Health Summit Promising Start
One of the benefits of a home office is I can watch television so I watched the six hour summit. I thought it was promising in that there is a wide area of agreement on goals albeit a cavernous gap in how to do it.
The basic gap seems be in several areas. Republicans feel the cost curve is not sent downward with either House or Senate bill. They also want more private sector free market solutions and less Federal mandates. A key area missing, say Republicans is tort reform and fraud reduction. Republicans would agree that we need more affordable insurance rates, more protection for pre-existing conditions, and more focus on prevention. Republicans want a step by step approach rather than a comprehensive system wide bill desired by Democrats.
The Democrats think they address these provisions at least partially. They say costs will come down because they establish a medical panel to evaluate what works, provide preventive care without co-pays, and are working on incentives for states to reduce lawsuits.
I think that if the Democrats included full tort reform and less mandates they can come to an agreement this year. The Republicans would need to agree to Federal standards on coverage mandates for insurance companies, although maybe they can be scaled down so costs can be less for consumers. What is striking is that the CBO says rates will rise more than 10% because the government mandates coverage levels higher than we get now.
The level of political theater was evident on both sides. I would say at least 50% of the comments were substantive and could lead to a bridge between the parties. I was disappointed that Reid, Pelosi and McCain and several Republican house members were highly political rather than cooperative. Leadership seems to be a problem on both sides as many junior members had better comments than senior members who seem so set in the blame game.
Obama was very good. He did not give his normal 10 minute answers and let members talk. He listened and minimized blame. He appeared to be genuinely trying to see what the common agreement was between the sides and tried to encourage positive discussion. On the other hand, it seemed that he was fairly set in his views that the Democratic plans do achieve the goals Republicans wanted since it has many of their ideas in it. If he wants a bi-partisan bill passed he will need to give a lot more. It seems up to Republicans to agree that the current bills have many of their ideas rather than have Democrats conclude that for them.
One of the best arguments came from Tom Coburn, a Republican who is a physician, said we must go much more aggressively after the estimated 15% fraud in Medicare. He suggested we use undercover patients who can reports fraud and Democratic Senator Chuck Schumer said that can be added. Coburn also admitted that he and his fellow doctors practice defensive medicine that is also raising costs greatly. We need, Coburn said, tort reform to allow doctors to prescribe only tests patients need and not for legal protection.
It is clear from the day long talks that Obama will need to mediate much more as the Congressional leaders are much more set to blame each other than compromise. What Obama needs to do is to give enough to Republicans that their moderates are satisfied. If he tries to pass this bill through reconciliation it will be a major political blunder. I believe the current bill is not the needed solution to our problems. No one convinced me that cost will be controlled under the current bills. All that will be achieved is more coverage at a huge cost to taxpayers. I think Republicans are correct that cost must be the primary focus. Obama says the bill is deficit positive but that is because we are all paying more taxes and premiums to fund it.