Healtcare Reform- Now or Never?

Indeed it does seem that change is imminent.
In order to have something in place before the next election cycle we may see a 3rd government run program slipped inbetween Medicaid and Medicare. This is the administration's opportunity to introduce a program that will eventually displace most private insurance for healthcare. Initially people will have a choice- but eventually few employers will want to pay for a more expensive, although responsive, private insurance plan. Fundamentally a 3rd program is the only way to actually dictate healthcare costs from the government's perspective. One can incentivize, cajole, extract promises, seek greater efficiency, but in the end if it is in the hands of private companies to set fees and approve procedures, the government does not control those costs. Obama also wants a legacy to his presidency he can point to and say 'I did this'. Just expanding private coverage does not provide that capstone. Look at the Massachusetts model: no one really got 'credit' for the program, it's still having problems, it's working but expensive. A 3rd government program can be implemented immediately,likely through CMS, and will result in additional hires to address unemployment- another one of Obama's associated promises. Private insurance cannot be relied upon to hire immediately. All the effort getting input from the stakeholders may ultimately just be a screen for implementing such a 3rd program. Obama has the votes in congress, he has Ted Kennedy to rally the country- I'm sure his team sees this as 'now or never'. We will see..

Obama moving quickly on health care?

President-Elect Obama has proposed significant changes to the U.S. health care system. Senator Baucus recently unveiled a 104 page health care reform plan. Aspects of the Baucus plan are strikingly similar to the Obama health care reform proposals. Some pundits have suggested that the Baucus plan may encourage an Obama Administration to move quickly on a comprehensive health care reform agenda and avoid some of the missteps that extinguished the Clinton Administration’s reform efforts.

However, a deteriorating economic climate may hamper or slow any comprehensive health care reform efforts. In fact, the economic climate may require that an Obama Administration initially concentrate on incremental change rather than sweeping reforms. Whether reform efforts are incremental or sweeping, it is likely that the State Children’s Health Insurance Program, Medicare sustainable growth rate formula, health information technology, and payments to Medicare Advantage plans will be among the early agenda items.

Michael Apolskis JD
Michael G Apolskis PC, Health Care Law, Chicago Area

Obama playing ball with Healthcare?

Whether reveling in victory or agonizing in defeat, if you thought we'd have a hiatus between now and the inauguration you've likely come to your senses. Obama will be pursued like no other president-elect before to provide immediate policy for our multiple problems, particularly the economy. In addition to a lame duck, we now have a duckling. As Reid and Pelosi dip their toes reluctantly into the economic mess, a bailout seems in the works for the auto makers. But the question is whether Paulson/ Bush will support one, and more specifically one that Obama - through Reid and Pelosi- may tie to developing vehicles with greater fuel efficiency and reducing layoffs. Outcome based bailouts? Obama is smart enough to use the immediate crisis in this industry to drive forth programs that fit his strategic environmental and social agendas, particularly with Bush feeling legacy pressure.

What might this mean for Healthcare? Although we are seeing health insurance demand greater accountability and experimenting at the margins with patient results, it is still a system that primarily rewards visits and procedures rather than outcomes. Some have said healthcare reform will take a backseat to the economy. But I suspect within the first several weeks of the new Obama administration he will move forward with a program for universal healthcare- even offering it as a means of creating jobs and helping a struggling economy. But will he provide a blank check to the existing structure by enrolling millions of uninsured-one way or the other- into what many believe is an increasingly expensive, broken system? Or will Obama leverage the economic crisis and demand for universal healthcare to create a path for substantial change in the delivery of care and payment methodology. Watch the auto industry for clues as to how sharp his elbows will be on the Healthcare court.
Doctor Steve