by Brian Klepper and David C. KibbeSix months ago, who could have imagined that a large percentage of rank-and-file Americans would support the Occupy Wall Street (OWS) against special interests’ rigging of the American dream? So why not go to the next step? Why not pointedly ask political candidates, “Will you take money from lobbyists?” and “If elected, what will you do to stop special interest
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Paul Ryan and Ron Wyden Blow the Medicare Reform Debate Wide Open!
House Budget Chair Paul Ryan (R-WI) and Senator Ron Wyden (D-OR) have embraced a Medicare reform plan that in concept borrows heavily from one championed by former New Mexico Senator Pete Domenici and former Clinton budget chief Alice Rivlin.Specifically, Wyden and Ryan are proposing to alter the earlier Ryan Medicare plan by:Continuing to offer the traditional Medicare plan—Ryan would have
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The Super Committee Failure—What’s Next?
The stock market today was shocked, simply shocked, that the Super Committee didn’t come up with a debt deal.I don’t know why. Republicans can’t vote for more taxes unless they're willing to get “primaried” from the right and risk losing their seat. Ditto for Democrats who would face the same punishment from their base if they voted to change the sacred defined benefit entitlements without at
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Romney Jumps on the Waiver Bandwagon--And Creates Even More Uncertainty Over the New Health Care Law
Republican presidential frontrunner Mitt Romney has pledged to end “Obamacare.” Upon taking office, he would immediately begin the process by granting the states waivers from having to implement it:“I’ll grant a waiver on Day One to get repeal started. On Day One, granting a waiver for all 50 states doesn’t stop it in its tracks entirely. That’s why I also say we have to repeal Obamacare, and I
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The Ryan Health Care Proposals—Not Your Congressman’s Health Plan
Update: The New Wyden-Ryan Plan - Paul Ryan and Ron Wyden Blow the Medicare Reform Debate Wide Open! In a speech at the Hoover Institution today, Representative Paul Ryan (R-WI) argued again that his proposal to reform Medicare, and now his tax credit proposal for replacing the Democratic health care law for those under-age 65, would guarantee to citizens “options like the ones members of
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The Health Leadership Council Medicare Proposal: Too Much Responsibility on Beneficiaries and Not Enough on Providers
The Health Leadership Council (HLC), a coalition of CEOs from many of the leading health care companies, has created a list of Medicare reform recommendations for the Super Committee tasked with finding at least $1.2 trillion in budget savings.As we begin the national debate over what to do about Medicare's unsustainable costs, I will suggest that the HLC proposal gives us one, of what will have
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The Debt Super Committee—Will We Get a Deal?
It’s back to work in Washington, DC and all the attention is now on the Super Committee and their goal of cutting spending by at least $1.2 trillion over ten years.If the committee fails to come up with a plan that passes the Congress, there would be $1.2 trillion in automatic cuts. The health care special interests have reason to hope they will fail—the fallback cuts would only impact Medicare
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Rethinking the Value of Medical Services
by Brian Klepper and David KibbeOne of American politics’ most disingenuous conceits is that health care must cost what we currently pay. Another is that the only way to make it cost less is to deny care. It has been in industry executives’ financial interests to perpetuate these myths, but most will acknowledge privately that the way we value and pay for medical services is a deep root of
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The Debt Deal: There Will Be Blood on the Floor on November 23rd
The debt deal is finally done. But it really isn’t an agreement on what cuts will be made, just the process that will be used to make them.The real work is left to the Congressional appropriators for the first $917 billion and for a super-committee of Congress for the second $1.2 trillion to $1.5 trillion in ten-year cuts.That second tranche is where health care will make its contribution. The
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We Are Reaping What We Have Sown—The Debt Standoff
On this blog a month ago, I said the politicians were starting to scare me with the apparent eagerness of some to actually take the government to default to make a political point.For weeks we have heard political leaders on both sides tell us there would be no default.But the two sides have so backed themselves into opposite corners that they have left no opportunity to meet in the middle.
