I’m quite sad that a public option isn’t in there. But it isn’t a case of it’s not in there because the Senate is whipping against it. It’s not in there because they don’t have the votes to have it in there. [...] We had it. We wanted it. They didn’t have it. It’s not in the reconciliation.
UPDATE: By now, it is assumed in Washington that Pelosi’s stance is the stuff of Senate influence. But all is apparently not lost, however. Other lawmakers are apparently considering other measures in the House to assure some sort of government-financed proposal. Also, the passed Senate bill does allow individual states to formulate their own public option provisions.
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.
House Speaker Pelosi says she is confident that healthcare reform will pass. This, apparently, is the major mode of thought coming from the Democrats as a result of the flurry of activity and speculation filling the Sunday morning talkfests yesterday. Relying on the sheer numbers of votes in her party, the pronouncement comes a few days ahead of President Obama’s announcement later this week of how he’ll proceed on reform.
Votes are one thing, but how those votes will be cast is quite another — and in the Beltway, perception is everything. The GOP is ready to counter any move by the Dems with criticism they hope to ride all the way to November. If it’s getting the bill through reconciliation (to avoid a filibuster)[1] or starting over from “scratch” — the GOP’s version of a legislative “gotcha” directed toward Obama — the Democrats seem to be playing a risky game with the nation closely divided on the reform bill as it stands today.
Spring break in Congress occurs on 3/26. Will things be wrapped up by them? Will the long road to reform end with votes to secure a bill, any bill? Or will it come down to reconciliation as the line in the sand: for the Dems, it means passing a bill to expand Medicaid, require employer-sponsored coverage, and require people to have coverage; for the GOP, it means fighting against reconciliation and turning Obama’s push for reform into a protracted referendum on the balance of power in Congress come November. | LINK
The House would pass the health bill approved in December by the Senate, and both chambers would approve changes, separately. [↩]
President Obama’s healthcare summit has come and gone. The mere fact that this meeting took place in front of cameras was reason enough to discount any potential for real bipartisanship to occur. The upshot? The Republicans stand firm on their ground to rally against any Obama proposal as the party brands itself on this issue ahead of a potentially gratifying November midterm.
Meanwhile, the White House and the Democrats will say that every effort is being made to “forge ahead” amid the apparent obstructionist natures of the GOP. The problem for both parties is that the American public is becoming tired of what it sees as a spectacle. According to a CNN poll [PDF], 86 percent felt that government is broken, with 14 percent saying it isn’t. Of that 86 percent, 81 percent say the government can be fixed, with 5 percent saying it’s beyond repair.
Whatever the ultimate effect this televised meeting had on patients, lawmakers, physicians, insurance companies, and other interested parties; one thing’s for certain: closed-door meetings are the only way anything can get done. Political theater for the world to see accomplishes nothing but shallow grandiosity on the bumpy road to an ultimate reform bill. | LINK
Ready…set…yawn? With all of the fanfare surrounding this morning’s healthcare reform summit in Washington, you’d think that its organizers were pulling double duty with producing the upcoming Oscars. We’ve heard the eleventh hour rhetoric from all sides — the potential for bipartisanship at this late stage in the game and how “wonderful” it is to get this forum televised so that the American people can finally acknowledge the transparency President Obama and the White House have always wanted to characterize since he came into power.
But with all of the pomp, circumstance, and…hyperbole surrounding this morning’s summit, it seems the prevailing thought is more of a, well, an afterthought. Although Barack Obama has trumpeted the bipartisan get-together as having the potential to hammer out a last minute deal that will please everyone everywhere, the public seems to have already made up its mind about the state of reform today — and the court of public opinion shows collective ennui over the multiple set-ups for multiple letdowns. Reform fatigue has finally set in.
When the ultimate news item from today’s marathon session will more than likely echo the fact that nothing can be agreed upon of any substance, the public whom Obama so much wanted to convince that reform was within reach has already packed up and moved on. According to one private Medicare exchange’s polling, approximately 1700 of them have already done so. Mr. President, let the latest installment of this drama begin.
Pennsylvania and Hawaii are the only two states in the country that do not have a mechanism in place for the regulation of premium rates set forth by insurers as it applies to their small businesses — a demographic courted heavily by both Republicans and Democrats as players in the final direction of pivotal health reform. The Pandora’s Box cast wide open by the recent Anthem BC scandal is adding a new critical layer of scrutiny not only to Barack Obama’s reform trajectory, but also to the ways in which Insurance market fluctuations influence the overall cost of healthcare delivery and access.
