Any momentum gained by President Obama when the issue of exorbitant insurance premium hikes was the healthcare topic du jour last month seems to be all but forgotten as Insurance continues to conduct business as usual. In Mass., the Blues in that state face fighting caps on their rates as its governor, Duval Patrick, reviews requests for increases of anywhere from 8 to 32 percent.

In California, the apparent epicenter of the firestorm over rate hikes, insurance companies seem loathe to change as well, citing the “increasing costs of healthcare” as  a reason for those hikes. All of this movement by Insurance is forcing Obama to take his message to the public to get support for reform. He’ll begin his week by doing so today in Philadelphia.

Wise move? It’s perhaps his only move. With the GOP urging going back to the drawingboard, moderate Dems uneasy over the pricetag of reform ($1T), and House liberal Dems suspicious of Senate motives once the bill is passed; it appears that Obama is turning to the only group left to fully convince the utility of a healthcare overhaul — the American people. | LINK

Physicians — especially those of the primary care type — are spared the potential problems that come with cuts in Medicare payments. At least for another month. President Obama has delayed the anticipated 21% cut in reimbursements while Congress has to take the matter up yet again.

Sen. Jim Bunning (R-KY) created a legislative frenzy last week when he placed a procedural hold on the bill that would have extended health care benefits to the unemployed for an additional length of time. That measure would have also allowed taxpayer subsidies to be used for premiums. Bunning relinquished his standoff yesterday, allowing this extension on cuts in payments to be avoided for another 30 days.

Polling, as a result, shows just how far cuts in Medicare payments to providers and provider organizations will go in threatening care delivery to a huge segment of the chronic care patient population — the same demographic responsible for the heaviest utilization of pharma, primary care, and acute care. Approximately two-thirds of primary care physicians polled by Medscape said they would cease to care for Medicare beneficiaries as a result of the cut.

An extension only holds off the inevitable, and although Senate Democrats are looking for ways to delay cuts further, there has to be a day of reckoning. That could come October 1, if senate legislators work to pass another bill [PDF] and try to reverse the SGR formula [PDF], which is responsible to establishing pay cut schedules in Medicare provider reimbursements.

With reform, the current band-aid strategy the Obama administration is using continues on its sloppy course.

It’s a little hard to tell if President Obama is making the point below (in his weekly address) to drive home the message that (1) he has to do something to save face as his #1 domestic priority falters at the hands of parties bickering with each other like five-year olds; that (2) he’s clearly warning his own party that it risks another GOP Contract with America come November if the reform vote is not acceptable to the Democratic constituency; or (3) that, given the recent publicity with respect to Blue Cross premium hikes in at least six states, a massive PR gambit has to be undertaken to positively spin reform on any level.

Regardless, it is a primer of sorts for his upcoming and much-publicized session with congressional Republicans next week on enabling bipartisanship in getting a sound reform bill passed. (The text of his entire address is here — and below the fold.)

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A year ago this week, it was full steam ahead on Barack Obama’s healthcare initiatives. It seemed as though the new president, who was sworn in just four days earlier, was wasting no time standardizing his imprimatur in preparation for the debate-turned-referendum on healthcare legislation. In addition to finding a CDC head, one of the key high-profile posts Obama and his administration were keen on filling at any cost (or so it seemed) was one that was finally and dutifully filled by the middle of the year – that of the U.S. Surgeon General.

The initial number one prospect? Dr. Sanjay Gupta, of course. The good doctor, who is reporting and (incidentally) practicing medicine in Haiti at this time, was subsequently the target of ridicule from those on the left and right. That the administration had the audacity (of hope?) to suggest a media darling with much in the way of perceived corporate influence with little, if any, legislative experience to qualify him for the position was the most appropriate candidate was, at best, naive … at worst, very shortsided and indifferent (read: too “corporate”) to those whom Obama wanted to help with his plans for health reform. A head scratcher the administration never fully addressed with critics.

