An Election, a Budget, and Two Summits = A Bold Obama Strategy for Health Care Change.

Like most participants in President Obama's Health Care Summit last Thursday, I was thrilled to be invited to the White House for the big public meeting on health care. At the Summit, the President did what the leaders and activists of the 800 organizations in our Health Care for America Now coalition have been urging:
he announced his determination to reform the country's health care system -- to cover everyone and to control health costs -- in this first year of his presidency.

I brought CDs with 300,000 signatures and emails collected by MoveOn, HCAN and my organization. The message to Congress: "Don't let conservatives and special interests block health care for all." By challenging all participants to control health costs as well as coverage, Obama is setting up the coming debate to demonstrate that the conservatives and special interests are bankrupt when it comes to real health reform - because they and the interests they represent are part of the problem, not part of the solution.

Obama signaled he was serious about health care with his first budget documents, released before his February 24 speech to Congress, containing a $640 billion "down-payment" on the cost of health reform in the next 10 years. And he set up the rationale for the urgency of going ahead with health care at the February 23 Fiscal Responsibility Summit, where Obama and his OMB director Peter Orszag argued that the only serious way to "bend the budget toward balance" is reorganize the health care system to control costs in this sector of the private economy that is also responsible for runaway growth in the Federal budget.

At a time when he has gotten the Congress to spend hundreds of billions to revive the economy and unfreeze the banking system, the President took on the concerns of conservatives and Blue Dog Democrats about growing deficits to set up the following equation: "When the economy recovers, the number one factor pushing up deficits will be Medicare and Medicaid spending. But these Federal programs is driven by rising costs in the entire health care system. So it is imperative that we reform the whole health care system to reduce inflation that is driving growth in Medicare and Medicaid spending."

But the important point that I want to emphasize today is that on Medicare and Medicaid, in particular -- which everybody here understands is the 800-pound gorilla -- I don't see us being able to get an effective reform package around those entitlements without fixing the underlying problem of health care inflation. If we've got 6, 7, 8 percent health care inflation we could fix Medicare and Medicaid temporarily for a couple of years, but we would be back in the same fix 10 years from now. And so our most urgent task is to drive down costs both on the private side and on the public side, because Medicare and Medicaid costs have actually gone up fairly comparably to what's been happening in the private sector what businesses and families and others have been doing. That's why I think it's so important for us to focus on costs as part of this overall reform package. [Link]

What is truly impressive is President Obama's ability to reach out to deficit hawks who disagree with him fundamentally on the budget - or insurance company executives who have a very different approach to health care -- and make them (and the media) feel as though they have been consulted, heard, and at least partially agreed with. Sooner or later, many of these forces will break with Obama, and he will have to assemble a majority in the Congress who support his approach -- and he will need the power of a powerful progressive movement to help him win. But for now this public openness works.

The new team has gotten this domestic policy summit thing down: Fill the East Room with a couple hundred Congresspeople and Senators and policy and organizational leaders from across the political spectrum. Give the President the microphone and let him impress us with his mastery of the issues -- and then send us off for two hours of wonky "break out sessions" where Congressional leaders dominate but others also get to weigh in. Finally, bring us all together to hear the President summarize the discussions (from reports from his staff) and declare his intentions -- to bend the arc of the budget toward balance (in the case of the Fiscal Summit) and (at the Health Summit) to reorganize the health care sector to cover everyone in a way that controls the main cause of long term budget imbalance, the spiraling costs of health care.

These gatherings are designed to do a number of things at once: to dominate the hourly cable and talk-radio programs and the daily and weekly news; to make a large number of elected officials and citizen leaders feel they have had an opportunity to advise the White House and posture in public, and to convey to the voters who elected him that he has a plan to achieve what he said he would do if he got to the White House. And on each occasion the President sent off the participants with the admonition to work together for progress -- and the implication failure to work together is a betrayal of the common good.

