Health Reform

The House's historic vote on Saturday feels almost like ancient history. By Monday, all eyes turned back to the Senate and the progress of the merged legislation being shepherded by Majority Leader Harry Reid.

H.R. 3962 passed by a margin of 220-215 with 39 Democrats voting against the bill and one Republican representative crossing party lines. (The New York Times has a great graphic illustrating the politics of this vote.) Speaking from the White House Rose Garden on Sunday, President Obama thanked lawmakers for their "courageous vote," and called on the Senate "to take the baton and bring this effort to the finish line on behalf of the American people."

The relay is being held up, however, as Reid waits for the CBO to return scores of the various proposals and options he submitted. Estimates are expected to be released by the end of this week, and merged legislation could be released soon after. Still the Senate is not expected to begin debating the legislation until after Thanksgiving, giving Congress essentially four weeks to try and meet President Obama's goal of signing health reform legislation into law before year's end.

It will be a sprint to say the least. You know our stance on the issue, and the White House, too, is stepping up its pressure to not let this slip into 2010.

At the very minimum, it currently seems Reid will try to pass legislation through the Senate before Christmas.That leaves open the option for conferees to work on merging the House and Senate Bills over the holiday recess and clear the way for a vote on final passage early in January.

In addition to the simple logistics of moving historic legislation through the historically slow moving Senate, Kaiser Health News, Slate, and the Wall Street Journal all give a good lay of the land, and here's our quick overview of some of the biggest issues going forward:

There were enough live-bloggers and Twitterers, and news alerts about the House health care vote on Saturday night that we decided not to add to the cyber-din. But that doesn't mean we weren't curled up on the bedroom floor, glued to the television, Blackberry in hand, trying to carry on five or six email conversations with people we've known for years, who also savored this moment. (Probably none of my email pals were simultaneously running up and down stairs from bedroom to kitchen during particularly windy speeches baking a basketball-themed birthday cake for a nine-year old but that's not strictly relevant). We are all too well aware of the obstacles remaining in the Senate, and we will post an update on that shortly. But watching that vote, seeing the satisfaction -- not political satisfaction, something deeper -- replace the exhaustion etched on Nancy Pelosi's face, was a remarkable moment. Long time coming.

One of the emails I got after the vote was from Len Nichols, the director of our health policy program (aka my boss). Len loves political courage. He loves bipartisanship. He also has a particularly soft spot for New Orleans. So naturally, Len was pretty impressed with Anh "Joseph" Cao, the sole Republican with whatever the Vietnamese-American equivalent of "chutzpah" is to vote for the Democratic health reform bill.

After all the sound and fury of last August, we're pleasantly surprised that the right hasn't risen again with all sorts of horror stories about the resurrection, so to speak, of the "death panels." Maybe because all that fear-mongering was finally discredited. Maybe we are finally getting just a little bit smarter.

The inevitable focus on the politics of health reform, and the disproportionate amount of attention paid to the public plan, sometimes obscures the many ways that the House and the Senate health plans are ambitious. Not perfect. Ambitious. I've heard experts, people I like and respect, say the legislation does "nothing" to advance the cause of quality of end of life care in America. They are wrong. The House and Senate bill each contain measures that would advance that cause -- not fix it completely, far from it, but they will take us important steps in the right direction. It's too soon to know which of these measures - if any -- will survive a final melding of House and Senate legislation. But let's look at them here because, except for the end of life consults which got way too much of the wrong kind of attention, they haven't gotten adequate attention. In an accompanying guest post. Dr. Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in New Hampshire, talks about what these changes can mean for his patients and their families.

We just posted on some of the measures within the House and Senate bills that may help lead us to improved care for people at the end of life. Here, Dr. Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., returns as a guest poster to tell us what it all means for his patients -- and the doctors who treat them. Byock, the author of Dying Well, has written for us before about the need to think more broadly about what kind of changes we need in our health care system -- and our communities -- to do a better job of caring for sick and frail people trying to get by in their homes.

Will be tweeting an event from US Budget Watch, a joint project between the Committee for a Responsible Federal Budget and The Pew Charitable Trusts, asking whether health reform fix our fiscal problems (Tag: #budget). Len Nichols, the director of New America's Health Polciy Program will be participating in the discussion along with a panel of experts on health care and fiscal policy. Things are about to get going, but in the meantime you can check out the two most recent papers from U.S. Budget Watch:  Evaluating Health Care Plans and Comparing Health Care Plans. 

Today was a big day for the House's health reform efforts.

The AARP, the American Medical Association and the American Cancer Society Cancer Action Network publicly announced their support for the Affordable Health Care For America Act (H.R. 3972) (and, particularly for the doctors, the Medicare Physician Payment Reform Act (H.R. 3961) aka the "doc fix.")

Today was the first time that the AARP has put its "full weight behind a comprehensive health reform package," the AARP statement says. "We started this debate more than two years ago with the twin goals of making coverage affordable to our younger members and protecting Medicare for seniors," said AARP CEO Barry Rand. "We've read the Affordable Health Care for America Act and we can say with confidence that it meets those goals with improved benefits for people in Medicare and needed health insurance market reforms to help ensure every American can purchase affordable health coverage."

Last night, the Congressional Budget Office released a preliminary analysis of the House Republican health care bill. The bill focuses mostly on cost and repackages a lot of the conservative ideas that have been around for years (and never came to fruition even while Republicans held the torch.)

According to the CBO, by 2019, the Republican bill would only extend health coverage to three million more Americans and reduce the federal deficit by $68 billion. In comparison, by 2019, the House Democratic bill would insure 36 million more Americans and reduce the federal deficit by $104 billion.

In case you missed the ‘Space' section of your daily paper a few months ago, two planets -- one the size of Mercury and one the size of our Moon -- collided in a far off solar system.  The smaller planet went the way of Alderaan. The larger planet suffered a big dent.

My own worlds collided this week when former-professor-in-my-department Kelly Devers teamed up with my former boss (on a research project) and friend-of-the-blog Robert Berenson to publish a thoughtful critique of the panacea fever surrounding Accountable Care Organizations (ACOs).  As much as we have trumpeted ACOs as the best cure-all since Clark Stanley's Snake Oil Liniment, Drs. Devers and Berenson's thoughtful analysis published by RWJF is a welcome contribution to the dialogue.

David Rogers, now with POLITICO, formerly of the Wall Street Journal, may be the least chatty reporter in Washington (trust me, I sat about 5 feet away from him for 12 years in the Senate Press Gallery... although I suppose if you averaged his taciturnity with my extroversion, you would have had two average chat-ers). He's also one of the best and clearest-thinking. He has institutional memory and historical context often lacking in the 24/7 rush-rush of much of the media today. So while so many people are hyperventilating about whether two off-year GOP gubernatorial wins will spell doom for health reform, David comes up with this reassuring and well-reported story, "Dems want to seize historic moment."

Health care is big for House Democrats: big like Social Security in the '30s and civil rights in the '60s, big like the war stories retold now in party caucuses as lawmakers grapple with the floor vote that is just days away.

All politicians live in the present -- or risk perishing, as seen Tuesday night. But history also sits on the shoulders of Democrats these days, and having failed to act on health care in 1994 -- and then having lost power -- they feel an almost inexorable push to seize this moment before it slips away.

The AP reports that the AARP is ready to announce it's support for the Democratic health reform legislation in the House. The endorsment from the influential retiree's lobby should provide a big boost as House Democrats are expected to vote on H.R. 3962 Saturday evening. Streaming video of the AARP announcement, set to begin at 11:30 a.m., is available below.

Meanwhile, the American Medical Association will announce it's position on the House bill's at 12 p.m. More on that after we get off the call.