Health Politics

Would you pay $4,000 for a knee brace, shoulder brace, and a heating pad? Would you pay for physical therapy for an imaginary person? How about two knee braces for a patient with only one leg? Probably not -- which is exactly why federal prosecutors are cracking down on fraud and abuse in Medicare and Medicaid.

How much of health care spending consists of fraud and abuse? And what can we do to stop it? These questions were the focus of a Senate Judiciary Committee hearing, "Effective Strategies for Preventing Health Care Fraud."

Deputy HHS Secretary Bill Corr and Assistant Attorney General Tony West testified about their departments' joint task force on health care fraud. The National Health Care Anti-Fraud Association estimates that fraud makes up about three percent of total health care expenditures (more than $60 billion a year). Other estimates go even higher.

We were tempted to say that providing all Americans with affordable health care is not as hard as landing on the moon... but then we remembered that we have landed on the moon...

Sen. Joe Lieberman (I-CT) may not be, to use Harry Reid's own words, "the least of Harry Reid's problems."

After all, Reid does have to worry about a couple of other guys and gals (from Roland '"no-leverage-point"  Burris to Blanche "tough race in 2010" Lincoln). But Lieberman's comments about possibly joining a Republican filibuster of health reform with a public plan certainly got everyone talking today, and he's been on our minds too. Earlier this month, while all eyes were on Maine Republican Olympia Snowe, who cast her ambivalent "aye" vote for the Senate Finance bill, anyone listening to the radio might have noticed that Joe Lieberman was making a lot of worrisome noises.

Senate Majority Leader Harry Reid's decision to include a public plan with state opt-out in the Senate bill may have made the headlines this week, but Christina Romer's remarks Monday may tell us more about what's next for health reform

Speaking at the Center for American Progress, the chair of the Council of Economic Advisers highlighted the importance of health reform to our nation's fiscal future. (Full text of her remarks here). In particular, Romer gave a strong endorsement of the excise high value health insurance plans:

Details are firming up in the merged Senate health care reform bill, reports The Wall Street Journal (subscription required). Here's a preview of major provisions that appear to be highly likely to make it into the final bill:

Public option. The Senate bill will contain a public option, reports the WSJ, but states can opt out. Reid came out in favor of a public plan with an opt out last week, according to The New York Times. Some theorized the White House preferred a "trigger" for the public option,  appealing to moderates like Olympia Snowe (R-ME). But the White House Blog said that President Obama and Reid are pursing the same strategy, and the president supports both a public option and Reid's efforts to create a final Senate bill.   

Friday, the Kaiser Family Foundation released the latest results of the monthly Kaiser Health Tracking Poll. Public opinion is holding fairly steady from last month's poll, starting a gradual rebound after support for reform dipped during the raucous August congressional recess.

A majority of respondents (55 percent) believe it is more important than ever to tackle health reform right now. By party, that's 73 percent of Democrats and 55 percent of Independents, but only 30 percent of Republicans. A majority of Republicans believe they would be worse off if health reform passes, while only 29 percent of Independents and only seven percent of Democrats believe health reform would hurt them. According to the Kaiser Family Foundation's Mollyann Brodie, 8 out of 10 Americans are in favor of eliminating insurance denials based on pre-existing conditions, making it the most popular of all the reform provisions currently under consideration. The poll also found a majority of Americans are confused about the timetable of reform, thinking insurance market reforms and help for the uninsured will occur immediately after the bill is passed -- in reality, changes will be phased in over the course of several years. 

In the odyssey of health reform, the public plan is the Proteus of our wonkish mythology -- constantly shifting, capable of divining the future, but never willing to give you a straight answer. Sorry, Politico's Pulse already took the soap opera metaphor, "As the Public Option Turns" so we had to get Homeric.

Still, trying to get a handle on where the public plan stands is like wrestling a wet seal.

Earlier in the week, Democratic House leadership felt confident they had the votes to pass a "robust public option" tied to Medicare payment rates, but the latest whip counts suggest the leadership still has some work to get 218 votes in the House.

Meanwhile, in the Senate, Majority Leader Harry Reid (D-NV) is leaning toward including a public insurance option that would allow the states to opt out. The White House is said to favor a trigger option, hoping to keep the Republican Penelope from Maine weaving at her loom.

All this is subject to change, and next week, it will no doubt change again. And the week after that, too.  However, lawmakers should not let the protean politics of the public plan obscure other key aspects of reform. Insurance market reforms like guaranteed issue and community rating, may not have the same siren call of public plan debate, but they are critical in making health reform work.

A new issue brief from the Robert Wood Johnson Foundation and Health Affairs provides a thorough overview of the issue, looking at why insurance market regulation is needed, what's proposed in the various bills, and the possible objections and barriers to proposed solutions.

Health care and bankruptcy. The two really shouldn't go hand in hand. Too often they do.

The Senate Judiciary Committee's Subcommittee on Administrative Oversight and the Courts held a hearing on medical bankruptcy earlier this week, "Medical Debt: Can Bankruptcy Reform Facilitate a Fresh Start?" Subcommittee chairman Sen. Sheldon Whitehouse (D-RI) introduced legislation that would make filing for bankruptcy less difficult for Americans with significant medical debt. His legislation, the Medical Bankruptcy Fairness Act of 2009, would also make it easier for those in medical bankruptcy to keep their homes, according to BNA (subscription required).

The Nationals may have never had a shot at the playoffs, but Washington's senators are still playing hardball in October.

Much of the action centers on the public plan, which has reemerged as one of the central issues in merging the Senate's HELP and Finance bills.

Senate Finance Chairman Max Baucus told reporters on Monday that he believed a "pure public option" did not have the votes to pass the Senate, but that there were many options on the table that could form the basis of a compromise.

Every Christmas, our Uncle Billy makes Italian sausage. In addition to various ground meats, he uses a rotating cast of cheeses and spices, along with the some well-guarded Testa family secrets (our guess: orange zest added to the fennel seeds). It's a big undertaking, full of cranks and casings. But it's nothing compared to the sausage making ahead for Congress on health reform.

The New York Times sets the stage in the House and Senate, laying out the challenges faced by Speaker Nancy Pelosi and Senate Majority Leader Harry Reid as they try to craft legislation that can pass their respective chambers of Congress and be merged into a final bill that President Obama can sign into law.

The challenge for Ms. Pelosi is to write a measure with sufficient coverage and benefits to appease the left wing of her caucus without alienating too many of the moderate and conservative Democrats whose votes she needs. [...]

Mr. Reid may have the more difficult job since Ms. Pelosi, of California, has a larger majority as well as stricter House rules that limit opportunities for Republicans to slow the process.

Unlike many university presidents, former HHS secretary Donna Shalala makes time to teach, and she offers a course on health reform.  When she assigned a paper on how to fix US health care, one student handed in a one-sentence paper:

"Campaign Finance Reform."

Shalala, now president of the University of Miami, gave him an "A."

As an academic, HHS secretary during Bill Clinton's health reform effort (and its aftermath), the head of a large university (which means a large purchaser of health insurance) and, for a time, a member of a health insurers' board of directors ("I wanted to see it from the other side") Shalala has seen health policy from many perspectives.

Addressing  a workshop for writers who specialize in health and health policy in Miami the other night, Shalala said she is increasingly confident that reform will pass.  "I think we are going to get a bill," she said. "You can see the contours of a deal." 

The center of the Democratic party, she continued, was pretty close to where the center of the country is.  Consensus is in reach -- even if we have "a lot of people moaning and groaning."