The good news is that many of the participants now feel pressure not to oppose the President directly. On health care, for example, the groups that wielded the knife that killed the Clinton health plan, the health insurance lobby and some groups claiming to represent small and big business, attended the Health Summit and pledged to help this time. Karen Ignani, who runs the insurance company association, now called America's Health Insurance Plans, declared to the President. "We hear the American people about what's not working. You have our commitment to play, to contribute, and to help pass health care reform this year." Dan Danner, representing the National Federation of Independent Businesses, the group that produced the Harry and Louise ads against Hillary Clinton's health reform, replied to Obama, "I'm honored to be here representing small business . . . and for them, cost is still the top issue. And we very much look forward to finding a solution together that works for America's job creators."

But how does the insurance industry meet President Obama's challenge to control health insurance costs, now bankrupting companies and experienced by you and me in rising premiums, growing out-of-pocket costs, and just plain inability to afford decent coverage? Here's Karen Ignani's answer, conveyed in the breakout session I was assigned to: She suggested that every player in the health system -- insurance companies, doctors, hospitals and other providers -- all get together and promise to voluntarily reduce their costs in the coming year by at least 1 percent. That's it. That's the best this representative of America's Health Insurance Plans could come up with! Voluntary price restraint! Bernie Madoff should try making this promise of volunteerism when he finally goes to trail. ("Members of the jury, if you don't send me to jail, I will voluntarily give back the money and do real investments, not ponzi schemes for the rest of my life.") When American health consumers, like the Madoff jury, hear this offer, they are likely to look for another solution.

In his concluding remarks at the Health Summit, in what may have been a feint to confuse everyone, President Obama declared "I'm talking to you liberal bleeding hearts out there. (Laughter.) Don't think that we can solve this problem without tackling costs." Well, it turns out that it is the liberals who have been promoting the most effective strategy for tackling costs that has so far been proposed: giving everyone the option of enrolling in a public health insurance plan, like Medicare for the non-elderly. The Lewin group estimates that something like half the population would enroll in such a plan, creating a very important benchmark and competitor for the private insurance industry. The Commonwealth Fund Commission found that a public health insurance plan will have premiums averaging 20% less than private insurance. And recent polling by Celinda Lake has found that 73% of Americans favor a choice of private or public health insurance over having just one or the other.

The public insurance option is controversial among some of the same people who, like Ronald Reagan in the 1950s, called the prospect of Medicare for seniors "socialistic." But the real impact of a public insurance plan would be to bring to bear some good old-fashioned competition in the health insurance market, which is dominated by a few firms in most states. According to a study in Health Affairs, in 40 states the top three carriers account for between 60 and 100 percent of the market. By now, everyone should know that Medicare is more efficient than private insurance, with fewer overhead costs like advertising - and much simplified billing and other procedures than private companies. And it is just this kind of simplified nation-wide administrative structure that would allow a public insurance plan for the rest of us to institute cost-saving and quality-improving reforms.

Everyone talks about the virtues of Health Information Technology in controlling costs. A unified system (like a Medicare for the rest of us) would be able to deploy IT system-wide more easily that a whole lot of private firms, each with their own administrative, billing and reporting systems. And the real cost saving potential for health IT comes when linked with a new system of "comparative effectiveness research," so that over time, the health system builds up a huge database of what works and what doesn't work in health treatments. Senate Finance Committee Chairman, Max Baucus, in his highly-regarded White Paper called Call to Action: Health Reform 2009, which proposes creation of a public insurance plan similar to Obama's, argues that the public plan, by virtue of its size and non-profit national charter, would be able to reorient America's health care delivery system toward services and activities that improve patient care and "bend the curve" of growth in national health care spending.

Study after study has endorsed the importance of a public insurance plan as a very effective mechanism for controlling system-wide costs, spurring competition and innovation in the private sector, and improving the quality of health care.

And yet, the conservative ideology dominates one part of the political spectrum. At the White House Health Summit, after he called on Senator Baucus, President Obama graciously gave the microphone to Baucus's minority party ranking member in the committee, Sen. Grassley, who thanked the President and then laid down the gauntlet on the public insurance option: "So the only thing that I would throw out for your consideration -- and please don't respond to this now, because I'm asking you just to think about it -- there's a lot of us that feel that the public option that the government is an unfair competitor and that we're going to get an awful lot of crowd out."

So the only time the public insurance option was seriously discussed with the President in the room, it was for the highest ranking leader of the Republicans at the Summit to try to rule it off the table, because - it would represent unfair competition with the private insurance companies.

