Reassessing Reform: No Need to Rush in Revamping Healthcare

I wrote on this blog a while ago that I viewed the glass half full when it came to healthcare reform. I thought we might actually accomplish health reform by this fall. Well, it’s now late July, and I unfortunately have changed that outlook. A friend of mine told me she was surprised by my earlier optimism, and I guess she was right. Here are four key reasons why the prospects have dimmed:

  1. Controversy over a public health insurance plan. There are several reform plans floating around Washington, D.C., but every version includes some form of a public insurance plan. The theory is that a public plan would provide another insurance option for those lacking insurance, and since it wouldn’t need to generate large profits, its medical loss ratios (a fancy way of saying how much of every dollar is spent on medical care versus overhead) would be controlled and it would have low overhead like Medicare. Insurance companies, worried about the competition, have targeted this as their number one priority to fight. Organized labor, however, wants the option. My national organization, the American Hospital Association, prefers the Senate Finance Committee’s version of the public plan, which is organized in a co-op fashion and would allow providers to negotiate rates with the co-op. But in any event, you have a clash of titans on this issue with the insurance industry versus labor.

  2. The cost of healthcare reform. The President has indicated he will not sign a bill unless it is budget neutral. However, the well-respected (and nonpartisan) Congressional Budget Office came out about two weeks ago and pointed out that the bills it has been able to “score” (a Washington term for figuring out the cost of the legislation) actually cost more money. Which leads us to item 3…

  3. The “Blue Dog” fight. The “Blue Dog Coalition” of the House of Representatives is made up of approximately 51 fiscally conservative Congress members. Although the Democrats control both houses of Congress, the Blue Dogs are a necessary part of that majority. The CBO determination of a couple weeks ago has made the Blue Dogs question the efforts in Congress, and they are fighting hard to cut more costs in the reform bills.

  4. Medicaid expansions. Earlier drafts of the various reform bills called for Medicaid expansions. Medicaid is a program for low-income people which is jointly funded by the federal government and state governments. In New Jersey, the cost is shared 50-50. So, no surprise, the nation’s governors have raised alarms about this element, pointing out that they too have very serious budget deficits to deal with and cannot take on the added expense of Medicaid expansion.

So some serious fault lines are emerging. The President is using his bully pulpit every day to talk up the importance of healthcare reform to the American people. His goal was to have bills passed through both the Senate and the House before the August recess, but it appears that at least one of the houses won’t make that deadline. I think a great deal will be determined by what happens when members of Congress take their August recess and go home to talk to their constituents about what they think of national healthcare reform. The New Jersey delegation has done a good job of reaching out to people, holding town hall forums around the state.

I’m not sure where my glass stands right now – half full or half empty. I still ardently hope that we can achieve national healthcare reform, but we need to get it right and not rush for the sake of rushing. Far too much is at stake for New Jersey’s healthcare system and the people who depend on it.

Written by Betsy Ryan at 14:41

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tracey dorrity said...
Hi. I'm a NJ resident. In this debate, I don't know why more issue is raised against the Insurance industry. The DEATH PANEL does exist and I'm facing it. In 2008, my son was diagnosed with Chronic Myeloid Leukemia. That's a rare blood cancer that effects mostly people aged 67+ (my son is 11 now.) It is not genetic or hereditary, but a fluke translocation of 2 chromosomes. Miraculous targeted gene therapy is now available. Scientists are beginning to look at CML as a "chronic" disease to be treated like diabetes. In other words, my son can live a normal, productive life with the meds and some bloodwork. Without a lifetime supply of medicine, the CML will take over and my son will die within 2 years.
NOW FOR THE PROBLEM: I pay very high premiums for excellent insurance. My son's meds cost $6000 per month retail. For the time being, he requires monthly, quarterly and annual testing and bloodwork (it will become less over time.) I know that my insurance company is tabulating and calculating every penny expended on my son. One day, a few years from now, the insurance company's DEATH PANEL will send me a letter that says: "Your son has reached his lifetime maximum benefit. He will not receive any further insurance coverage." Even now, I'm nervous when I receive statements from my insurance company.
I've visited my republican congressman's office and, not surprisingly, no one knew what a lifetime maximum benefit was. Nobody thinks about it. Well, I never thought of my son having a rare pediatric cancer either. As it's said, But for the Grace of God Go I. It can happen to anyone and everyone.
We must stop the insurance companies from having the ability to kill.
That's my more than 2 cents worth...
August 13, 2009 09:41
Betsy Clarke said...
Dear Tracey:

I appreciate your response to my Healthcare Matters blog. I was touched by your situation, and I have my staff checking to see if there are prescription assistance programs or other services that could help you.

You raise an excellent point about the responsibilities of insurance companies when it comes to healthcare reform. I believe healthcare reform is desperately needed and I’m frustrated that the discussion has gone so far off track. The current system really is unsustainable – for hospitals and others who provide the care, for our government, and most importantly, for people like you who face crushing costs and other pressures from their insurance companies.

Of course, no one industry is to blame for this broken system, but everyone must share in designing a better system for the future. So far, we’ve seen hospitals, physicians and pharmaceutical companies offer financial concessions to achieve healthcare reform, but not much from the insurance industry. There just doesn’t seem to be the political will to take on this interest group.

I’m impressed that you’ve raised your concerns with your congressman, and I encourage you to continue speaking out. I too will use your story in conversations with elected officials to make them more aware of the very real issues facing families in New Jersey and the rest of the country.

My sincere best wishes to you and your son,

Betsy Ryan
August 17, 2009 11:51