Health Care in trouble?

Look, I would be lying if I did not say that I was not concerned about the prospects of health reform. I would generally call myself a deficit hawk too. I actually opposed the Bush tax cuts, because of deficit reasons. I have talked many a time about controlling health care costs.

Am I annoyed that the bill does not do more to control costs? Yes, to some extent. However, I also think that unless we get more involved as a society in health care, until everyone realizes the consequence of doing nothing, we will not get any effective cost containment.

The lack of coverage in this country is pitiful. The fact that we have a completely fragmented system means that it is sort of harder to control the effectiveness. It also is hard to collect the data we need, because those claims data are "proprietary." We fly in a zone of no information.

What reform poses to do is decrease this fragmentation greatly. It gives us all more skin in the game. Now we can sort of sit pretty as everything else falls around us not knowing that we will soon fall into the abyss ourselves. Now, we move into the same boat and we have to care about the other. We sink or swim together.

The bill does not do enough to bend the curve. But, even more unconscionable, people want to slow it down to kill it (because given today's Washington Post we see the polls starting to turn the other way, and political capital waning). That's at least what Peter Orszag said on the TV shows this weekend.

The delay and kill is a classic strategy. You wait and merely attack and delay until the President's numbers soften, or you are able to gin up enough opposition to a bill. Ezra Klein points out that the operatives on the other side encouraged this, and speak in vague terms what they want. We want cost control, but we want higher reimbursement rates. We do not want a public plan, because it allows the government to negotiate. But, we want cost control. We do not want though anything on the table that would take these powers out of Congress where we can steer reimbursements in weird way, and continue the dysfunctional system.

The Republicans have decided to turn this into the Administration's Waterloo. Yet, the question must be asked, what the hell are the Republicans' plans? Health Savings Accounts and high deductible plans? The RAND study shows that people forgo cost-effective care as well as expensive care equally, leading to overall worse outcomes. Dana Millbank has a more amusing take on this.

Democrats too though have some blame. They are going to have to take tough votes, as Jon Cohn points out. Some of what will arise will not be politically popular. But, if you can get the aggregate together in a big bill, you would do well. And one is well advised to look at Nate Silver's blog posting, which states that there is a survival motivation. He also points out there is a lot more out there to work through.

Yet, as Silver points out, there are still glimmers of hope. Over the weekend, I heard Rep. Mike Ross at least start something constructive, supporting the Independent Medicare Advisory Committee (IMAC) Proposal (you will have to listen to the story). IMAC would essentially shield the Congress from the power to make decisions. The goal would be to send it out to an agency that would make Medicare decisions outside of Congress and the President. The President would sign off, and if the Congress did not like it, it would vote against the proposal in a joint resolution (this is a complex idea that deserves a post in its own right later). Or perhaps Orszag does it better.

In other good news too, today, Olympia Snowe pointed out that she may support a public option, and she signed that letter asking to slow down last week. Grant it, the words are not thrilling. However, Snowe probably does not want to slow down to kill. She likely wants to get further into the details (as does Ron Wyden).

Finally, it is worth taking a look at where we stand. As New America pointed out last week after CBO's reports, it looks good. Klein shows us that these are expected problems in the legislative process, and people on the Hill who work on this still remain optimistic.

And finally, it is important to remember the cost of this bill. Yes, it is expensive, but let us put things in context. My good friend and excellent reporter Joanne Kenen talks about it in the context of the overall economy, and links to some great sources. We also have to look at the costs, both economically and otherwise, of an uninsured population that swells to 50 million.