Last week was so busy—a new HHS secretary, the unveiling of Senate Finance's delivery system reform proposal, Obama's first 100 days, and the start of a possible pandemic flu—that we didn't have a chance to post everything that caught our eye. So as we start on this week, we pulled together a few quick links and comments from last week's "to-do" list.
Other than a few emails about a lunch that never happened (let's try again, Bob), we don't know Bob Laszewski personally but we really like his Health Care Policy and Marketplace Review blog. At times it seems equal parts insight and pessimism about health reform (we suspect he'd use the word "pragmatism" or "realism"), so when he starts talking about how we're possibly making progress on figuring out what health reform should look like, or half-way there on knowing how to pay for it, well, maybe it's not yet time to uncork the champagne, but at least we find ourselves wondering where we stored the flutes. (For any of you who know the ever optimistic Len Nichols, you'll know that here at New America's health program the champagne glasses are always—albeit metaphorically—half full.) Admittedly, Laszewski got glum again today about the doc payment fix and the Blue Dogs...
Congress approved a $3.5 trillion budget resolution with a bottom line that looks very favorable for health care reform. The resolution creates a deficit neutral reserve fund to transform and modernize health care that will allow health care reform to pay for itself over an 11-year window. Politico's David Rogers calls the budget resolution "a big leg up toward health care reform"and writes:
The victory sets the stage for a major battle this summer over health care reform in which Obama will have the added leverage of special budget procedures allowing him to circumvent the threat of a Republican filibuster in the Senate.
Democrats insist that it is still their intention to try to move forward without using this power, and the Senate Finance and Health, Education and Labor committees are each slated to begin their markups in June. If real progress is made, the hope is to avoid invoking the so-called reconciliation procedures, but the president and Democratic leaders badly wanted them as a backstop if no resolution is reached by Oct. 15.
The political focus on health reform has even some of the folks over at the Wall Street Journal sounding bullish on reform. In his "Capital" column, David Wessel lists four reasons why the time just might be ripe to fix health care:
Senators Baucus and Grassley and the members and staff of the Finance Committee are once again leading the way to a more sustainable health system. With the release of their delivery system policy options, the Finance Committee laid out a vision that will move Medicare and the system as a whole toward paying for value. The document includes many exciting policy ideas and provides an opportunity for the Finance Committee to build on its work to make sure we all receive quality care at lower costs. All ideas are worth a careful read. Upon my first look, I noticed the following:
Senate Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Chuck Grassley (R-IA) today released a set of policy proposals for reducing costs and improving quality in the health care delivery system. On Wednesday, the two senators will meet with other members of the Finance Committee to walk through the options.
It's 50 pages and we haven't read it all yet but here for your convenience are some of the main areas of focus:
- Linking Payment to Quality Outcomes
- Promoting Primary Care
- Fostering Care Coordination and Provider Collaboration
- Infrastructure Investments to Support Delivery System Reform
- Promoting Quality, Efficiency, and Care Management in Medicare Advantage
- Combating Fraud, Waste, and Abuse
“Everyone agrees that America’s health care system is broken,” said Baucus in a press release. “ The policy options Senator Grassley and I are releasing today put some meat on the bones of those ideas to strengthen our discussion moving forward. But nothing is set in stone. I look forward to a robust dialogue with my colleagues on these ideas in the coming months, as we work together to build the comprehensive health reform this country needs.”
The Senate Finance Committee has sent the nomination of Governor Kathleen Sebelius to be Health and Human Services Secretary to the full Senate by a 15-8 vote (only two Republicans, Olympia Snowe of Maine and Pat Roberts of Sebelius's home state of Kansas joined the panel's 13 Democrats). We aren't sure yet how quickly the full Senate will vote but it can't come a moment too soon. Several major health agencies (including the one that runs Medicare) don't have their new chiefs in place yet, and the health reform clock is ticking fast.
Finance Committee chairman Max Baucus of Montana said in a statement:
I congratulate Governor Sebelius and will push for immediate action by the full Senate so that she can finally roll up her sleeves and get down to helping out on this critical work of reforming the health care system. Too many families and businesses are hurting as a result of the health care crisis and I believe Governor Sebelius is the right person to help create a lower cost, higher quality health care system that Americans need.
