Two health-policy wonks weigh in on Obama speech

Republicans holding up health care proposals
Republicans hold copies of their health-care proposals as President Obama addresses a joint session of Congress Wednesday.

Who better to ask for reaction to President Obama’s speech to Congress on Wednesday than two of my favorite health policy wonks?

I find myself frequently turning to researcher Lynn Blewett and health economist Steve Parente for their insights on any number of issues in health-care reform and policy. Both have drawn state and national attention for their research.

Blewett is director of the State Health Access Data Assistance Center (SHADAC) in the University of Minnesota’s School of Public Health. Blewett, an associate professor, and the center calculate uninsured rates for states and advise them on health policy. She recently has analyzed federal health reform for Minnesota state legislators and policymakers. The center also recently developed the consumer health confidence index for the Robert Wood Johnson Foundation, which funds SHADAC.

Parente has testified on Capitol Hill this year during the health-care reform debate and has crunched numbers for compromise reform plans from some Republicans and Blue Dog Democrats. He is director of the Medical Industry Leadership Institute in the Carlson School of Management at the University of Minnesota. Parente, an associate professor of finance who earned his Ph.D. at Johns Hopkins University, also was a volunteer health-finance adviser to John McCain’s presidential campaign in 2008.

Blewett says “the devil is still clearly in the details and whether the Republicans are going to play or pay.” And Parente thinks that if existing bills can’t garner the support, new bills are “likely already being crafted as a life raft for the administration and GOP.”

I asked them to write up their thoughts for MinnPost and they graciously obliged.

‘The devil is still clearly in the details’

By Lynn A. Blewett, Ph.D.
Many of us outside the beltway were waiting to see what strategy the president would take after the August recess. Specifically, would he drop the controversial public plan?

He did not. Yet he did open the window for possible variation. For example, the public plan option might only be offered in areas where there wasn’t an affordable choice of health insurance or where only one private plan was offered. He also mentioned that the public plan option could be a nonprofit co-op plan in certain areas.

Lynn Blewett
Lynn Blewett

He endorsed the individual mandate — all individuals would be required to have insurance — and the employer pay-or-play provisions — employers either pay for coverage for employees or pay into a fund to provide subsidized coverage.

He did give a few bones to the Republicans: first, the endorsement of high risk pools to be used in the four years needed to get the insurance exchange started, an idea included in Sen. John McCain’s presidential campaign. He also endorsed immediate development of state-level demonstrations to test malpractice reform, another key Republican issue.

The cost of the proposal got down to $900 billion, which made me skeptical about achieving universal coverage.

Finally, he appealed to the character of the Republican leadership to get to the table — citing the late Sen. Ted Kennedy’s successful bipartisan legislation with Sens. Charles Grassley, R-Iowa; Orrin Hatch, R-Utah; and McCain, R-Ariz. Will it work? President Obama is determined to pass a bill but the devil is still clearly in the details and whether the Republicans are going to play or pay.

A new bipartisan Plan C could be ‘life raft’

By Stephen T. Parente, Ph.D.
It was a fine speech rhetorically. The president appeared to embrace a version of the Sen. Max Baucus plan with an individual mandate, which was originally Sen. Ted Kennedy’s plan in 2008 — for those keeping score. Invoking Kennedy was intended to remind Republican senators who worked with him in the past to honor his memory and perhaps guilt those opposed into passing the bill as the president proposed it. As the cameras passed over Sens. Orrin Hatch, John McCain and Charles Grassley, it was not clear they were convinced.

Stephen Parente
Stephen Parente

The source of payment for the estimated $900 billion price tag was attributed to cost savings from reducing Medicare and Medicaid fraud and abuse. While such efforts are long overdue, the president did not mention why those savings were not being used to pay for the soon-to-be-bankrupt Medicare program. The president’s conviction to protect Medicare would be better demonstrated if he appointed an administrator for the program.  No administration has left a federal program responsible for nearly a trillion dollars in expenditures without leadership for such a long period of time.  

Polling data on health reform five days from now has to show a major change in direction of public acceptance for conservative Democrats to believe the clock has been reset. If not, the bills passed in committees in the House and Senate (Plan A) will be likely abandoned. The Baucus bill (Plan B) faces opposition if no Republicans end up signing on beyond the three who helped craft the bipartisan solution. That leaves an opportunity for a Plan C to achieve the president’s and GOP’s aims for about half the cost. Such bills are likely already being crafted as a life raft for the administration and GOP. Neither side wants to face the midterm elections with complete failure.

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Comments (1)

  1. Submitted by Tim Nelson on 09/10/2009 - 09:57 am.

    Lets assume the bill goes through.

    The following changes:

    1) Pre-existing conditions, okay.
    2) Can’t drop coverage.

    The following doesn’t:

    1) Percent covered.
    2) Pay in before coverage.

    Your new insurance will cover 5% of the total, but only after you spend the first $100,000.

    Welcome to useless insurance coverage. Lets make sure everyone signs up.

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