Tag Archives: President Obama

Health Reform ? hurray

This week will long be remembered as a momentous time in American health policy and politics.

President Obama signed the landmark health reform legislation and the Senate seems poised to complete the complicated process with passage of a reconciliation bill making a number of changes in the earlier law.

I have long worked for far-reaching overhaul of how we finance and deliver health care in America, and I celebrate this major accomplishment.

We are all hearing several narratives from different quarters ? that predictably conflict:

After decades of trying ? by Democrats and Republicans, far-reaching health reform has passed into law.

This is a major victory for a more compassionate and communitarian society.

President Obama and his party can be proud of their leadership on achieving this.
This legislation gives the federal government a significantly greater role in directing the American health care system.

Republicans will campaign against a government takeover of health care, and they could see major electoral gains this fall and in 2012.

Will it work?

Can we afford it?

Each of us will choose which of those and other narratives to emphasize.

I am very glad it passed, even with its flaws and other consequences that we don't yet know about.

On the whole ? we badly have needed to cover the uninsured ? and this legislation, when implemented, will do that in a big way. The fact that not everyone will be covered is surely true ? but this is a major step in the right direction.

As the head of a major public safety net institution, I am very concerned about the proposed cuts in Medicare. I have to believe, and I do, that these will not occur ? to anything like the extent promised ? because of the predictable push-back of seniors and health providers.

So what that means is this will add hugely to the federal budget deficit ? not a happy prospect, to be sure.

I continue to believe that our nation must press ahead with additional health system reform, that delivers quality care at much lower costs. We can do that ? but it will stretch us like nothing we have ever done before. Just like this process has challenged our political system.

Here at UNC we are dedicated to reform, and we are determined to be a leader ? creating a new model for organizing and delivering care.

So … Health reform has passed … With much more to come! I believe we will be arguing about all of this for months ? indeed for years to come.

Stay tuned!

Unexpected turn in health reform

Health care reform just took a dramatic and unexpected turn.

Only a few weeks ago it seemed that the Congress was about to complete action on a fundamental overhaul of health care financing and delivery in America, and send this legislation to President Obama, so that he could sign and complete his top domestic policy priority before his first State of the Union Address.

But . the special election in Massachusetts, to fill the seat held for decades by Senator Edward Kennedy – astounded the nation and upended the plans for health reform. Scott Brown was elected – the first Republican to hold this seat since 1952!

This surprising election had many ramifications – but two were uppermost – the Senate Democrats now number 59, no longer can they end a filibuster and have their way; and elected officials around the country, especially Democratic House and Senate members, were asking themselves if they should back away from health reform, lest they suffer the same fate.

For a few days, there were several creative scenarios debated – ways for the Congress still to get health reform done quickly. However, now it seems that has quieted down, and it looks like this will be dragged out much longer.

Will we ultimately see big time health reform this year? I wish I were more optimistic – but I think the chances are now much less than 50-50. As I have repeatedly said – in this blog and elsewhere – we badly need to overhaul how we pay for and deliver health care, so that we cover the uninsured, do so at lower cost and with consistent quality and safety.

It is more likely now that we will see some more modest reform of health insurance, some expansion of Medicaid, and the launch of some demonstration projects for delivery reform. Those are not insignificant – we need to do them, but the disappointment is palpable. What could have been was much more.

My short-term prediction is that health reform will go quiet for several weeks – as the congressional leaders try to work out a smaller package behind the scenes. They will bring it forward only if and when they have it worked out and they are confident that they can get it done.

Once again – stay tuned. Maybe much longer.

Senate Finance Committee Chair unveils his plan

Last week, President Obama spoke to a joint session of Congress about health reform, and polling afterwards has shown an upturn in support for him and for his recommendations for overhauling health care in America.

Today, Senator Max Baucus, the chair of the Senate Finance Committee, unveiled his long-awaited proposal. I continue to believe the SFC will be the main focus of congressional action on this very important issue. Click here to download a pdf version of the proposal.

The Baucus plan is still being analyzed by all the pundits and policy wonks I plan to write soon about its details. But based on the summary I've read, I like it. I believe it is a serious effort to deal with the big issues we face in an honest fashion.

Our concerns about the cost of care, the lack of access due to uninsurance and the quality and safety of health care in America are very real and they deserve to be faced and dealt with in a comprehensive fashion. The American people know that a lot is up for grabs, and they want this done right.

On September 17th, I will be part of a press conference at the National Press Club in Washington, DC. Several of us will be speaking on behalf of a much larger group of people who have worked on these issues for a long time researchers, clinicians and other leaders. This group from across the ideological spectrum is urging the Congress and the President to work together to make the most of this opportunity to put right some basic problems in our health care system.

Here is a link to the letter and a partial list of those of us who have signed it: http://www.healthreformusa.com/petition/index.php

Also, the leaders of the four medical schools and academic medical centers in North Carolina have come together to put forward our recommendations on health reform. Drs. Victor Dzau from Duke, Paul Cunningham from ECU, John McConnell from Wake Forest and I wrote a letter, which we sent last week to Senator Kay Hagan and Senator Richard Burr.

We believe that the academic medical perspective on health reform is important to the national effort but it is especially important in North Carolina, given our major role in research, teaching the future health workforce, and caring for so many of our most vulnerable citizens. We will be working together to articulate these issues and concerns over the coming weeks.

This major national debate is now at full stage but it will go on for a while yet. In football terms, I'd say we are mid-way through the third quarter now.

Stay tuned much more to come.

National Health Reform the main event

The decibel level of the Washington health reform debate is going up rapidly.

President Obama has put health reform at the top of his domestic agenda, right next to saving and strengthening the economy.

The challenge is how to deal with the main problem faced by most Americans the staggering cost of health care, while at the same time dealing with covering the uninsured and our quality / safety concern.

Two ideas that have often been raised — but just as often said to be out of bounds are front and center in the debate now.

They are (1) setting a limit on the amount of health care benefits that can be received tax-free, and (2) mandating that everyone have health insurance (and subsidizing the cost of health insurance for those who cannot afford it).

The tax cap (or taxing excessive health benefits, if you want to call it that) will force people toward more cost-effective health insurance plans, and will raise tax revenue that can pay for the subsidies for those who need them.

Mandating that everyone have health insurance (with subsidies for those who cannot pay themselves) is the surest way to make certain that everyone (or almost everyone) has coverage.

I have long been in favor of both of these ideas and they seem to be supported by growing numbers in Congress.

The next few weeks / months will be filled with rhetoric and passion. Let's get on with it.