We'll be tweeting the Senate Finance Committee's roundtable discussion on delivery system reform. You can follow our coverage of the event live on Twitter (tag: #SenFin), and read our wrap up of the roundtable later today.
Spring break may have just ended, but two Senators are already thinking about summer.
In a letter to President Obama on Monday, Senators Edward Kennedy (D-MA) and Max Baucus (D-MT)—chairs of the Senate HELP and Finance committees, respectively—reaffirmed their commitment to passing health reform this year and announced that their committees will be ready to mark-up legislation early in June.
Baucus and Kennedy write:
The unprecedented level of funding devoted to health care reform in your budget this year leaves no doubt about your commitment to the goals of expanding coverage, reducing costs, and improving health and health care. We have a moral duty to ensure that every American can get quality health care. We must act to contain the growth of health care costs to ensure our economic stability; to help American businesses deal with the health care challenge; and to make sure that we are getting our money's worth. With your continued leadership and commitment, and working together, we remain certain that our goal of enacting comprehensive health care reform can be accomplished with the urgency that the American people rightly demand.
The letter is the latest sign that health reform remains at the top of the national agenda.
You know you have a hot and complex issue on your hands when an editorial in a major newspaper seems to attack rather than educate and confuse rather than clarify. I noticed such a troubling editorial in the Washington Post last week. "Clarity in Need of Courage," is fraught with serious analytic errors and overlooks the crux of what it will require to restore fiscal balance in our nation.
First, the editorial contradicts itself. On one hand, it suggests that economic recovery will depend in part upon dealing with our long term-fiscal imbalances. Yet, it then denies that health reform and Medicare reform are central to improving that fiscal imbalance. Has the Post forgotten what Peter Orszag and other savvy observers have been saying for years? Our core fiscal problem is the system-wide health care cost growth that drives excess Medicare per capita cost growth.
If health reform had a breakfast menu, the issue of a public health insurance option would be the special of the day. At the Kaiser Family Foundation's newsmaker briefing Wednesday morning (video here), Nancy-Ann DeParle was cooking. The director of the White House Office of Health Refrom served up a host of answers to reporters' questions—many of which had to do with whether Americans should be able to choose between private plans and a competing public health insurance option.
On the issue of the public plan, DeParle explained some of the President's reasoning behind his reform proposals, saying, "he wanted a mechanism to lower costs and to keep the private sector honest by having a competitive public plan in there." She made clear that the public insurance option was just one item on the menu of reform options and that if there are other ways of accomplishing those goals, "he'd be open to hearing them." DeParle noted people often have different definitions for what a public plan is, but that everyone agreed on the basic goals of lowering costs and increasing competition and choice. Asked to give her own definition of the public plan, she replied:
Senate Finance Committee Chairman Max Baucus (D-Mont.) and Ranking Member Chuck Grassley (R-Iowa) today announced a series of health reform roundtables for the months of April and May that will focus on delivery system reform, coverage, and financing. From the press release, the scheduled hearings are as follows:
April 21, 2009 - Reforming America's health care delivery system: this discussion will focus on improving the quality and efficiency of care through establishing value-based purchasing programs and strengthening the role of primary care, better managing patients with chronic illnesses, facilitating the use of comparative effectiveness research and other tools that support evidence-based care, reducing hospital readmissions, reforming payments to private plans in Medicare, and increasing transparency and reducing fraud and abuse in federally financed health care programs.
May 5, 2009 - Increasing access to health care coverage: this conversation will focus on potential policies to expand health care coverage to all Americans including proposals to strengthen the health care safety net, expand public health care programs, expand access to private health coverage by creating premium subsidies for low-income Americans and reform the individual and small group health insurance markets, create tax credits for small businesses to afford insurance, make it easier to shop for and find affordable coverage options, and focus on the prevention of disease and promotion of healthy lifestyles.
May 14, 2009 - Financing comprehensive health care reform: this discussion will focus on policies to finance the cost of investing in comprehensive health care reform.