Today, the position is filled, not by a neurosurgeon media megalomaniac, but by a family doc with an MBA (just like me!) who appears to have a passion for what the office stands for: the promotion of low-cost preventive medical services and a commitment to the president and to the American people for compassionate and accessible delivery of care. | LINK

The funny thing about 20/20 vision in politics besides its keen ability to note history as it unfolds in the political process…is the ease with which it gives pundits in any genre a basis to pontificate^[1] or, rather…create, new issues and stories.  A recycling of information, if you will — the lifeblood of the blogosphere.

For Doctor Pundit’s inaugural accounting of its yearlong then-and-now pontifications on healthcare policy, we begin with an issue whose posting on this blog became its #1 blog entry for all of 2009 (according to Google Analytics statistics). Obama’s ascendancy to the the highest elected seat in the land carried along with it the hopes and dreams of the disenfranchised in this country who were hungry for change — any change — from the stranglehold that (they thought) was the Bush administration’s clamp on any meaningful attention to domestic policy in favor of its affinity for foreign policy and the War in Iraq. Healthcare was just one of those domestic policy points Obama supporters were clutching as possible rallying points for galvanizing their candidate’s ability to win the nation’s highest office — one which, for the first time, seemed a real possibility for an African-American candidate.

Enter Barack Obama, who not only won the 44th presidency, but also answered his party’s mandate in doing so. As part of his commitment to the people who placed him there (or to himself, as healthcare policy reform was as self-serving a legacy accomplishment for Obama as was any other domestic issue), Obama would finally make healthcare accessible to all. And he would get the Republicans and Democrats — and Pharma and Insurance — to work together to make it possible. Lofty? To Obama, at the time, not especially.

Apparently, expansion of the federal government’s role in financing Medicaid is a priority. According to the WaPo, Obama plans on allowing states temporarily to sign up jobless residents for Medicaid, with the federal government for the first time paying the entire cost of doing so. Even more boldly, the new president will also provide “unprecedented” federal subsidies to increase the affordability of COBRA, a temporary coverage mechanism for laid-off workers that, for many, remains unaffordable.

Fast forward 12 months later, and Obama is fighting for not only a candidate’s political life but also his own legacy as it applies to the reform of healthcare on a national level. A year ago, Obama had high hopes on expanding both Medicare and Medicaid to deliver high quality healthcare to those who needed it the most. At the time, it appeared to Obama, at least, that cost was no object. A year later, multiple iterations of CBO analyses have shed light on what lawmakers, Obama, and now the American people know only too well: Obama’s promises to increase healthcare access to the almost 50M uninsured have broken down on a massive level, its overarching meaning reduced at this moment to a vote this Tuesday in the state of Massachusetts on an open U.S. Senate seat. Twelve months and thousands of contentious healthcare townhalls later, Obama’s dreams of the affordability, bipartisan entreaties, and corporate cooperation of Pharma and Insurance with respect to healthcare reform are turning into a cruel reality on how he just seemed to lose all control of the debate.

1. …or rant, although I’ll try to stay away from heavy-handed verbal drama [↩]

Barack Obama’s back is to the wall this week. There’s irony occurring on many fronts. For one, the state which has served as the beacon for his multitude of campaign promises on healthcare reform — Massachusetts — is the battleground for a struggling Democratic candidate all too willing to carry the late Senator Ted Kennedy’s reform mantle into the next decade in the face of fierce Republican opposition at the hands of an opportunist who just wants to nix any Democrat’s vote on reform on a national level.

Also, the nailbiter of a race for Kennedy’s senate seat is just the latest election contest to test Obama’s campaigning mettle. Up until now, he has not been particularly effective for either former NJ Senator-turned-Governor John Corzine (who lost his seat last year) or former VA Gov. Tim Kaine, who lost as well. Finally, this entire push and effort for Obama’s party to elect the Mass. Dem candidate is now widely seen as a referendum on the healthcare debate — as sentiment in which Massachusetts’ troubles with reform are driving a wave of conservative populist sentiment against Obama and his campaign for healthcare reform on a national level.

