Praise without end for the go-ahead zeal
Of whoever it was who invented the wheel
But never a word for the poor soul’s sake
That thought ahead and invented the brake

---Howard Nemerov, former US Poet Laureate

Give Me a Brake
President Obama really ramped up his health care reform efforts this week, but the Senate isn’t buying it, and neither is a significant contingent of the public in general. I predict we have August off with neither the House nor Senate getting a bill on the table before the recess.  Today, E & C Chairman Henry Waxman is alleged to have stomped out of a meeting in the Speakers’ office madder that heck about the growing disagreements among the tri-comm committee chairs, and threats of mutiny from the Blue Dogs. Aaaarrrrff! Congress has applied the brakes to health reform until some major problems can be addressed. This is tough -- we need reform, but...

Obama’s press conference got pretty good reviews all in all. He effectively made the point for me that it’s not just about the uninsured -- it’s more about the entire ‘house of cards’ of rising costs that needs to be addressed. We need to focus on slowing cost increases if we plan to spend over $1 trillion in new or reallocated dollars, or we’re just plum crazy. But, geeze. We’re not yet bending the cost curve with the current proposals -- which must happen. Then too, the House bill has some nasty provisions in there (nixing specialty hospitals; prohibiting opting out of any public coverage participation for docs; an undefined public option; imaging EU cuts; etc.).

These concerns and more are why ACC did not endorse HR 3200.  Rather, we've praised the SGR fix in their bill (and that the Senate seems to be willing to sacrifice!), along with the other positive things they proposed. But we had to reserve the right to fight against the things we don’t like in there—which is why we couldn’t endorse. As I said last week, AMA made a tough strategic decision to support the bill. You have to give them some credit for carrying the water for us all on getting the SGR fix to happen when the House bill goes to conference in the Senate. They sure got slammed by the Wall Street Journal for that, and I know that many AMA members are pretty hot about that decision, as are a good number of state societies. Dermatology, some of the primaries, and a small number of other associations also endorsed. I’m sure glad we decided not to. The Congress is certainly not “there” yet with what’s currently on the table. And, there’s no agreement on how to pay for reform yet.

New Timeline
Obama’s meetings at Children’s Hospital in DC, his prime-time press conference on Wednesday, and then a town hall forum in Cleveland, Ohio, on Thursday contained a few significant messages of change: he’s talking about 'we have to get this done by the end of this year, rather than get the bills introduced before the August recess.' That slow down is a big deal -- there’s no way either chamber will now introduce a bill this week. The House could. But I can’t believe they will. The Senate Finance Committee and Harry Reid (and the Blue Dogs in the House) have said very emphatically, ‘we’re moving too fast -- slow it down, damn it, until we get it right. Good thinking, gang. Sen. Baucus is still working on getting his Republican colleagues on Finance to agree to a strategy -- and they want more time. The problems to solve: how to ‘bend the cost curve;’ and how to pay for the expanded access. [more]

Obama’s right about getting a bill done this year though. If this drags on past December, reform will languish. Hello. We NEED reform. While some of our colleagues will celebrate a delay or even a failure of this process, we need to convince them that that would actually be a disaster for medicine and the country. Costs are going UP over 8% this year for most employers during this recession. Unbelievable.

Without reform, Congress will have no tools other than extreme price controls to offset rising costs in our defective fee-for-service system -- and what they will do in that situation will undermine the profession’s viability and health care in general. If the status quo prevails, we’ll all need some massage therapy (which will need to be a mandated benefit). The Medicare 2010 Physician Payment Rule is clear evidence of what is coming if we don’t get real reform, and soon. Gawd!

For more on this topic, check out a panel featuring me and Jane Delgado, president and CEO of the National Alliance for Hispanic Health, on CNN.com LIVE! We had a great opportunity to discuss the need for reform, for improvement of quality care as the hidden secret of ‘bending the cost curve,’ about the value of guidelines, performance measures and appropriate use criteria, and about why price controls don’t work.

So, the brakes have been applied. Not a bad thing -- if we get moving after Labor Day. Congress will not make their August deadline for health care reform legislation, and even the House Energy & Commerce has pulled the plug on the mark-up of HR 3200 because of a lack of votes. This means our Legislative Conference in September couldn’t be at a better time. Plan to be there.

*** Image from Flickr (Let Ideas Compete). *** 

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