Health Politics

Or, at least, the Senate will be working this weekend. The Senate plans a rare Saturday night vote on a motion to proceed with Senate Majority Leader Harry Reid's $848 billion health care reform bill,  released earlier this week. The pressure is on for Senate Democrats, who need 60 votes to ensure the bill makes it to the floor to begin debate.

Reid melded the Senate Finance and HELP committee's reform bills, but his "deep personal involvement in assembling the overhaul of the health care system," makes it  "Reid's bill," writes Carl Hulse in The New York Times. If Reid successfully guides the health care reform bill through the Senate, it could be the biggest victory his career, and a huge boon for Obama and the Democratic Party, writes Hulse, but if he fails, it could mean disaster for the Democrats and an even tougher re-election battle for Reid in his home state of Nevada. Many Democrats expressed faith in Reid's skills as a legislator and a tactician, according to the Times,

Over the past year or so, we began detecting some subtle changes in how Democrats were talking about malpractice. They weren't embracing the Republican tort reform agenda, weren't about to start limiting damages and saying "Sorry Charlie" to people who had suffered heartbreaking harm. But they weren't just changing the subject either. They were recognizing a problem, and considering solutions. Liability problems as well as larger obstacles to addressing serious patient safety problems.

We posted about it a few times (here and here). I started reading more about it, and I started talking (and listening) to what doctors had to say. Not just lobbyists for doctors, but doctors. Including some progressive docs in primary care who favor health reform or a single payer system. I have a piece online in American Prospect today, outlining some alternatives to traditional malpractice lawsuits that are worth trying. (Not to replace the current court system, but to test alternatives. And while we test alternative dispute resolution or other approaches, it should be voluntary.)

As we've written a lot on end of life care, we notice when others do the same.  NPR's Joseph Shapiro this week reported on La Crosse, WI where 96 percent of the adults who die have an advanced directive. That extraordinarily high figure arises from the innovations and commitment from Gundersen Lutheran hospital. Careful, sensitive discussions by trained doctors and nurses -- they use a 12 page guide -- is time consuming. Medicare doesn't reimburse them for that time, A provision in the House health care bill would change that -- the provision that was caricaturized as a "death panel." The Senate bill doesn't contain it.

After weeks of anticipation and speculation, Senate Majority Leader Harry Reid has unveiled the legislation that will bring health reform to the Senate floor in the coming weeks.

While waiting for the details of the bill to come out Wednesday, we created a little office pool, called the Price is Right for Health Reform. In an office-wide email, we asked our peers to guess the CBO's estimates of the gross costs of the bill. Showcase Showdown rules (closest without going over) applied. We were intentionally vague in our question because estimating the true costs of the bill is inherently a difficult process.

The number we were looking for was $848 billion. The CBO's estimate of the gross cost of the bill is essentially the total cost of coverage provisions over the next 10-years. This is the number most frequently reported in the media as the "cost" of the various health reform bills being discussed. But is this really the best indicator of the true costs of health reform? Maybe not. First, timing matters: $848 billion over ten years is a lot different than a $787 stimulus bill where 90 percent of the money is spent within the first 3 years. So do deficits. How much does a bill cost if it's fully paid for and in fact reduces the deficit as is the case for both the House ($109 billion) and Senate ($130 billion) bills?

We received plenty of calls from our co-workers asking just these questions. We tried to stay quiet, because we were interested in what the educated, non-health policy wonks think about the cost of reform. True to our think tank's "post-partisan roots" we got a range of answers from "too little" to "$600 trillion, Obama lies." We got a couple of "$1" which we assume was a reference to the bill's deficit neutrality, and $90 billion which seems like a reasonable estimate of yearly costs.  But the majority of the answers clustered within the $800-$900 billion range, surprisingly close to the final answer. Few people seemed willing to go above $900 billion, suggesting the power of the official price tag President Obama put on reform during his September address to a Joint Session of Congress. So who won? The answer after this non-commercial break:

If polling on health reform were a band, we'd call it The Hold Steady.

Several new surveys out this week show the public remains as conflicted as ever on health reform -- convinced of the need for change, but worried about the impact on their lives and the lives of their family.

