Healthcare

For members of Congress trying to decide whether to vote for healthcare reform because they are unsure whether there are significant costs controls, yesterday’s letter from three leading health economists should provide them with the authoritative answer: pass the bill. The letter, authored by David Cutler, Henry Aaron, and Alice Rivlin and co-signed by almost 40 other leading health policy experts, outlines 10 provisions in the compromise bill that are aimed at reducing costs.

Historically, physicians felt it was their duty to care for indigent patients and were able to do so because insurance companies paid a reasonable reimbursement.

With the advent of HMOs and indexing of payments to Medicare, the margins for physicians were significantly reduced, making it impractical for them to continue free care.

The reason physicians accepted Medicaid and Medicare in the beginning was out of a sense of duty to the poor and elderly. They never suspected that it was the camel's nose under the tent and everything would be indexed to those payments. In other words, no good deed goes unpunished.

We've brought you a lot of news and commentary about the ugly underbelly of the process Democrats are engaging in to try and pass healthcare reform, we have assessed the politics of the effort again and again and we have also reported on the problems both Republicans and Democrats have with the substance of the bill. Today, on behalf of Democrats, I have agreed to pass along a positive assessment, just in case you missed it.

In the 25 years since I gave up my IBM Selectric for a computer, I have spent countless hours trying unsuccessfully to fix glitches, usually coming up with one plan of attack and repeating it endlessly and fruitlessly. (I now happily have a really smart tech guru who fixes stuff for me, often within minutes.) In the bad old days that turned to nights while I tried to unfreeze my screen or coax some incomprehensible error message to disappear, I used to tell myself that I defined insanity— “doing the same thing over and over again and expecting different results.” (The quote is sometimes attributed to Albert Einstein, but more often to novelist Rita Mae Brown.)

The Hill's A.B. Stoddard talks about the steps the House and Senate will have to take in order to pass healthcare reform over various procedural hurdles and with a CBO score awaiting them.

When President Barack Obama spoke in the East Room of the White House on Wednesday, surrounded by all of those white-coated doctors and nurses, his somber tone and dramatic words were directed not at Republicans who have voted unanimously against everything the Democrats have thrown up on the board, but at his own party.

"At stake right now is not just our ability to solve this problem, but our ability to solve any problem," Obama said. "The American people want to know if it's still possible for Washington to look out for their interests and their future. They are waiting for us to lead. And as long as I hold this office, I intend to provide that leadership."

He was talking about his last-ditch attempt to resurrect healthcare reform, but the more expansive issue President Barack Obama raised is the more valid one:  Does the government have the “ability to solve any problem”?

Put it another way: Has the personal ambition of too many individuals holding power and influence consumed their ability to act for the common good?  Does their shameless demagoguery so poison the atmosphere that reason is smothered?

A good argument can be made either way as to whether the White House — specifically, the president’s wife — should be so focused on childhood obesity, but the very fact that it has risen to the top, so to speak, as an issue of national importance should alarm us. It’s a problem. A society composed mostly of people too lazy to take care of themselves just a few minutes a day with good exercise and healthy eating habits has more problems than might meet the eye.

For a while on Wednesday, surrounded by 150 people wearing white coats or hospital scrubs, I thought I was in the employees’ lounge of the Washington Hospital Center. Nope. I was in the East Room of the White House, where doctors, nurses and other care professionals had gathered to cheer President Barack Obama’s update on healthcare.

Stepping up to the podium, the president took charge of the issue with a compelling message. We all agree the status quo is unacceptable, he pointed out. We’ve been talking about it long enough. Now’s the time for action. And the American people deserve an up-or-down vote on healthcare, which he challenged Congress to schedule within the next couple of weeks.

Applying some basic game theory, it seems highly likely that Democrats will take the president’s advice today and push ahead to pass healthcare reform. Let me try to set aside my own personal beliefs and examine what the optimal outcome for each political party is for whether healthcare reform passes and the corresponding argument they might make to voters. I’m not endorsing this type of zero-sum approach to policymaking and politics generally, though I think it’s reasonable to assume at this point that there are some irreconcilable differences on how to proceed (even if the president was correct in his letter that there is more agreement on policy approaches than generally understood).