Monday, February 22, 2010

Health Reform in the Red Zone (reprise)

Last September I wrote about the President proposing his own health reform package. Now that the plan has finally been proposed I thought I would republish that post and look at it in light of the Whitehouse health reform proposal. I have been reading through it and will be watching the health reform summit this Thursday with interest to see what develops. To carry the football analogy a little further, Mr. Obama may need to settle for a field goal. CBO Director Elmendorf said in a blog post that he had received many requests for a cost analysis of the president’s plan, but unfortunately the Presidents plan does not "provide sufficient detail on all of the provisions. Therefore, C.B.O. cannot provide a cost estimate for the proposal without additional detail" he said. If Whitehouse estimates of $950 billion are accurate, then it will put the total cost of the plan right between the $871 billion of the Senate bill and the $1.05 trillion of the House proposal. How to pay for this will be a sticking point going forward...
Healthcare reform efforts are inside the twenty yard line with less than two minutes to go. President Obama has been trying to guide his team through a difficult and slippery first three quarters of attempting to make a touchdown on healthcare reform, and so far their is no score. There have been fumbles, fouls, and dropped balls, and what sometimes seemed hot dogs on his own side not playing as a team.
I have said before that I believe the President will propose his own reform package this fall, and I think after he addresses Congress this week we will see the Whitehouse developing their own bill. So far they have resisted taking positions on many specific elements of a the House and Senate healthcare bills, instead expressing openness to different ideas, while allowing Congress to go its own way. But this approach has left many lawmakers divided over some of the more controversial elements, such as how to control costs. Since many Americans seem to favor of a slower, less ambitious approach, the President is moving towards a proposal that might bear his name and could carry serious political risks. But it is time for Mr Obama to take the ball and run with it.
The biggest obstacle is overcoming opposition to a public option, which the President would prefer, but has said is not absolutely necessary. One idea that he may favor has been proposed by by Sen. Olympia J. Snowe (R-Maine) is the concept of a "trigger" in which a government run program would be implemented only if private insurers were unable to deliver affordable insurance plans to most consumers within three to five years. This is the same type of "trigger" used in the Bush-sponsored Medicare prescription drug law. So far, the government drug coverage has not been needed.
"If somehow the private market doesn't respond the way that it's supposed to, then it would trigger a public option or a government-run option, but only as a fail-safe backstop to the process," Sen. Ben Nelson (D-Nebraska) said on CNN's "State of the Union" program. "And when I say trigger, you know, out here in Nebraska, in the Midwest, I don't mean a hair trigger."
The "Gang of Six" is still working on a plan that would included an insurance co-op, and there is still the possibility that the President may allow some form of tort reform and the ability for health insurance to be purchased across state lines into the bill. An incremental approach with three or four bills may be another way forward, instead of going for everything at once. The lessons of the past will not be lost on this administration, and perhaps it might be time for thinking of settling for a field goal instead of driving for the end zone.

"Individual commitment to a group effort -- that is what makes a team work, a company work, a society work,
a civilization work."
Vince Lombardi

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