initiative to proactively reach out to them to forge a compromise, they will be under intense pressure now to actually make some compromises of their own or they will truly look like the "Party of No." Thus, no longer will they be able to effectively pursue their slash and burn agenda of dismissing and trashing the whole bill.

Now for the way forward. As I have said all along, the House should pass the Senate bill.  But here are three specific ways they should improve it. First, they should remove all of the most egregious "special deals." Even though these deals exist in all legislation, this issue has done more than anything else to infect the process and distract and outrage the public. And there is no substantive defense to most of it. It undermines the Dems efforts to try to act with integrity in the best interest of the country at large. And of course stripping the bill of these deals removes the best talking point of the Republicans. Second, the Senate should agree to other modest changes by the House to give them a "win" and allow them to claim victory in making improvements to the bill. It won't change much about the substance, but it will go a long way to making house members feel better and give them something to run on in November (i.e., "thanks to my insistence, we actually improved the bill."). 3. Finally, and this will be most controversial, the Democrats should add a serious and meaningful provision on malpractice reform. It is simply indefensible, in this age of out-of-control healthcare costs, to not take on this issue. It is true that actual malpractice costs add relatively little to the cost of health care. But defensive medicine (the practice of ordering tests and procedures for fear of being sued if you don't) adds quite a bit. And by not taking it on, you appear as if you are trying to curry favor with trial lawyers. The fact is that everyone must give their pound of flesh if we are to succeed in this effort and the failure to address this issue in such a comprehensive bill is a huge and unacceptable void.

If the Dems do these three things, they have preserved the "heart" of their comprehensive reform, which is good for the country. But they have also improved the bill, stripped it of its most insidious components, and added an issue that should have been in from the beginning. They will also being showing real compromise, which will improve public support, and they will put the Republicans in a real box. How could the Republicans ever say the Dems did not compromise in good faith when they added perhaps their number one priority (malpractice reform). This will probably result in a few Republican votes. But even if it doesn't, the Dems will gain the upper hand politically and can move to reconciliation in a far better posture to defend their actions come November. One can hope. What say you?

Wednesday, February 24, 2010

National Health Reform Will Benefit Massachusetts

See this excellent Op Ed (although I am admitedly biased) in today's Globe co-authored by UMass Memorial CEO (and my boss) John O'Brien dispelling the myth that national health reform will do nothing to benefit Massachusetts.  As he and his co-author Phil Edmundson note, it will actually do quite a bit. 

Tuesday, February 23, 2010

From Ronald Reagan to Goat

Last evening, Senator Scott Brown announced that he would join 4 other Republicans to vote with Democrats against a Republican filibuster designed to stop a vote on President Obama's jobs bill.  As I predicted in my February 4 post, Brown may end up frustrating Republicans more than the President.  I just didn't think it would happen this soon.  In this story from the LA Times, James Oliphant notes that on account of this vote, almost overnight Scott Brown "has gone from being the darling of America's conservative activists to being their goat."  Oliphant notes that many of these activists were hailing Brown to be the next Ronald Reagan who could usher in a new era of conservatism, but now only days later they have exploded into the blogosphere with this:

"Cries of "letdown," "betrayal," "sellout," and "RINO" -- "Republican in name only" -- flew around Twitter. By late Tuesday afternoon, more than 4,200 people had left comments on Brown's Facebook page, most harshly negative."

Perhaps this says something about those activists who supported Scott Brown.  But it clearly says something about Scott Brown.  It says that in this early test, he is putting his money where his mouth is and trying to be the independent voice he claimed he would be.  Let's hope it continues. 

Saturday, February 13, 2010

Congratulations Eric Schultz

Harvard Pilgrim Health Care announced Wednesday that Eric Schultz will become its next CEO, replacing Charlie Baker who left the plan to run for Governor.  Eric has served for 10 years as the CEO of Fallon Community Health Plan in Worcester.  Eric is a very good and seasoned health plan executive.  More importantly, he is a great guy and I wish him all the success in his new role.  Harvard Pilgrim is lucky to get him. 

I also want to say a word about the guy who didn't get the job: Bruce Bullen, the long-serving Harvard Pilgrim COO.  Many don't know that Bruce served as the state's Medicaid Director for 10 years and transformed that program to become one of the best in the country.  Having served briefly in that role, I have a sense of how hard it is.  But Bruce made it look easy.  He was responsible for the first federal waiver (under the Weld Administration), which served as the foundation on which health reform in the state was able to happen.  And then he went on to help Charlie turn around Harvard Pilgrim.  He is an exceptional and smart executive and I know he will go on to continued success in whatever endeavor he decides to pursue.