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The Awful Dichotomy Between Health Care Politics and Policy
Amy Goldstein has an important article in today’s Washington Post detailing the place Don Berwick, the Medicare and Medicaid administrator, finds himself in.It is all but certain he will have to leave his post at year’s end, when his recess appointment expires, because the Senate will not confirm him for a lack of Republican support.Berwick is one of the most respected health care experts in the
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The Debt Ceiling Debate—Some of These People Are Nuts
I don’t know about you but the politicians are starting to scare me with their inability to make progress in the federal debt limit discussions. Worse, is the apparent eagerness of some to actually take the government to default to make a political point.I know a lot of conservatives say missing the August 2 deadline isn’t a big deal but I think it is.The 2011 deficit is projected to be $1.6
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Inconvenient Facts for Both Republicans and Democrats—Neither Side’s Health Care Proposals Are Supported By Past Performance
I call your attention to Ezra Klein’s column in the Washington Post this morning.In it he cites data that has been out there for a long time but Ezra puts some perspective on it that never occurred to me before.Examining the Kaiser Family Foundation brief, “Health Care Spending in the United States and Selected OECD Countries” he points out, “Our government spends more [as a percentage of GDP] on
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Earth to Republicans: You Are In Big Political Trouble Over the Ryan Medicare Plan
Update: The Wyden-Ryan Medicare Plan - Paul Ryan and Ron Wyden Blow the Medicare Reform Debate Wide Open! It should now be clear to Republicans they are in trouble over the Ryan Medicare plan.Yesterday, they lost a seat in a solid Republican New York House district. Their candidate had benefited from lots of money and House leadership attention. The big issue was the Ryan Medicare plan.All month,
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The Lightweight Romney Health Plan
Mitt Romney has outlined his new health plan. He outlined five key steps in an op-ed in USAToday. Here is a summary:Step 1: Give states the responsibility, flexibility and resources to care for citizens who are poor, uninsured or chronically ill.who are poor, uninsured or chronically ill.Step 2: Reform the tax code to promote the individual ownership of health insurance.Step 3: Focus federal
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Neither the Republicans Nor the Democrats Want to Face the Provider Cost Problem But Both Want to Dump the Problem on the Consumer
A key piece of Paul Ryan’s deficit reduction plan is to change Medicare as we know it. It appears his bold Medicare premium support proposal is failing to gain traction--it is dead as part of any deficit reduction deal this year. Worse, his Medicare proposal looks to be giving Democrats lots of political ammunition for the 2012 elections.What lies at the heart of Ryan’s Medicare difficulties is
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There Aren't Enough Rich People To Pay For Medicare And Medicaid!
I hear more and more of my progressive friends arguing, in the context of deficit reduction, that we should be raising taxes before getting aggressive about reducing the cost of Medicare and Medicaid -- as well as Social Security.To a point, I agree.This country is in such a hole that it is senseless to deny that at least some new taxes will be needed to pay for all of the nation's bailouts and
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The Budget Fight: It Will Be A Long Hot Summer, and Fall, and Winter…
The good news is that Democrats and Republicans are finally seriously engaged over the country’s fiscal crisis.And, each side is presenting a starkly different course for the voters to choose from.When it comes to the health care entitlements, Republicans want to cut the health care entitlement benefits and therefore ease the pressure on federal spending.Obama wants to largely leave the programs
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What It Will Take to Bring America’s Health Care Costs Under Control––We Have to Change the Game
Last week, I posted that I was disappointed in Paul Ryan’s health care budget proposal because it lacked cost containment ideas other than the usual conservative reliance upon the market and defined contribution health care.In my last post, Why ACOs Won’t Work, I argued that the latest health care silver bullet solution, Accountable Care Organizations (ACOs), are just a tool in a big tool box of
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Why ACOs Won’t Work
First, I think Accountable Care Organizations (ACOs) are a great idea. Just like I thought HMOs were a good idea in 1988 and I thought IPAs were a good idea in 1994.The whole notion of making providers accountable for balancing cost, medical necessity, appropriateness of care, and quality just has to be the answer.But here’s the problem with ACOs: They are a tool in a big tool box of care and
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The “Path to Prosperity”—Where’s the Health Care Cost Containment?
Paul Ryan’s overview of his proposed 2012 Budget Resolution contains an honest and compelling description of America’s debt and deficit spending dilemma.Every American should read it.As I read through his discussion of the huge hole we’re in and the imperative to fix it, he had me thinking that we finally have a politician willing and ready to deal with the problem. But when I got to the end of
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So How Are Democrats and Republicans Different?
Just how is the way Wisconsin Republicans have handled the political confrontation over worker rights different than the way Washington, DC Democrats handled last year's health care vote?With apologies in advance to Ezra for taking some liberties with his column yesterday evening in the Washington Post:What happened in Wisconsin [Washington DC] tonight [last March]By Ezra Klein [Bob Laszewski]
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Fixing America's Health Care Reimbursement System
This post is authored by Brian Klepper and first appeared at Kaiser Health News:A tempest is brewing in physician circles over how doctors are paid. But calming it will require more than just the action of physicians. It will demand the attention and influence of businesses and patient advocates who, outside the health industrial complex, bear the brunt of the nation's skyrocketing health care
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The Republicans Had Better Get Organized on Health Care
If the past week is any indication, the Republicans will have real trouble come 2012 trying to convince voters they have a plan to fix the American health care system.Last weekend, President Obama endorsed the Wyden-Brown bill that would give the states the opportunity, in 2014, to take their share of the almost $1 trillion the new health law collects and use it to craft an alternative health
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Defined Contribution Health Care—The Conservatives' Silver Bullet
Conservatives are in a full court press these days telling us the answer to America’s out-of-control health care costs—and our fiscal crisis—is to move Medicare, Medicaid, and the tax code subsidy for private insurance to a defined contribution system.Instead of the federal government defining a benefit and then shouldering the cost of whatever that promise leads to (today’s defined benefit plan)
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Will the Congress Change the Health Care Law During the Next Two Years?