Implications for the these two states are obvious, as government regulatory oversight could go a long way in keeping the relationship between small business and the insurance they purchase an open, transparent, and freely accessible system for consumers of healthcare (patients), giving states’ insurance commissioners added muscle. Alternatively, control of regulatory processes by the federal government could add just another layer of bureaucracy (read: increased administrative healthcare costs to the taxpayer and shifting rising costs to other entities — like Pharma) to an already overburdened HHS Dept. Over the next few days, the unfolding issue of federal gov’t Insurance regulation over state’s private insurance markets will become a hot-button one, adding some eleventh-hour drama to the health reform debate. | LINK
President Obama’s version of the reform bill (the one he is personally proposing and defending, come later this week) is getting a shot in the arm. Hoping to stoke public animus against the recent massively outrageous insurance premium hikes by Blue Cross in California and in other states, Obama will once again renew the call for a bill mostly on his terms.
Coming nearly a year after he put the push toward reform into overdrive, Obama will include the new provision that will allow the government (HHS) and states the power to bar or limit such increases — even demanding rebates for consumers of healthcare in such an environment. All of this is in anticipation for the bipartisan summit with senate Republican and Democratic leaders at which Obama will add previous provisions which include barring claims denials for pre-existing conditions, and a tax on HDHP (Cadillac plans).
Republicans are standing fast on their admonition to force Obama essentially to start from scratch, with a nod toward a more tepid bill with less obvious government funding. The showdown takes place later this week and will be televised. | LINK
UPDATE: The WH has posted Obama’s proposal summary. | LINK | At initial look, the president’s plan does not appear to repeal the antitrust exemption. | LINK [PDF] | Also, without public option language in the proposed bill (as expected), what’s next for each side? The heavily hyped bipartisan summit awaits this week. But what about afterwards? Assuming the Republicans stick to their guns, obliterating the WH’s strategy of forcing them to defend their antipathy toward the bill on fiscal grounds, will the party extend the drive for nay votes toward mditerms? Since the Dems are down by at least three votes, this could be likely. Perhaps, a protracted fight among both sides will be good for the bill’s ultimate passage on (mostly) Obama’s terms — then, and only then, will the true transparency of the proposed bill’s language come to light as Americans may use November as a referendum on health reform.
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.)
The first study of the anti-CSF prototypes for treatment/reversal of Alzheimer dementia is underway.
The trial will measure in the cerebrospinal fluid (CSF) and blood plasma of amnestic mild cognitively impaired (MCI) patients the biochemical changes that are associated with AD and correlate them with the pharmacokinetics of the drug and its metabolites.
For California, the bleeding never ends. Today, Gov. Schwarzenegger releases his spending plan for 2010-11 which details even deeper cuts to its Dept. of Human Services.
A year ago, this blog cited a study which detailed the difficulties cancer patients faced when navigating the byzantine nature of health plans which essentially made it difficult, if not impossible, to receive life-saving treatments. The paper [PDF] went on to describe the problems these patients would still face even when eligibility requirements for government assistance via Medicare or Medicaid were at least partially met.
Either through ignorance of policyholders’ plans limitations or via the inability for their out-of-pocket costs to cover the difference, cancer patients have continued to face significant challenges in accessing crucial care. The verdict may still be out on the finer points of President Obama’s goals for reform, but Insurance does not really seem to be waiting for his signature on legislation to react.
With respect to one insurer, news comes of a cancer patient’s current fight to obtain treatment oncologists thought could save his life. Relapsing neuroblastoma has sidelined a five year-old’s life right now; his insurer has refused a new treatment option it deems as expiremental — in spite of covering a cheaper treatment in 2007 that was also called such, resulting in a full remission. The child’s parents are suing the carrier.
Advocates for insurance reform have taken a backseat in the reform debate, which is not surprising. Although, Obama has described his reform plans are not a referendum on reform of Insurance in a strict sense, it is apparent that sound arguments based upon solutions in the way coverage is paid and delivered need to transcend the rather simple promise of non-discrimination based upon claims denials.
