Wednesday, December 09, 2009

Personal thoughts on DC's latest

Just want to share a few thoughts with you ......

First - Take a deep breath.

Next - Remember the reason that health reform is being debated. The present system is NOT SUSTAINABLE. The status quo is not an option because the status quo cannot continue unchanged. The most generous optimists project that government sponsored health programs will be completely depleted by 2017.

As for what is going on in D.C., here are the latest options being discussed, along with my personal (editorial) comments:

1.) Include persons between 55 and 64 in the Medicare program.

Does this include everyone between the ages of 55 and 64, or just those who cannot obtain employer-sponsored coverage?

Does this mean that reimbursement will be at Medicare rates or at another rate?

2.) Private insurers would be required to spend 90% of premiums on clinical services and programs to improve care.

The obvious answer to this for insurers is to increase premiums so that the bottom line remains the same.

3.) The Office of Personnel Management, which currently oversees health policies for federal employees, would manage a new system of national health plans available in every state to people who do not receive coverage through their employer.

Absent from this discussion is the personal mandate. As I see it, there is no way increase the risk pool. In addition, there would need to be a considerable ramp-up of the OPM.

4.) The Office of Personnel Management would be empowered to negotiate rates with insurers.

OK. This is better than the House bill? This "renames" the public option and puts it squarely in the Executive sector, beyond the control of the Legislative Branch. Hmmmm..

5.) Buried in there somewhere is a "trigger" for the public option.

I am unable to verify the existence of this "trigger," so will refrain from comment.

This is a piecemeal approach to a public option, and much like Frankenstein, may exceed the expectations of the creators.

Lastly - What happens next is that CBO will have to score the various options. (Insiders say that several different combinations were sent for scoring.) That may take a week. In the meantime, Reid is looking for cloture on the manager's amendment, which includes compromises he has worked on for the past 10 days. Other cloture votes will be required subsequently. More concerning to me than all the above is the rumor that if the Senate is unable to reach an agreement by the end of the year, the Democrats would push for bypassing a conference bill and call for a direct endorsement of the House bill.

Just a few thoughts to help you sleep tonight,
Angela (Angela F. Gardner, MD, FACEP)

PS Discussions continue on an amendment that would allow direct importation of drugs from countries approved by the FDA. Obviously Pharma opposes.......but the savings could be immense.

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