Democrats have major reason to be concerned. At risk is not only the entire meaning of the final vote on healthcare reform, but also the precedent this entire episode sets on 2010 as a predictor of Obama’s ability to lead the party out from under increasing Republican fervor for domestic policy alternatives on issues other than healthcare, not to mention a smoldering Afghanistan policy. | LINK

The run up to passage of the health reform bill has left a gaping hole for Obama to fill — that of CMS head. (Tom Daschle obviously didn’t work out.) The NYT has a concise wrap of the apparent indifference the White House has given to the issue of exactly who will be running Medicare, and it goes so far as suggesting that it is an issue that is secondary at the moment. Obama’s lack of attention in this area is yet another indictment, for some, of his lack of key leadership in spite of his commitment to health reform as his number one domestic policy point.

Given that whomever Obama appoints to the position passes Senate confirmation, the enormity of the task leading CMS will require talent health policy watchers have rarely seen in this position. Overseeing the development of multiple insurance exchanges along with the possible formation of payment advisory commissions, oversight bodies and demonstration projects in the midst of the most sweeping federal legislation in decades is not for the faint of heart. Can’t wait to see his appointee’s qualifications. | LINK

The quest for a public option has been watered down immensely since the end of the House debate on the matter. What seemed like a real sense of purpose among House Democratic congressional leaders in securing legislation to include a public option — even in the face of futile derailments by more conservative Dems and Republicans last month — has all but been abandoned now. In fact, total acquiescence to the Senate’s desires is the rule, according to many officials today close to the legislative process being worked out at this hour.

Essentially, the endgame is what I have predicted all along in the pages of this blog — a mandate not on public financing of healthcare, but the close rein on the influence of Insurance on healthcare financing.

In obvious maneuvering among House and Senate leaders, as well as the president, the goal of getting a reform bill out complete with all the trappings of the Democrats’ talking points of “achievements” and “future gains” is gaining momentum. Government insertion into Insurance is the major issue to be resolved by the time President Obama touts his health reform “accomplishments” in his annual State of the Union address in a few weeks. All of this rests against a backdrop of revised statements from Speaker Pelosi and Obama, to name a couple, carefully worded as the tepid bill awaits House-Senate merging.

• Pelosi has recently listed “new” goals for the bill without ever mentioning the public options she has so long supported: We are optimistic that there is much that we have in common in both of our bills and that we will resolve or reconcile this legislation in a way that is a triple A rating: affordability for the middle class, accountability for the insurance companies, and accessibility to many more people in our country to quality, affordable health care.
• Obama says that — although he has always favored a public option — it has never been an essential part of his desire to overhaul the nation’s healthcare system.
• House Dems, who acknowledge the precarious nature of the inclusion of a public option, now are saying they favor reforming Insurance if they aren’t “let off the hook”.

Compromise or capitulation from the House? At this point, it really doesn’t matter. Just get the thing passed so we can start focusing on its influence in the second decade of 21st Century Healthcare. | LINK

President Obama is already honing his skills in defending what will likely be his biggest domestic policy issue “win” for the foreseeable future — passage of the healthcare reform bill. Guess whom he’s attacking (throwing under the bus?) to get the job done — the progressive bloc of the Democratic party whose coattails on which he sailed into the presidency on their mandate. Obama, on his pending signature legislation which does not reference a public option — from NPR:

This notion I know among some on the left that somehow this bill is not everything that it should be … I think just ignores the real human reality that this will help millions of people and end up being the most significant piece of domestic legislation at least since Medicare and maybe since Social Security.