If Obama ever wished he could tell Insurance to just go and “take a hike”, I’m sure he wouldn’t mean it in a literal sense. A California-based insurance company’s decision to raise policyholders’ premium rates by as much as near 40% has prompted a state inquiry and the ire of HHS Sec’y Kathleen Sebelius. The attention the White House is giving this case at a time when reform efforts are rocky is somewhat of a balm for the president’s increasingly wounded pride on the effort to promise wider healthcare access and affordability as dictated during his campaign for the nation’s highest office. Why would an insurance company, even if it is for-profit, create such a negative PR issue for itself at a time when unemployment — and by extension, healthcare inaccessibility — in California and nationwide are at such cripplingly high levels?
Obama is currently changing the focus of his administration’s effort at domestic economic fixes from healthcare to jobs creation. But he hasn’t completely abandoned healthcare lately — in spite of the recent media coverage hinting of the president’s pressuring Nancy Pelosi to just go with the Senate version pronto.
At an effort to keep health reform from the jaws of death, Obama has invited GOP leaders to discuss possible bipartisan compromises in a meeting slated for the end of this month.
Asked if he was willing to start from square one, the president said he wants “to look at the Republican ideas that are out there. And I want to be very specific. ‘How do you guys want to lower costs? How do you guys intend to reform the insurance markets so people with preexisting conditions, for example, can get health care?’”
Haven’t we been here before? Over a year into his presidency and his dreams of reform passage still the stuff of pipes — patients, providers, and pundits are probably growing as weary as the GOP (now that filibuster is not a possibility) watching this fight play on.
A White House statement Sunday said Obama repeatedly has made it clear “that he’s adamant about passing comprehensive reform similar to the bills passed by the House and the Senate.”
“He hopes to have Republican support in doing so, but he is going to move forward on health reform,” the statement said.
Obama hopes? For all of those wondering just how flawed the Democrats’ bipartisan strategy has been up to this point with respect to reform, it is unfortunately totally being laid bare now. The battle for reform on Obama’s terms is rapidly slipping away. | LINK
A couple of weeks ago, I interviewed the CEO of the EHR/PHR tech company MediConnect, Amy Rees Anderson. What follows is the second half of that interview here on Doctor Pundit.
DP: How important is portability of the health record for patients beginning to benefit from EHR adoption?
Ms. Anderson: The cheapest way to facilitate the portability of the records is to have the doctors adopt electronic medical records at point of care. Once this occurs the ability to retrieve and transfer records will become substantially more affordable. Again, I don’t think we will see this adoption for doctors really start to boom until we incent the current providers to do so. I do, however, believe that the rising generation of physicians who grew up with their handhelds and tablet PCs will come right out of school using these systems already. But it’s the physicians who have been practicing for years that we need to incent to switch over. Without electronic health records we can still retrieve and digitize the paper records like MediConnect has been doing since 1996, it just comes at a higher cost than if we dealt with all electronic records.
DP: Do you see any immediate barriers to adoption with respect to hospitals, vendor interface, or broadband availability in resource-poorer regions of the country?
Ms. Anderson: I don’t think broadband availability is the barrier to adoption today. The majority of records are stored in offices in the metropolitan areas of the country where the highest numbers of people live anyway, which has ample availability for high speed. In the smaller areas, where the Internet is slower, the doctors can keep records on a local server that can connect and upload to secure online storage in batch mode, so it won’t prohibit them from the changeover to electronic records. With regard to vendors, I think it’s important to let doctors choose whatever electronic records software works best for them in their own practice. Trying to force everyone on to one system is just not practical. That said, every system should allow for the transmitting secure health data to other systems as requested by the patient controlling that data.
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
DOCTOR PUNDIT @ ONE YEAR
Announcing a year-long series here at Doctor Pundit which reviews healthcare policy trends over the previous year and compares them with current issues. Catch the archives here.
Either through ignorance of policyholders’ plans limitations or via the inability for their out-of-pocket costs to cover the difference, cancer patients have continued to face significant challenges in accessing crucial care. The verdict may still be out on the finer points of President Obama’s goals for reform, but Insurance does not really seem to be waiting for his signature on legislation to react.
Again, I don’t think we will see this adoption for doctors really start to boom until we incent the current providers to do so. I do, however, believe that the rising generation of physicians who grew up with their handhelds and tablet PCs will come right out of school using these systems already. But it’s the physicians who have been practicing for years that we need to incent to switch over. Without electronic health records we can still retrieve and digitize the paper records like MediConnect has been doing since 1996, it just comes at a higher cost than if we dealt with all electronic records.
