Health Care

The state of the current economy is the environment in which the healthcare debate is being conducted.

The average American is "expert" on three broad policy areas: the economy, the healthcare system, and the education system, if he or she has, or is responsible for, school-aged children. On each of these subjects, the average American does not rely on professional policy experts or elected leaders, whether national or local. They rely on their own experience and knowledge, and that of their neighbors.

If a person's employment hours are being cut; if their next door neighbor is out of a job; if houses in their neighborhood are being foreclosed; then the pronouncements from "noted economists," the Federal Reserve, or even the President, stating the recession is over or that the economy is improving are not heard; or if heard, are not believed.

The same is true of healthcare. If your health insurance does not cover certain things or a favorite doctor stops taking insurance or medicare, or drug prescriptions can't regularly be filled because they are too expensive for the patient's circumstances, then that is the basis on which they judge the healthcare system.

So as the healthcare debate goes forward, the public's concerns about other insecurities in their lives has considerable impact on their reaction to the healthcare debate.

---

To further complicate the situation, Americans are saying enough is enough. For the last year and a half, if not longer, they have been besieged with the message that this problem, along with others, has to be fixed or "the world as we know it will come to an end." There were stimulus bills, "bailouts," and even the next ice age is just around the corner. They have been told for years that debt is bad, and yet it grows and grows and grows. They know that ultimately the money has to come from them or their children or their children's children.

---

The Government's efforts to change the current healthcare system has a "commander-in-chief, the President. It has a "chairman of the joint chiefs", the White House Chief of Staff. However, it does not have a "commanding general" to lead the effort. This lack of an Administration leader focused solely on this issue has complicated the health care debate.

The loss of Tom Daschle as the Secretary of HHS and White House healthcare czar has had an immeasurable impact on the Administration's efforts. While the Secretary of HHS, Kathleen Sebelius, and the White House health czar are people of quality and experience, they do not bring to the effort what Tom Daschle would have brought to the table.

---

Congressional townhall meetings across the country are experiencing record crowds. Is it all about the healthcare bill and are they affecting public opinion generally?

Anecdotally, the majority of people showing up at these events are not part of protesting crowds or groups organized to disrupt. Rather, these are folks who have real concerns about a variety of issues that are currently being dealt with in Washington.

A recent survey by Gallup (8/09) asked whether the protestors made folks more or less sympathetic to their views. It was a split decision. 34% said they were more sympathetic while 21% are less sympathetic. The rest say they are not affected.

---

In February 2009 86% said that the economy was the most important problem facing the country. 13 months earlier, January 2008, 38% held that view. During the same time period, the number mentioning healthcare had dropped from 13% to about 10%. Today, 60% name the economy, while 25% say healthcare. [Gallup 8/09]

---

There are a variety of theories about how the President and the Democratic majorities in the House and Senate might be able to pass a substantial healthcare reform bill without Republican support.

A default position that is regularly discussed is the use of the reconciliation process. The advantage of this course is that it is not subject to a filibuster and can pass the Senate with 51 votes.

While passage of the legislation under the reconciliation process places some limits on the content of the bill, it appears that enough could be included to make it a significant accomplishment.

It is assumed that Speaker Pelosi will be able to muster the votes to pass in the House anything that will clear the Senate.

By all accounts, the Budget Reconciliation Process has never been used for anything of the scope of proposed healthcare legislation. Its uses have ranged from the Tax Equity and Fiscal Responbsility Act of 1982 to the College Cost Reduction and Access Act of 2007.

Some suggest that Republicans in the Senate would be infuriated and would look for ways to retaliate procedurally. They could attempt to slow things down generally or hold up judges. But that is likely to be a short-term problem. At some stage the Republicans are likely to try and slow things down anyway as we get closer to the 2010 elections.

The fact is that the Reconciliation Process has been a regular part of Senate procedures since it was established by the Congressional Budget Act of 1974. It was used for the first time in 1980 to deal with the Omnibus Reconciliation Act of 1980. It has been used 22 times so far...14 times when Republicans controlled the White House and 8 times when Democrats were in control of the White House. Reconciliation bills have been vetoed 3 times, all by President Clinton.

