Health Politics

I ran into an old friend the other night at an overpriced grocery store (slowing down the checkout out of anyone unfortunate to be in either of our lines), and as we chatted in the parking lot trying to catch up before our frozen food started to drip, he asked me whether he, a progressive, should be disappointed about health reform.

It depends on your perspective, I said, voicing some of the thoughts that had been clattering around in my brain recently. What's your starting point?

If you start from your most optimistic, sky's the limit moment, say last November 4 or January 20, expecting to get a $1.5 trillion deficit-oblivious bill that covered absolutely everyone immediately and had a robust public plan and completely rebuilt our health care system ... you know, all the things that some hoped for in the "happy talk" stage of reform when the stars were all aligned for change but none of the hard decisions had been made and the Republicans hadn't opted for the "try to beat'em, don't join'em Waterloo strategy.." well, then disappointment is understandable.

The newspapers are full of stories about how the CBO score of the Finance committee health reform bill is good news and good momentum for Baucus. The CBO says the Finance bill (post mark up) will reduce the deficit by $81 billion over the next decade and expand health coverage to 94 percent of nonelderly Americans, at a cost of $829 billion over 10 years.

Democrats rejoiced, reports The New York Times,

The much-anticipated cost analysis showed the bill meeting President Obama's main requirements, including his demand that health legislation not add "one dime to the deficit." Indeed, the budget office said, the bill would reduce deficits by a total of $81 billion in the decade starting next year.

The report clears the way for the Finance Committee chairman, Senator Max Baucus, Democrat of Montana, to push for a panel vote within the next few days, and sets the stage for Democrats to take legislation to the floor for debate by the full Senate this month.

With the Senate Finance Committee mark up over (at least temporarily) -- we're only a CBO score away from having all health care bills voted out of their respective committees. The next step is merging the two Senate health care bills: the current Finance bill and the HELP bill. (HELP finished its marathon mark up session back in July).

Senate Majority Leader Harry Reid is taking point in this monumental task. Any and every Senator interested in health care wants to be in on the action when Reid merges the bills, but he's keeping the seating limited.Politico writes,

Reid has decided to keep the group intimate, limiting entree to Finance Committee Chairman Max Baucus (D-Mont.); Sen. Chris Dodd (D-Conn.), who ushered the bill through the Senate health committee; and top White House aides, according to a Senate leadership source.

The list of Republicans backing (or more or less backing, or a reasonable facsimile of backing) health reform efforts by President Obama and the Democratic-led Congress is growing:

California Gov. Arnold Schwarzenegger.

Former HHS Secretary and former Wisconsin Gov. Tommy Thompson (a Bush appointee).

Former CMS administrator and FDA Commissioner Mark McClellan (ditto).

Former Senate Majority Leaders Bill Frist, Bob Dole and Howard Baker.

New York City Mayor Michael Bloomberg (Democrat turned Repubilcan turned independent).

The Hastings Center recently published a series of articles on American values and health reform, including one on stewardship by New America's Len Nichols. Hastings has now created a related web site and blog, The Values and Health Reform Connection to expand the conversation. They invited me to write one of the inaugural essays, "Honest Debate - and Pragmatic Solutions." I wrote about values and politics (not as synonyms) and honesty and quality. (I think working moms by nature and necessity tend to find themselves pondering the practical side of things more than the ethereal and philosophical) I'm cross posting below. Other early contributors include Maggie Maher, "Dr. Val" Jones and William Sage. Hastings also invites your comments and contributions, as do we. 

Liberty. Justice, Responsibility, Solidarity.

These are some of the American Values highlighted in the Hastings Center's report on "Connecting American Values with Health Reform."

Watching health reform unfold here in Washington, however, that "Connection" is painfully elusive.  The debate is not a careful calibration of competing rights, values and obligations. It's a political moshpit. Instead of values, we have vitriol.

The Urban Institute has an excellent new analysis of variations in insurance coverage by congressional district.

Analyzing the latest data from the American Community Survey, the Urban researchers looked at rates of private coverage, public coverage, and uninsurance for non-elderly adults (under age 65). They also examined how these rates varied with poverty, producing the fascinating maps you see above (click to open in a new window) and the following conclusions:

1. Rates of private coverage are lowest in districts that have higher poverty rates, which tend to be concentrated in the South and West;
2. The needs in these high-poverty districts have led many to above-average rates of public coverage;
3. Despite these higher rates of public coverage, uninsurance remains most serious in districts with low rates of private coverage.

The underlying context of this analysis is to provide a clearer picture of the states and districts which will benefit the most from the passage of health reform. So let's take a look at some particularly interesting and politically relevant districts and states (NPR has an equally nifty map of the uninsured using the latest Census data):

Today, President Obama welcomed doctors (including my dad!)  from every state to the Rose Garden to rally in support of health reform. "People who are most supportive of reform are those who know the health system best -- the doctors and nurses of America," the president told the crowd.

Though doctors have been hesitant (and sometimes hostile) toward reform in the past, many doctor groups came out in strong support of health reform this year, including the AMA and the ACP. Doctors know our current health care system is unsustainable, and they've seen firsthand the painful, personal toll it takes on patients and their families.

When Bill Frist was Senate Majority Leader, he did not advance the cause of comprehensive, bipartisan health reform and will be remembered for his role in the Schiavo case (although he did take heat for working with Democrats to expand federally-funded stem cell research). Mostly he pushed for malpractice reform (in a very partisan model) and for small business purchasing pools (also from a GOP perspective).  If there were compromises to be had under his watch, he didn't have them.

Better late than never.

We've watched Frist over the past few months. As we've noted, he has backed a fairly expansive approach to prevention and population health, and recently endorsed the individual mandate (which was a centrist Republican idea before it became a Democratic idea). Now he tells Karen Tumulty of TIME that he'd vote for the Democratic health care reform bill in Congress -- even if there's a lot in it he isn't crazy about. (He later told ABC News Radio that he doesn't like the Baucus bill as currently drafted, according to the Politico.) 

The Republican stance on Medicare has Paul Krugman tearing his hair out. Or maybe he wants to tear their hair out. In a column titled "The Politics of Spite," he writes:

At this point, the guiding principle of one of our nation's two great political parties is spite pure and simple. If Republicans think something might be good for the president, they're against it -- whether or not it's good for America.

Now, it's understandable that many Republicans oppose Democratic plans to extend insurance coverage -- just as most Democrats opposed President Bush's attempt to convert Social Security into a sort of giant 401(k). The two parties do, after all, have different philosophies about the appropriate role of government.

But he argues that when Democrats opposed President Bush's plan to privatize Social Security, they did it in an ideologically consistent way. Not so the Republican assault on health reform. 

Two short anecdotes from this weekend in Washington:

1) Seen on Washington's Massachusetts Avenue -- a vanity license place  that said B INSURD

2) Listening to "Marketplace" in the car Friday afternoon with my not-quite-nine year old, (born and bred, for better or worse, inside the Beltway) as two commentators debated whether health reform or revamping financial regulation should be the top congressional priority. This confused my son, who asked my [predictable] opinion and then formed his own. "You know, we really need to do health care first, because if the economists don't have health care, they could get sick and die and then no one would be left to fix the stock market." 

From his mouth to the Senate's ears...