President Obama didn't respond conclusively, but he correctly summarized the case for the public insurance option: "The thinking on the public option has been that it gives consumers more choices, and it helps give -- keep the private sector honest, because there's some competition out there."

So the debate has finally been joined. The President is in favor of competition and choice to bring down costs. And the Republicans, echoing the insurance industry, are afraid of competition and have no other real answers to the problem of rising health care costs. Sound like a good fight to me.

###

I also attended the February 23 White House Fiscal Responsibility Summit and I was brought face-to-face with the reality that Republicans and some Democrats do have a proposal for dealing with Medicare and Social Security costs. They want an independent Commission on Entitlements that would propose caps on overall entitlement spending and automatic cuts to those programs when spending exceeded the caps. The Commission would devise the specifics and then present them to the Congress for an up or down vote - dispensing with the democratic niceties of debate or amendments.

Prior to this first summit I had worked with allies to urge the White House NOT to have Peter G. Peterson, the notorious budget hawk and advocate of such a commission, speak at the Summit - and to urge them not to announce a White House task force on Social Security. Perhaps to punish me for this successful pre-Summit agitation - or perhaps to let me see what they were up against, the White House assigned me to the Budget Process break out session that was dominated by Senators and Congresspeople -- like Judd Gregg and Evan Bayh and Kent Conrad - who made an entitlements commission the subject of the session. Their focus was on capping and automatically cutting Social Security and Medicare -- the very opposite of health care reform that takes on the drivers of health care inflation, the insurance companies.

I got only one opportunity to speak in a session dominated by Senators and Congresspeople, but I am especially proud of the small section (page 44) devoted in the official report to the dissenters:

Still others - for example, Representative Obey, Representative Van Hollen, and Roger Hickey - stated express opposition to a commission.

• Representative Obey stated that he believed a commission would thrill the policy wonks but nobody else, and that in the end nothing would be accomplished. "Cound me among the strong skeptics," he said.

• Representative Van Hollen's central concern with a commission process was his belief that Congress should not outsource the key fiscal policy decisions on health care, taxes, and Social Security to someone else. In his words: "Huge policy issues cannot be subcontracted." He feared that a commission would be viewed as undemocratic and and abrogation of congressional responsibility.

• Roger Hickey believed that "an extraordinary procedure" has already been employed in the past year, to great effect - namely, the presidential election. He argued that the American people had spoken in favor of expanded health care and a fairer tax distribution, and also for greater honesty and transparency from their government - not in favor of handing over decisions on fundamental issues such as taxes, health, and retirement to a closed group of insiders.

My moment of glory at the Fiscal Responsibility Summit.

Comments

[AlanMaki]

First of all you have failed to address the issue of single-payer universal health care which has massive support in spite of the fact that you have helped bring many leaders of the 800 organizations you represent out of the struggle for single-payer.

800 is an interesting number.

It just so happens the the United States has over 800 military bases on foreign soil.

I would suggest that instead of 800 U.S. military bases dotting the globe we should shut these bases down and establish 800 public health care centers across the United States... that would be sixteen health care centers providing socialized health care for everything a person would be able to get care for from their family doctors--- all just like the Veteran's Administration provides.

A person shouldn't have to get shot up in one of Obama's three wars in order to qualify for free health care.

In Winnipeg, Manitoba, Canada they have the Mt. Carmel Clinic; this could be the model for 800 public health care centers across the United States.

This is beating swords into plowshares while creating over four million good paying union jobs... now, there is a real stimulus package.

[AlanMaki]

My reference to 16 public health care centers refers to 16 public health care centers in each of the fifty states... 800 public health care centers in all instead of 800 U.S. military bases dotting the globe on foreign soil.

What are these 800 military bases used for anyways? Anyone care to explain?

[xs10shal]

I'd like to thank the author, Roger Hickey, for standing up for the majority voters and reminding his group of congress persons that there has been a mandate on these issues. He wrote a really informative article on where the lines will be drawn and beltway mentality to hide what they do until the party is over.
I like Obama's approach to the summit and I could live with the two option plan. The posts show that their are significant people who distrust the government to handle their health, some who think handling health is for sniverlers and don't want any stinking insurance, and some are like me. I need health insurance and I am ready and waiting to not be tied to a job because I need the medical insurance or worry that a company bankruptcy or layoff will leave me to hustle up coverage that won't exclude a pre-existing condition. I take only one medication, but without insurance it costs $720 per month (forever).
So masterful leader, good show on giving us options because I would much prefer not worrying about coverage and I want science dictating my treatments, not insurance company executives; and for those that trust business to look out for their best interests, there is a plan for you, too.