---

The following is a summary of a small part of the vast amount of survey research that has been published relating to the proposed healthcare legislation.

• While the number of people who think Obama's healthcare plan is a good idea has risen slightly from 33% in April to 36% in August, the number who think it is a bad idea has risen from 26% to 42%.


• The number of people who think Obama's plan will result in the quality of healthcare getting better has risen only slightly from April to August from 22% to 24%. The number who think quality will get worse has risen from 24% to 40%.


• 58% believe the government would do a bad job if given responsibility of implementing or running the healthcare system. 32% think the government would do a good job.


• 59% believe that the proposed healthcare legislation will not benefit them personally. 31% say it will.


• 55% think it is the responsibility of the Federal Government to guarantee health insurance for all Americans. 38% do not.


• 60%+ of Americans think it is a good idea to raise income taxes on households and businesses that make more than $250,000 per year, and use the additional tax revenues to provide health insurance for the uninsured.


• Folks are split about evenly on whether it is possible to provide healthcare coverage for most Americans without increasing the budget deficit.


• 51% of respondents say they do not have a good understanding of the issues involved in the healthcare debate. 66% believe that the Members of Congress don't have a good understanding of the issues.


• 43% of those 65 and older think the changes will reduce access to healthcare. This view is shared by only 26% of those 18-49 years of age.


• 53% of those 18-49 think the changes will expand access to health care, a view shared by only 24% of 65+ folks.


• This is what Americans think about the healthcare legislation:


• 62% - will raise their healthcare costs


• 56% - less freedom to choose doctors and coverage


• 65% - make everything more complicated


• When it comes to who people would rather have make healthcare coverage and treatment decisions, 40% select insurance companies and 40% choose the government.

[The surveys from which the above items are taken include NBC/WSJ, NYT/CBS, Quinnipiac, Gallup, Time, CNN]

---

The number of medical students studying to be primary care doctors dropped by near 52% since 1997. There will likely be a shortage of 40,000 family physicians by 2020. [USAToday 8/09]

A Weill Cornell Medical College study found that "a third of the money received by primary care physicians pays for interactions between a doctor's practice and patients’ health plans." [NYT 6/09]

---

The number of medical students studying to be primary care doctors dropped by near 52% since 1997. There will likely be a shortage of 40,000 family physicians by 2020. [USAToday 8/09]

A Weill Cornell Medical College study found that "a third of the money received by primary care physicians pays for interactions between a doctor's practice and patients’ health plans." [NYT 6/09]

---

The following is some demographic data that may be of interest.

---

The following commentary by your editor was published in the Washington Post on August 30, 2009, as one of a number of comments in response to the following question.

"With polls showing that President Obama is losing ground. What could he do to regain the initiative?"

First, the President should not over-read or over-rely on polls. To get some perspective, check out the August 26 piece by Jeremy Rosner of Greenberg, Quinlan, Rosner Research entitled "A pollster's advice, Don't trust the polls on health reform's demise."

Second, Obama should show that he understands that people are being asked to accept changes in the health-care system while they are in the throes of actual or potential

crisis in their personal financial "systems." And that he has heard the concerns raised by affected Americans nationwide. While the media attention to various town halls was in the best tradition of "if it bleeds it leads," most of the people who came out did so out of a real need and interest to learn more about health-care system proposals.

Third, invite House Speaker Nancy Pelosi and Majority Leader Harry Reid to a meeting, just the three of them, and work through with them a plan for going forward. Work "with" the Congressional leadership to come up with a single bill that represents the doable, sans the wish list of every idea for changing health-care that has been suggested in the past several decades. And get to that bill before the process kind of stumbles on to it.

Finally, choose a dramatic forum, perhaps a joint session of Congress, to lay out a bill that includes core changes but reflects having heard what is bothering the people he was elected to lead.

Return to Home Page