[Ip-health] Biggest Shift in US Health Care May Emerge in 45-Day Sprint

[Miles Teg]

"Presidents from Harry Truman to Bill Clinton have tried and failed to
reshape the health-care system, running into opposition from industry
and doctors. Truman's efforts to provide insurance for all Americans in
the 1940s were criticized by the U.S. Chamber of Commerce as a step
toward "socialized medicine." The American Medical Association shared
that assessment."


Biggest Shift in US Health Care May Emerge in 45-Day Sprint

Wednesday 17 June 2009

by: Nicole Gaouette and Laura Litvan  |  Visit article original @
Bloomberg News

photo
Sen. Christopher Dodd (D-Connecticut) at the Senate Health, Education,
Labor and Pensions Committee markup hearing on health care reform on
Wednesday. (Photo: Charles Dharapak / AP)

    The largest expansion of U.S. health care since the creation of
Medicare in 1965 may emerge from legislation designed to reshape the
medical industry and change how Americans receive and pay for care.

    Congress today begins crafting legislation that Democratic leaders
plan to push through both chambers by their August recess. The measure
may require all Americans to get medical insurance, force insurers to
accept all patients and end the tax break for employer-paid health
benefits. These changes may be hammered out with unprecedented speed at
the urging of President Barack Obama, who four days ago said "this is
the moment."

    Obama has made a health-care overhaul his top domestic priority,
using his February budget proposal to call it a "moral" imperative to
extend coverage to the country's 46 million uninsured. Obama also tied
the long-term fiscal soundness of the U.S. to controlling medical costs.
Health care consumes 18 percent of the U.S. economy and may rise to 34
percent by 2040, the White House Council of Economic Advisers reported
June 2.

    "I don't think we've ever had anything this large in American
history aimed to go this quickly that touches everybody's lives," said
Robert J. Blendon, a professor of health policy and political analysis
at Harvard University in Cambridge, Massachusetts, in a telephone
interview. "They're moving at a pace we've never seen before."

    "Moment Is Right"

    The U.S. will spend more than $2 trillion this year on health care,
the Health and Human Services department reported in February. Today,
the Senate Health committee will begin debating a bill that includes
"gateways" where consumers may compare coverage plans. The Senate
Finance Committee later this week will unveil a bill that among its
provisions will call for taxes on health benefits, and House committees
will release a draft of their own comprehensive measure that would
create a government-backed plan to compete with private insurance.

    "We know the moment is right for health care reform," Obama told the
American Medical Association in Chicago in a speech June 15. "We know
this is a historic opportunity we've never seen before and may not see
again."

    The coming weeks will be pivotal if the House and Senate are to meet
their goal to send Obama a single bill in October, said Drew Altman,
president of the Henry J. Kaiser Family Foundation, based in Menlo Park,
California, one of the nation's largest private foundations devoted to
health.

    "Planets Are Aligned"

    "We have these big debates about comprehensive health reform every
19 or 20 years in our country, and we've failed every time," Altman said
by telephone. "This time, the planets are aligned as they've never been
aligned before, but there still are a lot of obstacles before we'll know
whether they've pulled it off or we've failed again."

    The timetable may be slowed as Democrats on the Finance Committee
seek a bipartisan compromise. Republicans in the Senate have been
pushing for more time to assess the costs of the various proposals.

    A portion of the health committee bill, proposed by its chairman,
Democrat Edward Kennedy of Massachusetts, and fellow Democrat
Christopher Dodd of Connecticut, may cost as much as $1 trillion over 10
years while covering just 16 million more people, the Congressional
Budget Office said June 15.

    Senator Mitch McConnell, a Kentucky Republican and minority leader,
says he is skeptical of the "chaotic" legislative process. He complained
that the bills haven't been seen by Republicans or "scored" - assessed
to see how much they will cost to implement.

    "We don't have bills," he told reporters yesterday. "We don't have
scores. And at the same time the majority is saying we need to act
quickly. I think it would be highly irresponsible in the extreme."

    Reid's Response

    The Senate Democratic Leader, Harry Reid of Nevada, scoffed at
McConnell's complaint, saying: "We are moving too fast on health care,
we're moving far too fast, in their mind, on energy, and certainly we're
moving too fast" on Supreme Court nominee Sonia Sotomayor. "Is there
anything that we're moving just right?"

