OK, we’ve had the Obama Health Care Reform Summit. Enough key members of both parties showed, and everybody got a chance to express their view. The president remains a brilliant articulator and a cool head. One has to be impressed with these abilities. He makes clear there are a lot of needed and good things on the Senate bill. But, for a lot of viewers, Republicans will have struck a note about 2,700 pages of legislation in the Senate bill, and a trillion dollars in spending, and an awful lot of unanswered questions. The bottom line of this event is that nothing really changed.

This is a cause for concern. As physicians, we tend to forget that there’s more than $200 billion of new funding for physician services embedded in that Senate bill, which is sorely needed to stabilize the profession and medicine, and most of it is not the Medicaid expansion, but rather a very significant expansion of private coverage for currently uninsured and underinsured individuals and employees of small businesses and their families. A lot of EMTALA write-offs would get reimbursed here, and we tend to forget that there are billions of dollars of new funding for chronic disease management, prevention and new services for which we have long advocated. And then there’s the $10 billion to fund pilots for real payment reform to get us out of the current dead-end circumstance of endless certain reimbursement cuts if the status quo continues. 

The bill also has a lot of good insurance reforms. Republicans are right that there will be no real cost containment in the current insurance model until we create a competitive and large risk pool and across-state-boundary competitive insurance bidding for the individual and small business marketplace. The bill does contain this innovation, along with a lot of administrative simplifications that are long overdue.

But the bill also contains a lot of things that should have been dropped out, like the independent payment advisory board (IPAB), prohibitions on physician-owned hospitals, and a disregard for the need for tort reform. The excise tax issue with respect to “Cadillac coverage” was in essence horse-traded off the table by the president as a ‘gimme’ to the unions when he set the threshold at $27,000 for family coverage and put off implementation until 2018. So, funding a modified bill will thus require taxes on high-income families and on some high-income individuals’ investment portfolios.

The two parties came into this from very different positions. The Dems need a bill to be passed. Republicans need for that not to happen. The Summit, while promoted by both sides as offering some fresh ideas about how bipartisan progress could be made, offered little hope it will. There is no bipartisan spirit here. That’s what the Summit made clear.

What will happen now? Personally, I believe we can’t trust anyone who thinks they know what will happen. Unlikely as it is, the Dems may still try to pressure a reconciliation, even though I think it’s unlikely without a lot more work, but we’ll see. Pelosi said on Saturday that she thinks a bill will be ready by their Easter (spring) break. I don’t know.

 

 

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