Health Reform: Back to the Future

No one thought health reform would just go away after Massachusetts released “Guess Who’s Coming to Dinner” starring Scott Brown, but the Bay state’s stunning decision to let an unknown Republican fill the shoes of Ted Kennedy was a haymaker so big, it knocked the lights out of the process for 5 full weeks.

It was a refreshing break indeed, but now health reform is back. Right where it left off, it turns out.

OK, it’s different in that President Obama released a complete plan of his own this Monday. That’s something he’d not done before, even though he admits health care is Numero Uno on his domestic agenda.

But the President’s plan looks a lot like the bill passed by the Senate last December. It has no Public Option. It extends coverage to 25 million uninsured Americans using subsidies and an expansion of Medicare and Medicaid. It costs about the same as the Senate Plan ($950 billion), and it eliminates the most egregious practices of the private insurers (A comparison of the President’s bill and the Senate bill appears here).

So after tomorrow’s Health Summit, Congress will be dealing with more or less the same bill that many House Democrats abhor and that squeaked through the Senate on a razor-thin margin that no longer exists, thank you Scott Brown.

So what will happen next? Well, the Republicans think they have won the public argument (that is, they have backing of the centrists, the swing-voters): Obama’s plan is government-run health care…end of discussion. So they’re going to stand pat.

"There is no negotiation when it comes to either the House or the Senate bill," Eric Cantor, the second-ranking House Republican told the Washington Post. In fact, he said, "I don't look at (tomorrow’s Summit) as negotiation. I look at this to see if the president wants to come clean and start over."

Republicans know it’s not politically viable for either party to “start over”—there is a country that needs to be run after all. But given the hand they have to play, they will be content to stand back and watch the Dems do a very bad thing…whatever it turns out to be. They win the game, according to their calculations, in November.

Meanwhile the Democrats believe they’ve made considerable concessions already (bagging the Public Option and the surtax on high-income Americans to pay for expanded coverage) and that has led to exactly zero Republican support, let alone a willingness to negotiate. And they believe voters would be seriously POed if they didn’t at least try and run a play to get the ball into the end zone. It is, after all, on the one.

So for Democrats, it’s, “either we do this ourselves or it’s not getting done.”

Now, given the Scott Brown calculus this all comes down to the Dems trying to pass health reform using a parliamentary mechanism known as reconciliation, in which a simple majority of 51 Senators can do the deed. The biggest hurdle to this scheme is in the House, where Speaker Pelosi has to figure out how to get enough votes for the Senate bill despite its abortion language, which many find abhorrent.

Oh and if they can paste the Republicans for being the “party of no” or coax them into producing a detailed plan of their own that they can shred to bits, so much the better.

"The question is, does policy matter or has this become completely political?" said John Rother, AARP's executive vice president for policy and strategy.

We know the answer to that one.

Glenn Laffel, MD, PhD
Sr. VP Clinical Affairs, Practice Fusion