Yes, this is significant legislation, but Insurance will not be shedding a tear on a provision whose contingencies it has been expecting and planning for^[1] this entire time. | LINK

1. The Senate version of the reform bill uses tax credits in a more restricted manner than the House to allow patients to shop for coverage in an exchange. Within the exchange, the House bill would make available a government-run plan, which negotiates with doctors and hospitals on payment rates. The plan couldn’t pay doctors and hospitals at a lower rate than Medicare does. The Senate would require the Office of Personnel Management to contract with insurers to offer at least one multistate insurance plan in each exchange. [↩]

The political and healthcare blogosphere is all abuzz this morning over a WaPo piece yesterday in which President Obama makes the declaration that he did not campaign on the public option. As the spin begins to pile up from the Dems over the next few days’ media onslaught of reform bill coverage, leave it to this very pragmatic president to explain why he is suddenly behind this bill 100 percent.

In the interview, Obama vigorously defended the legislation, saying he is “not just grudgingly supporting the bill. I am very enthusiastic about what we have achieved.”

“Nowhere has there been a bigger gap between the perceptions of compromise and the realities of compromise than in the health-care bill,” Obama said. “Every single criteria [sic] for reform I put forward is in this bill.”

Obama said the public option “has become a source of ideological contention between the left and right. [..] I didn’t campaign on the public option.”

Hmmm, the chronicles in Doctor Pundit from last July (in the thick of an orchestrated campaign on his part to steer wavering Democrat moderates to the public option camp) paint a slightly different picture.

Obama, sensing this, held a photo op on 7/15 to tout, once again, the need for a strong public option. Feels at little like his campaign all over again, as his statements (campaign promises) court Senate Republicans (voters) for their approval (targeted votes from moderates and Obama’s ultimate bill passage victory and healthcare reform legacy).

Media Matters, the left-leaning fact checking watchdog group, cites many other instances of an Obama push for the public option as the political centerpiece to his domestic agenda. Although there is no doubt as to the scope and influence of this legislation, there’s plenty of doubt about Obama’s motives in protecting a legacy point which may not follow him to a second term.

Former Governor and DNC chair Howard Dean, MD, a darling of the right? Okay, that may be stretching things a bit; but after a nation has had time to fully digest the latest political goings-on in Senate chambers on the Hill, his sentiments are being echoed amongst those who identify as moderate and center-right. Actually, many more Americans left and right, no doubt exasperated over the drama occurring daily in the Senate, are simply fed up with their elected officials acting like stubborn children fighting over a bill whose potential impact lessens by the hour.

The latest polling adds to this assertion, and Howard Dean’s — for that matter. You can also add liberal MSNBC commentator Keith Olbermann to that list. The heavy run-up to This Week In Healthcare Reform began more than a year ago (it seems like a century) with Democrats promising their base that a public option was essentially assured. What a difference a year makes. With a vote — which now seems almost pointless — in peril by Christmas; political wonks, pundits, and the average American feel that the reform bill is gone. Many of them want Congress to just start over.

All of which leaves whatever Obama settles for and possibly signs — due a heavy explanation to the people who put him into office. | LINK

Here’s the latest scorecard in the Senate’s handling of the health reform bill and its debate:

• Joseph Lieberman flip-flops on the Medicare buy-in provision.
• Obama, essentially condoning Lieberman, praising any bill that passes in advance.
• Howard Dean, once ebullient about the structure of the bill, is now discouraged and wants it killed(!)

How far we’ve come in this entire healthcare debate — the same one that had the potential to bring all lawmakers of ideological stripes together; the same one that motivated a majority of the country to put Obama into office; the same one that gave hope to millions without healthcare access; the same one that emboldened the majority party in the U.S. legislature (the Democrats) to craft spirited debate among supporters — is now the same one, reduced to a couple of talking points on either side, upon which its ultimate passage rests.

Sen. Arlen Specter (R-PA) has recently proposed an amendment to Medicare legislation which is designed to seek up to a one year delay in eliminating the consultant code for specialist reimbursements. Some specialists are saying that this proposed change to Medicare billing documentation — designed to offset what CMS calls “significant” overpayments to consultant physicians — will affect the breadth of specialty care for Medicare beneficiaries.

This would, of course, code such visits as routine and non-consultative, affecting reimbursement rates negatively for subspecialists. Are these the types of cuts President Obama is seeking within Medicare to pay for reform?