No. But I expect the Patient Protection and Affordability Act to be “relitigated” in 2013, to one degree or another.I recently posted on the controversy over the individual mandate. I suggested a number of alternatives to the mandate—including my own ideas.I was asked if I really thought the Congress would change the individual mandate in the short term.As I have posted before, it will be the
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Alternatives to the Individual Mandate—Some Are A Lot Better Than Others
With Constitutional challenges to the individual mandate now threatening the very life of the new health care law, Republicans aren’t the only ones that would like to see it jettisoned and replaced with something better.And it isn’t just the Constitutional challenges that are prompting a second look. The mandate doesn't work politically and it doesn't maintain the integrity of the market because
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Things Are About to Get Ugly—-Republicans Plan to Defund the Health Bill Next Week
Word is that House Republicans will attach an amendment to the latest federal spending bill that will cut-off funding for the health care bill.The last Congress never finalized a budget for the current fiscal year—the feds have been operating under a series of continuing resolutions. The most recent one will expire on March 4th. If another resolution is not agreed to, much of the government has
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Has the Florida Judge Stopped the New Health Care Law in Its Tracks?
Reading page 75 of today's Florida opinion it sounds like that is his intent:(5) InjunctionThe last issue to be resolved is the plaintiffs’ request for injunctive relief enjoining implementation of the Act, which can be disposed of very quickly.Injunctive relief is an “extraordinary” [Weinberger v. Romero-Barcelo, 456U.S. 305, 312, 102 S. Ct. 1798, 72 L. Ed. 2d 91 (1982)], and “drastic” remedy [
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Now We Have Real Uncertaintly--The Entire Health Law Ruled Unconstitutional!
We all knew the question of the constitutionality over the new health care law was going to be taken up by the Supreme Court.We knew that because the law inexplicably lacked a severability clause a judge could throw the whole thing out if the individual mandate were to be found unconstitutional and critical to the legislation.And, we expected this Florida judge would likely rule against the law
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It Will Be Democratic Senators Leading The Charge To Fix Or Improve The New Health Law
I wrote this Kaiser Op-Ed before today's federal court ruling, that held the entire health care law unconstitutional because of the individual mandate. Now that two federal judges have held the individual mandate unconstitutional, this one overturning the entire law because of it, I have to wonder just how long the Democrats are going to wait before they try to amend the Affordability Act in
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"Quit the RUC"
Brian Klepper and David Kibbe have a notable column at Kaiser Health News arguing that the American Medical Association's Relative Value Scale Update Committee (RUC) is specialist dominated and steers health care resources away from primary care:Not surprisingly, the Committee’s payment recommendations have consistently favored specialists at the expense of primary care physicians. More
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The House Health Care Repeal Vote, the National Debt, and the Imperative for Democrats and Republicans to Compromise
This week's House health care repeal vote is little more than a political stunt--everyone knows the effort will die in the Senate.But, when the day is done the only way for the Republicans to do anything with the new health law will be to work out a compromise—repeal before the 2012 elections is impossible and it isn’t very likely after the 2012 elections. Even if the Republicans sweep the
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Strong Evidence A Bipartisan Agreement on Health Care Was Possible in 2009
Readers of this blog have often heard me say that a bipartisan agreement on a health care bill was possible in 2009--driven from the Senate Finance Committee. I have continually made the point that the two sides were much closer than is commonly believed--or partisans are willing to concede.Every time I post this, the overwhelming reaction is that I am wrong--with one side inevitably blaming the
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Karl Rove’s Criticism of AARP Was a Cheap Shot and Uninformed
Readers of this blog know that I am willing to call AARP out when I think they deserve it. Witness my recent post criticizing their reaction to the chairs of the Deficit Commission and their preliminary report when AARP acted more like a narrow minded advocate than an enlightened organization that understands the inevitability of fundamental reform to the entitlements.And, I have never been
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Improving The Health Law In 2011: Realistic Ways To Reach Bipartisan Compromise
This post originally appeared at Kaiser Health News.The new health care law can be changed in ways that would make it acceptable to a bipartisan majority in the new Congress -- and, therefore, to the American people. But to find this elusive middle ground requires consideration of the competing philosophies at the heart of the nation's political divisions regarding this sweeping measure.For
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