Musings on Health Reform—Where Do We Go from Here
Originally Published in RMP Advisor, January 2010As we go to press, House and Senate conferees are working (behind closed doors) to create a final health reform bill. Regardless of the result, I believe we will be dealing with this issue for years to come. If a bill passes, there are massive regulations still to be written, and the next Congress will undoubtedly seek to recast the legislation. On the other hand, if a merged bill fails to pass both houses of Congress, the country still needs to pass a reduced version of health reform in which the parties can agree.
This process of passing health reform legislation has become an abject lesson in government sausage-making. Some examples:
- The deal granted to Senator Ben Nelson to exempt the State of Nebraska from paying for expanded Medicaid services, which is being legally challenged by other state Attorneys General.
- The bill will reduce payments (and cut benefits) for the popular Medicare Advantage (Part C) program, except for the 800,000 Medicare Advantage members in Florida, who are exempted from this provision.
- Additional hospital payments are targeted to certain states, such as $100 million for a hospital building project in Connecticut, and an increase in Medicare hospital payments in Iowa.
- A proposed tax on Cadillac health plans (a good idea to reduce healthcare costs), while at the same time promoting plan standards that encourage rich benefits (which may be considered Cadillac plans).
As the great philosopher Pogo stated, “We have met the enemy and it is us.” The private sector, and each of us, needs to do a better job of cutting waste from our healthcare spending and showing the government how to do it, so we will be less dependant upon the type of government interventions that we are currently witnessing.