    Presidents from Harry Truman to Bill Clinton have tried and failed
to reshape the health-care system, running into opposition from industry
and doctors. Truman's efforts to provide insurance for all Americans in
the 1940s were criticized by the U.S. Chamber of Commerce as a step
toward "socialized medicine." The American Medical Association shared
that assessment.

    President Lyndon Johnson defeated similar opposition in 1965 when he
pushed Medicare, the government's health program for the elderly and
disabled, through Congress. Johnson benefited from a landslide victory
for Democrats in the 1964 elections and U.S. attention to widespread
poverty.

    Positions Will Emerge

    Unlike Clinton's 1993 attempt to change medical care, when industry
opposed attempts to rework the system, insurers, drug- and
device-makers, doctors and hospitals have committed to cut costs over a
decade in support of Obama's agenda.

    As details of the bills emerge, the health-care groups will take
positions, said Altman, of the Kaiser Family Foundation.

    "The real debate will only begin when we have legislation on the
table," he said in the interview. "Then we learn which interest groups
are at the table and which ones aren't. As hot as this has gotten, we
haven't seen real opposition yet."

    In the House and Senate, Democratic leaders are trying to push
proposals through on a six-week timetable more often seen with bills
dealing with a national crisis rather than broad- based social policy.

    Two Weeks of Deliberations

    In the Senate, the health committee today will start what it
expected to be at least two weeks of deliberations on the Kennedy-Dodd
plan. Senate Finance Committee Chairman Max Baucus, of Montana, said
yesterday he hopes his plan draws support from the top Republican on his
panel, Senator Charles Grassley of Iowa. The Finance Committee is
scheduled on June 23 to begin work on its bill. Baucus said yesterday he
will release his proposal this week.

    The Senate committees' schedules call for finishing their separate
bills before the week-long Independence Day recess begins June 29, and
merging the proposals upon their return. Democratic leaders plan for the
Senate to take up a measure sometime soon after the recess, although
debate hasn't been set.

    The packed schedule will be a particular challenge for the slower,
more deliberate Senate. Democrats, who control 59 votes, must be able to
secure the backing of 60 senators to overcome the possibility of a
filibuster. The fast pace also may be an asset, said Senate historian
Donald Ritchie.

    "Sometimes there's an advantage in setting a short schedule,"
Ritchie said. "That gets people responding to the bill, it's easier to
schedule votes, people are more willing to cut a deal and compromise.
Leadership around here often gets their best work done here before a
recess when everyone has a plane ticket in their pocket."

    House Action

    In the Democratic-controlled House, three committees working on the
same legislation plan to release a detailed draft outline later this
week. Representative Charles Rangel of New York, chairman of the House
Ways and Means Committee, said his panel may release an outline of
health policy changes first, followed days later with the details of the
necessary tax increases and spending cuts.

    Rangel said he wants the more popular aspects of the health-care
overhaul, such as expanding coverage to the uninsured, before spelling
out the way to pay for the changes that will cause "heartburn" for many
lawmakers.

    Employer Benefits

    One issue is taxing employer-provided health benefits, which Obama
opposed during his presidential campaign. In an interview yesterday with
Bloomberg News, Obama said he wouldn't rule out such a proposal.

    "I don't want to predetermine the best way to do this," he said.
"I've already put forward what I think is the best way. Let me see what
comes out of the Hill and we'll have that debate then."

    Rangel's panel and the other two House committees - Energy and
Commerce and Education and Labor - may hold hearings next week before
the July break, said Nadeam Elshami, a spokesman for House Speaker Nancy
Pelosi.

    All three panels would then work to approve the legislation in July
and the full House would take it up by month's end.

    The Democratic leadership in both chambers plan to use the summer
recess and early fall to put together one package that can pass the
Senate and House and go to the president.

    "The president wants a bill by Oct. 15," Baucus said in an interview
yesterday. "He'll get it."

t r u t h o u t | Biggest Shift in US Health Care May Emerge in 45-Day
Sprint (18 June 2009)

http://www.truthout.org/061709HA