[Mike020202]

I'd like to see them expand Medicare a little bit at a time until we're all on it.

[lcky9]

As usual the government is at the root of this health care issue, they have no over site they ALLOW themselves to be over billed they don't have a clue at what they are doing and we should trust them with our health care.. I think not.. while I am not the kind to run to the doctors very often I get no break for not doing so.. however, others think that going to the doctors is a social event.. which is why we have a whole country on anti depressants instead of dealing with their problems we have the walking zombies. we are talking about those that take these pills for an extended period of time.. We have a nation of hypochondriacs and a bunch of people doing inconclusive studies telling everyone that everything is bad for you one week from one study and the next week these very things are declared alright by another.. What we need is less commercials, and advertising for doctors, drugs and medical conditions. As for Obama's health care thanks but NO thanks.. and that goes for his putting our records on computers, the government can't even protect our social security numbers from being stole how the heck can they protect our private information.. The only ones that should even be going to the doctors are those that really need them because of a disability.. Some aches and pains are normal and part of getting old, get use to it..

[jbowen43]

The solution is very simple. "Medicare for all" paid for through a combination of a progressive payroll tax and progressive monthly premiums based on one's ability to pay. For taxing purposes no type of income would be exempt, not inheritance income, dividends, salaries, wages, or capital gains. None.

[wrabbitt]

We need to change the crooked system, that lobbyists use to influence our elected officials! Maybe if we create term limits,and, make lobbyist bribe illegal,like it use to be, things would change back to "We the people,"till that pipedream happens we have the internet! Look up you elected official, and, see how much money they get for voting for or against a bill that could make money for special interests, and, remember that they can't do it any more if they are not in office! they will have to go back to chasing ambulances, or find another career! Enough of them already have criminal records! Between the perverts and tax cheats and those with the biggest airplane that wastes more fuel than anyone elses, we have quite the collection of old farts, and self centered money wasting backwards thinking political manure ever seen!

[Timothy Doubledee]

Seems there are a lot of posters who have so easily forgotten that old Benjamin Franklin saw they like to bring up when the subject is the war against Islamic terrorists--the one about trading liberty for safety. So easily do dupes accept the yoke, with promises that all their earthly ills are problems for someone else to fix or pay for, never understanding the link between liberty and responsiblity.
Most of the upswing in costs for health care in the last decades can be traced directly to regulation and outright dictates from government. Read the history of how the AMA was formed in order for doctors to conspire to get the government to limit their competition, so they could increase their own compensation artificially. Look into the history of how the FDA limits what truly free markets could otherwise provide to willing consumers at a fraction of the cost in terms of health care services. See how insurance companies are told, by government, exactly what kind of coverage they must offer, even when there is a willing market for a whole variety of coverages, artificially raiseing the costs for everyone. Check out the statistics on how hospitals are forced to treat non-citizens for "free", causing them to raise rates for anyone who actually pays for treatment. Understand how we in America subsidize other countries' drug usage by paying more-than-full price so they can impose price controls for their own.

(cont.)

[Timothy Doubledee]

(cont.)
You want to whine about profiteering from the standpoint of practitioners and those with the knowledge and skills necessary to do the job, yet you insist on binding them with a host of Lilliputian ropes preventing them from finding the best ways to provide their services to willing customers at prices negotiated freely, and for their trouble they get wealth and class envy thrown in their faces. What happens to your precious "right" to health care when those with the know-how decide to pull a John Galt on you? Are you going to pass a law against cancer and heart disease, as if it would cause those diseases to disappear, instead of causing the government to cause those afflicted to "disappear" instead in order to make you believe the ruse?

The lessons of world-class socialism are slavery, of the mind at first, and eventually of the body. America is supposed to be better and smarter than that.