Thursday, February 11, 2010

Music to My Eyes

Judy Feder wrote a thoughtful story today for Kaiser Health News that makes the case - far better than I did in yesterday’s post - on why the House should vote to accept the Senate bill. It is a must-read. Her concluding remarks say it all: "But after decades of trying and failing, hoping and waiting, can anyone who truly values reform say no to this opportunity to get to work? To me, that would be unconscionable."

Wednesday, February 10, 2010

The Public Wants Health Reform

The Democrats are cowering.  They are panicking.  They are so freaked out by Scott Brown's election that they are becoming somewhat irrational and interpreting the election in the wrong way.  They think the country has lost its energy for health reform.  But they are wrong.  And if they don't figure it out soon, they will likely face very serious consequences in November.  The fact is that the public still wants health reform and they trust Democrats more than Republicans on the subject.  This has just been confirmed in a Washington Post poll.  You can find the story here.  The bottom line is that nearly two thirds of those polled (and 56% of independents!) want Congress and the President to keep working to pass health reform.  See the poll results below. 

And when it comes to which party is doing more to compromise with the other - Obama trounces the Republicans.  About half of those polled believe Obama is doing about the right amount to compromise (and the same amount felt he is doing too little).  But only 30% believe Republicans are doing the right amount and 58% believe Republicans are not doing enough.  See these results below. 

The point is that not much has changed other than an election in Massachusetts.  And even the Brown folks acknowledge that the election had as much to do with terrorism (Brown effectively used the Christmas attempted plane bombing incident and Obama's insistence on civil (and not military) trials, to stir up fears) as it did with health reform.  (For my sober analysis of the election, read here.)  The House should wake up and pass the Senate bill.  That is the quickest way of getting this done and starting down the path of meaningful reform.  The problems with the bill can and will be fixed when cooler heads prevail.  In time, the many benefits of the bill will come to light more clearly and these Dems will have something good to run on.  Keep hope alive!

Tuesday, February 9, 2010

It Takes A Village

For seniors, part of the difficulty of staying out of a nursing home is the inability to do the little things: transportation, home visits, shopping.  See this interesting story about a new concept of senior "aging-in-place" villages cropping up around the country, where volunteers support seniors with those basic needs to help them be able to stay at home.  Although still an experiment, the concept seems to be picking up steam in many places, including Boston.  Perhaps it takes a village after all.  (And if you are interested in a unique healthcare model in Massachusetts for integrating care for seniors, see my Boston Globe op ed in the side bar from 7-20-09 entitled Retooling the Medicare/Medicaid Model).

Thursday, February 4, 2010

Brown and Obama: New Best Friends?

The conventional wisdom says that Senator Brown will be that 41st vote that mucks up the President's agenda. Maybe. But conventional wisdom is often wrong. Here's why I think it might be wrong in this case. Senator Brown and President Obama have a lot in common right now. The President desperately needs to show the nation that he can get things done; as a result, he will be willing to compromise and make more deals than before Brown was elected. And Scott Brown may be just the person with whom to make a deal. Brown needs to desperately show Massachusetts voters that he is not in lock-step with the national Republican Party and he is the true independent voice he claims. Brown's reelection will come very soon (less than three years) and he knows that when the current political tsunami subsides, Massachusetts voters are still generally a very liberal lot and will not tolerate a Senator who follows the national Republican party line.  Given these political realties for both Senator Brown and President Obama (realities which will trump ideology every day of the week), don't be surprised if the agenda Brown ends up mucking up is not that of the President, but the national Republican party.

Monday, February 1, 2010

What's Up in Idaho and North Dakota?

These are the only two states not represented on a list of contributors to the campaigns of Scott Brown and Martha Coakley in the last three weeks of their campaign.  For details, see here.  Many find it surprising that residents in the other 48 states gave to one or the other of the candidates (Brown: 48 states;  Coakley: 44 states).  But with the 41st vote in the balance, it should be no surprise the election generated such national interest.  My question is what the heck is going on in Idaho and North Dakota?  Are they pathetically out-of-touch or far more evolved than the rest of us?  I am starting to lean toward the latter explanation.