The build-up to the President’s State of the Union speech was fairly chaotic. With no
one, probably including the POTUS himself, sure about what he should say about
health reform after the Scott Brown election upset, the focus rapidly shifted
to jobs, jobs, jobs and the economy, as perhaps it should. Health reform became
#2 priority at best. Telling comments indicate just how muddled things have
become since the Massachusetts
miracle. The President himself has said that Congress needs to “take another
look” at health reform, indicating he understands the present proposals won’t
fly. While in his SOTU speech he emphasized he wouldn’t abandon the patients
and small businesses that are being harmed by the status quo, and he
acknowledged that his team and he did not do a good marketing job of the
virtues imbedded in Congress’ proposals.
Senate Majority Leader Harry Reid said bluntly that the
Senate is not ready to take up reform again at this time, implying that he
wants a month or more off. That’s telling. On the other hand, Speaker Pelosi
said ‘reform cannot wait and that we will move forward with it rapidly.’ She believes
the House can pass the Senate bill with the understanding that passage would be
accompanied by and contingent upon also passing at the same time a simple
majority (“reconciliation”) bill that corrects the issues in the Senate bill
the House members cannot tolerate. I was disturbed to hear that she believes a “public
option” should be included as a necessary correction. This is just not
listening to the drum beats of the public or her Blue Dog moderate colleagues, and
this would never be accepted by the Senate.
Meanwhile, Republican strategy on reform (and almost all
issues) is to just say “no” as a means of trying to undo Obama and the
Democrats in the mid-term elections. I think this is going to incur just as
much wrath of the public as the strategy of the Democrats to try to
do too much and spend too much while the nation is still in a very difficult
economic circumstance. Virginia’s
new governor Bob McDonnell, who served as the surprising choice of the Republicans to give
the official response to Obama’s SOTU speech, simplified health reform down to
two basic needed things Republicans want: tort reform and the ability to sell
insurance products across state lines.
These are both very good ideas. But,
Bob, even as much as all of us physicians believe tort reform is an essential
and conspicuously missing part of the reform strategies produced by the
Democrats, fixing the problem will of itself not eliminate the massive economic
problems that will bankrupt the system in the near future. And, when Republicans had
the control of Congress and the presidency just 2 years back, they didn’t get tort
reform done, or even really try. So, while tort reform is truly a critical
element of what physicians need to promote viable practices and reduce
defensive medicine costs, it by itself will not foster the needed expansion of
access, improvements in quality and coordination, or overall reductions in
costs required. Again, allowing insurers to market and sell insurance products over
state lines is a good idea to reduce premiums for small businesses and
individuals and to reduce administrative costs for insurers. The amazing thing
is that the Blue Dog Democrats included that strategy in the House bill for the
proposed purchasing exchanges that would cover individuals, small business, and
those currently uninsured.
It would be breath of fresh air if a few Republicans
would step forward with something a little more comprehensive than these two
good ideas to more effectively challenge the Democrats. Paul Ryan (R-Wisconsin),
who will be at ACC.10 to share his ideas on reform, does have such a
strategy -- he needs more of his colleagues to embrace a broader agenda.
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