[idest]

I thought we were until I read your post. Now I know at least one American is still in grips of a Limbaugh-induced independen­t-thought-­coma.

[RenoSage]

In November the American people voted for CHANGE. A big part of the change was to be HEALTH CARE REFORM. It is a sad commentary that other nations have universal health care for their citizens
and we do not.
Republicans choose to give it an ism label, but the truth is that they are and always have been catering
to special interests.

[Bush-Rolled]

President Harry S. Truman tried to pass universal health care in 1948 but was stymied by the Republican Congress of his day. Perhaps 61 years later we are at last ready to join the industrialized nations, all of which, except the United States, already have universal health care.

[zaz33]

the media BLACKOUT of single payer health care' -

http://www.commondreams.org/view/2009/03/07-6

[VinnieTheSnake]

Mr. PlaceboStudman, please don't be afraid. Fear is the guiding principle of the insurance companies' program to derail universal care for Americans. (Profit before care is their motto.)
Most of the research done in the medical field is done at our universites. The patents are handed to the pharmaceutical companies, gratis usually. Stem cell research would be included in that.

I was offended and insulted that professional groups that favor single-payer health care were not invited until there was an uproar from "the people" to get them a seat. I'm not talking about whacko groups, I"m talking about the Nurses Union, Physicians for National Health Plan, Representative John Conyers!

[mnyegele]

DistaNation has an idea I never thought of. I'd favor letting any one enroll in Medicare. Either way we are giving citizens access to health care.
The big problem is simple - the Senate. Thanks to Nancy Pelosi we have a well-disciplined House that actually passes meaningful legislation. The Senate is another matter. The first problem is the filibuster. Then we must muster a 60 vote majority even to get legislation on the floor. There are two solutions. First, we should abolish the filibuster, even though a number of Senators, including Barbara Boxer, have defended this institution. Second, we need to adopt a nuclear option. Simply cut the Senate out of any form of debate whatsoever. Pass everything with an up-and-down vote. The Senate is incapable of meaningful action. I'd also suggest replacing Henry Reid, with a majority leader who knows how to fight.

[disintaGreatNation]

Health care reform is going nowhere. There are too many interest groups and lobbyists to get anything meaningful accomplished.
Instead of trying to reach consensus, Pres. Obama should act by fiat. He should order the Dept. of Defense to issue every legal resident of the U.S. a form DD-214. This would allow all legal residents access to VA health care. The VA will obviously need to acquire more facilities and personnel. These will become available at low cost as private sector health care withers.

[blueken]

Why on earth are we the only modern industrilized country in the world that doesn't negotiate with drug companies? Why don't we have a universal billing system for hospitals, clinics and doctors? Why do we treat people that do not contribute a penny to the system in our hospitals? Why has the burden of health care expense been put on the shoulders of small business in America? No one wants to pay, but many of us do. Why can't we share the burden more evenly?

[theclosetconservative]

It doesn't matter if you call it something different, it is what it is: socialized medicine. It has never worked in Canada, the U.K, or the rest of Europe. What we have right now is an obscene hybrid of a capitalistic and a socialistic system. That's in large part responsible for the rising costs. Barack Obama is President and is therefore entitled to push for what he wants. However, he that does not learn from history is doomed to repeate it. 1994=2010? Maybe. http://theclosetconservative.com

[gvc]

It what sense does it "not work" in Canada? We have higher life expectancy, lower birth mortality, fewer people in jail (yes, there's a relationship), and lower costs. Nobody makes life-threatening choices to avoid treatment because of the cost, and nobody goes without healthcare.

As for "socialized," this is the new mantra to replace "liberal" and other epithets. Canada has a federation of provincially run heath insurance schemes. The delivery is not socialized. And the provincial schemes are way less heavy handed than HMOs. Nobody tells you what doctors you can see and the list of covered services is universal. There is no such thing as exclusion for prior conditions. And you are never cut off for change in employment status.

[verdantbeast]

Motto. It works less well in some places (it's rather baroque in Ireland), but still does a better job of taking care of most people than our stupid American system.

Every system has some horror stories, but only in America do we routinely deprive people of care, make them pay exorbitant amounts of money for life-saving treatment, force them into poverty and bankruptcy just to stay alive, and then blame them for it.