A Washington Post-ABC News poll released Tuesday shows 48 percent of those surveyed supported the proposed reforms; 49 percent opposed them. An AP poll released Monday found a similar split, with 41 percent in favor; 43 percent opposed and 15 percent undecided.

These even divides are consistent with past polls, suggesting that the uproar in August was more of a bump in the road than turning point. However beneath the topline questions are some interesting trends.

It's Monday, the day after Sunday, which in America means a surprisingly large number of Americans are talking trash about their fantasy football teams. (Good hustle Ben, but the Cleveland Steamers are on a roll.) So forgive us for the gridiron gab, as we reset the play clock on health reform.

As you know, the passage of H.R. 3962 in the House two Saturdays ago pushed health reform into the red zone and brought us closer to the goal line than we've ever been before. The problem, as the Senate prepares to take the field, is that the goal posts keep getting pushed back. A slow handoff between Senate Majority Leader Harry Reid (D-NV) and the CBO has delayed the bill's release, but Reid seems determined to keep the ball moving. Roll Call's Emily Pierce lays out the potential Democratic gameplan going forward:

Be careful  what you wish for! Maggie Mahar,  who writes the Century Foundation's Healthbeat blog,  had a piece in the Washington Post's Sunday Outlook section calling for a public plan option -- but telling progressives who had yearned for a fully single payer system to visualize the downside.  Just imagine, she wrote, if a movement conservative like Sarah Palin ends up making the rules.  That could make the current controversy about abortion in the health insurance exchange seem tame. What about coverage of contraceptives? Or the ability to decline life support? Think the government wouldn't intrude on such sensitive private decisions? Ever heard of Terri Schiavo?

Of course, we do usually have checks and balances in our system. The party that controls the White House doesn't always control Congress, and it's even rarer for one party to control the White House, the House and a filibuster-proof Senate. And as anyone who has watched the long and winding road of President Obama's health reform agenda, even a filibuster-proof Senate has a mind (and politics) of its own.  Still, Maggie makes a point:

One of the nice things about our jobs here at the New America Foundation is that we get paid to do things like read Gail Collins. So since today is really gray and wet and yucky here in Washington, and we're stuck in one of those capital of the free world moments of Waiting for the CBO, we're gonna share her latest column. You can pretend you are working too.

In troubled times, it is important to try to maintain a certain level of serenity. Right now we citizens have quite a lot on our plate and there is no reason to go completely crazy about the least little thing. 

For instance, at that right-wing tea-party rally in Washington last week, it seemed a little weird when Jon Voight warned the crowd that if President Obama wasn't stopped, the United States would wind up with a health care system like New Zealand's.

At the time, I could not help wondering what New Zealand ever did to Jon Voight. Also if he's made any movies since the one where he got eaten by a really big snake.

First, thank you to all our veterans for their service and sacrifice.

This Veteran's day we're a bit caught up in the upkeep of grant reports, so he's a quick run down of the news and issues that caught our attention:

Tuesdays with Harry: Politico reports that Senate Majority Leader Harry Reid took procedural steps yesterday that would allow him to open debate on a bill Tuesday next week. Of course there a lot that needs to happen before then, including the release of bill with CBO scores, but still, it's a good sign that things are moving in the Senate.

My Life, Your Work: Former President Bill Clinton spoke to Senate Democrats at their weekly meeting Tuesday. His message? Git'er Done. "The worst thing to do is nothing," Clinton told reporters.

The baton has been passed from the House to the Senate and the latest reports suggest legislation may come to the floor as early as Monday next week. The Hill's J. Taylor Rushing lays out how things could play out in the Senate:

Senior aides and senators say Democrats plan to pivot quickly and file the first procedural vote as early as Monday. A "motion to proceed" vote, which brings the bill to the floor, would require 60 votes -- a first, critical test of the caucus's unity on procedural votes.

Senators don't expect any momentum from Saturday's successful 220-215 House vote, however. They say the most realistic scenario is for a Senate vote by Christmas followed by final passage in mid-January.

That would allow sufficient time for House-Senate conference talks and final House-Senate votes during January's first weeks. Such a scenario would also put final passage around the time of President Barack Obama's State of the Union address.

Roll Call's Emily Pierce has more on the logistics and politics of this move: