Healthcare Outsider

In honor of the upcoming vote in the senate on Sunday, Healthcare Outsider would like to give you, the laypolicymaker, a better understanding of what the reconciliation bill looks like.

By the way, unless you want to truly appreciate why our congressmen are so violently cranky, we recommend that you don’t read the entire thing in one sitting. You can check it out after the jump.

-Michael B. Sauter

Medicaid, the national medical insurance program designed to provide coverage for the least advantaged Americans, has been slowly losing funding since being created as part of the 1965 social security act. Now, as medical costs continue to skyrocket, small practices are losing money because their states have set standard payment rates lower than the costs of the treatments. Rather than lose money and their practices, small town physicians are opting out of treating Medicaid recipients. This trend is sending the nation’s poor and sick on costly hunts for doctors who will agree to treat them. [CNN Money]

In light of this, it’s tough to tell why people might be clamoring for health care reform…

-Michael B. Sauter

After a series of deadlines, setbacks, votes, procedural loopholes, and violent town hall meetings (remember those?) congress appears to be on the brink of either passing or failing the health care bill. Once and for all. Really, they mean it this time.

After netting two more yes votes from on-the-fence democrats in the form of Dennis Kucinich and anti-abortion moderate Dale Kildee, the train of reform seems to be finally about to reach the point of no return – an up or down vote which will either solidify the bill as a piece of legistation or end debate on it for at least another election cycle. Lawmakers expect the vote to come some time Sunday afternoon. Most Americans are, rightly so, skeptical the vote will ever take place. Most believe that something is bound to come up – either Nancy Pelosi will have a flat tire or Mitch McConnell will come down with the flu – postponing the conclusion of this hellish descent into political madness for another several months.

-Michael B. Sauter

The Congressional Budget Office has thrown its hat into the ring of speculation and estimated how much health care reform might very well cost.  After nearly a month of writing random numbers on slips of paper and picking them out of a bag, the CBO has decided the total cost of the health care reform package will be $930 billion over the next ten years. After picking out the next set of numbers completely in absence of data or evidence, the office has conjectured that the bill will actually serve to reduce the deficit by $1.3 trillion over that same period.

This report is only the latest in what seem to be totally arbitrary divinations as to what health care might actually cost us over the next decate. Depending on whether you ask republicans or democrats, the reform bill will either reduce the deficit significantly by cutting inefficiencies in the system… or it will cost us out firstborn child, our national security, and our fleeting edge over the communists. Even independent groups have suggested that pending legislation will either cost us $200 billion, $850 billion, it might save us $1.3 trillion, or final expenditures might end up somewhere in between any of these. Considering how drastically these figures coming from supposedly respectable groups differ from one another, we might as well assume they have been taking turns blindfolding one another and throwing darts at numbered balloons. Who pays these people? [Washington Post]

-Michael B. Sauter

In a move that is certain to net big change in insurance, Health Secretary Kathleen Sebelius issued a strongly-worded demand that health insurers cut back on premium rates for the sake of strapped-for-cash Americans. Sebelius acknowledged that this may affect company profits, but that cooperating with the administration’s demands would be good for the country. Considering how deeply big insurance cares what the government thinks of it, this crushing blow should prompt it to make the changes right away.

Sebelius also sternly suggested they start cooperating with the administration in their push to pass the reform bill. The health insurers’ lobby is expected to issue a response which should say something very much like  ”fat chance.” [Reuters]

-Michael B. Sauter

One of the last scenes in “Back to the Future III” finds Marty McFly (played by recent olympic hero Michael J. Fox) speeding on a runaway train, heading towards a cliff at breakneck speed. Marty and his scientist friend “the doc” are throwing special logs packed with jet fuel onto the fire with the hope that the train will make it to 88 miles per hour –  sending it to a time when the bridge is complete – before they reach the end of the rails and crash  into the ravine as a spectacular fireball.

I bring up this classic moment in one of the best trilogies in film to give you an idea of where health care reform is right now. Here’s an analogy key: the train is the health care bill, Obama is Marty McFly, and the cliff? The cliff would be the inevitable final vote in the congress. Obama has just tossed another jet fuel log into the fire, and the day of the make-or-break vote seems to be drawing ever nearer. There is one major difference here between the train in the movie and health reform: no matter how quickly the bill moves to the vote, it will never pass (nor will it time-travel to a date where it has a shot of doing so.)

The Obama administration and the House Democrats have ramped up their efforts to bring the proposed reform bill to vote by using a tactic called “reconciliation.” This would allow them to make some minor changes in the original bill (using proposals from the health summit last week) and pass it with a simple majority, instead of the now-impossible 60 votes required to circumvent a Republican filibuster. Obama is even including some ideas the conservatives have been harping on since day one, including increased tort reform efforts and better oversight on medicare and medicaid waste. Maybe the president can’t travel through time, but it sounds like he might just have shortened the gap enough to make the jump across.

Of course, nothing is ever easy, especially when you’re talking about the United States Congress. There is a  major downside to this reconciliation tactic: because it entails taking an approved bill and adding minor components, certain unpopular measures in the original senate language cannot be changed. The most notable of these immutables is an unpopular leniency towards federally-reimbursed abortion coverage, which even some middle-of-the-road democrats (who voted in favor of the house bill last time) said would force them to oppose the bill, no matter what else is in it. Also, key Republicans are saying that Obama’s attempts to appease their party by including these last-minute conservative measures won’t be nearly enough to salvage what they have repeatedly called a fundamentally flawed piece of legislation.

So, is Obama losing his mind by throwing another log into the fire, pushing the bill to a certain fireworks display of a demise just a little faster? At this point, every day the bill languishes on the table is another day Obama’s approval ratings drop in the wake of this ugly debate. Perhaps Obama is wise to just want to get it over with as soon as possible and move on with other (equally-doomed) initiatives. Besides, when the train inevitably goes over that bridge and the American media is there to gawk at it, it should at least be extremely entertaining. [Reuters]

-Michael B. Sauter

HCO knows many of you are still holding your breath while the political dust settled before passing judgement about the bipartisan health care summit last week. Did the Democrats win? Did the Republicans win? Did the  win? The Atlantic Wire has a nice collection of opinions on how things went. which, in aggregate, prove string theory. (because all things apparently happened at once)

If we were to guess, based on our national history of health care legislation, and summits in general, everyone probably lost.

-Michael B. Sauter

A Stanford study has shown that an incentive-based program encouraging the food industry to reduce our nation’s salt intake would prevent hundreds of thousands of deaths and save the government $32 billion in healthcare costs.  The report revealed that nearly 75% of Americans consume more than the recommended amount of sodium on a daily basis, which leads to high blood pressure, heart attacks, strokes, and delicious fast food fries. [Reuters]

The national slug and leech lobby (NSLL) has been a major proponent of of the recommended measure, claiming “salt is much more dangerous than most people even realize, and our constituents  would like to limit its availability in any way we can.

-Michael B. Sauter

A study at three major hospitals has revealed that doctors are probably not euthanizing children dying of cancer, thank goodness. The report, which compared parent interviews with statistics of 141 cases of terminal cancer in children, showed that doctors were most likely administering safe doses of morphine to children, despite some requests by their parents to administer lethal amounts to end their suffering. Any subsequent deaths, the report concludes, were likely coincidental, and not due to overdose. We can all breathe easily, knowing our national priority is still that of preserving life at all costs, even if that life is actually just three days of unbearable pain, ending in an undignified and even more horrible death. [NYT]

-Michael B. Sauter

Anthem Blue Cross, California’s largest health insurer, is being sued by Consumer Watchdog for what it claims are manipulative premium rate hikes, unfair treatment of existing customers, and just a complete disregard for human decency. The group cites proposed premium increases by up to 39% in some cases to be an intentional effort to drive existing customers into weaker plans. The apparent problem the Californians have with what seems to be a completely reasonable business practice is that they claim older customers and those with preexisting conditions who have been making payments for years are being forced into plans that they’ll still pay through the nose for, but will no longer cover them for anything that is actually a health risk. They might be able to get their tonsils out for cheap, but will they get help with their chemotherapy treatments? Probably not.

While the case won’t be heard for some time, we expect it to be thrown out on the grounds that most health insurance plans work like that anyway. [Reuters]

-Michael B. Sauter