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The Health-Care Bargaining Chips

As the White House and Congress get to the horse-trading part of putting together a viable health-care plan, there will inevitably be some winners and some losers.

For instance, when it comes to raising the money to pay for expanding insurance coverage, Senate Democrats apparently think that President Obama's proposal to cap tax deductions for the wealthy is too daring. So they're pushing him to tax employer-supplied health benefits instead. But unions are opposed, some middle class families would see their taxes go up, and the move could come at a political cost to Obama, who campaigned against such a move.

Obama today is speaking to the American Medical Association convention in Chicago. Liberals are adamant that without a public insurance option, costs won't go down sufficiently. But many doctors fear that a government-run insurance plan would limit their payments. Doctors do like the idea of reducing malpractice lawsuits, however -- which is in turn opposed by consumer advocates and trial lawyers.

You get the picture. At some point, the health care debate isn't a zero-sum game anymore.

Lori Montgomery and Ceci Connolly write in The Washington Post:

The White House is caught in a battle within its own party over how to finance a comprehensive overhaul of America's health-care system, as key Democrats advocate a tax plan that could require President Obama to break his campaign pledge not to raise taxes on the middle class.....

In recent days, Obama has revived a tax plan he first offered in February: limiting itemized deductions for the nation's 3 million highest earners. Polls show that the idea is popular -- it was Obama's biggest applause line last week at an event in Wisconsin -- and it would enable him to abide by a campaign pledge to pay for coverage for the uninsured with new taxes on the rich.

"He believes this is the most equitable way to do this," said senior White House strategist David Axelrod. "It places the burden on people who can most afford it."

But many Democrats, particularly in the Senate, have balked at the idea, saying they prefer a tax that has some hope of winning Republican support. In legislation that could be unveiled as early as this week, Senate Finance Committee Chairman Max Baucus (D-Mont.) is expected to propose a new tax on the health benefits that millions of Americans currently receive tax-free through employers.

Sheryl Gay Stolberg and Robert Pear write in the New York Times:

In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials.

It is a position that could hurt Mr. Obama with the left wing of his party and with trial lawyers who are major donors to Democratic campaigns. But one Democrat close to the president said Mr. Obama, who wants health legislation to have broad support, views addressing medical liability issues as a "credibility builder" — in effect, a bargaining chip that might keep doctors and, more important, Republicans, at the negotiating table.

Former president George W. Bush was fixated on capping malpractice jury awards. Stolberg and Pear say that's not what Obama is talking about.

Dr. J. James Rohack, the incoming president of the medical association, said Mr. Obama told him at a meeting last month that he was open to offering some liability protection to doctors who follow standard guidelines for medical practice.

And Obama is apparently looking for payback:

[O]ne Republican who met with Mr. Obama in April recalled that the president said he was willing to go against his party to get medical malpractice reforms into a health bill — but that he would expect Republican support for the legislation if he did so.

Meanwhile, Lori Montgomery and Scott Wilson write in The Washington Post that in his weekly address on Saturday, Obama

outlined measures to trim spending on federal health programs for the elderly and the poor by an additional $313 billion over the next decade...

Obama proposed limiting the growth of Medicare fee-for-service payments, taking hospitals and other health-care providers at their word that they will reduce costs. He also proposed cutting subsidies to hospitals that treat uninsured patients on the theory that such payments will decline as more people are covered through his plan.

The president also called for reducing payments to drug companies that serve Medicare recipients. Advisers declined to release details, saying the idea is still under discussion.

Mark your calendar, because ABC News has announced that Obama will participate in a nationally-televised, prime-time event called "Questions for the President: Prescription for America" next Wednesday.

And Washington Post opinion columnist Robert J. Samuelson further ratchets up his Obama critique, writing that the president's health-care plan is "naive, hypocritical or simply dishonest" or "all three." Samuelson even goes so far as to argue against providing insurance to the 46 million uncovered Americans because it would "actually worsen the spending problem."

By Dan Froomkin  |  June 15, 2009; 12:25 PM ET
Categories:  Health Care  
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati   Google Buzz   Previous: Quick Takes
Next: The Deficit-Attention Disorder


Actually, regardless of who pays or how, health care costs will continue to rise precipitously as long as providers are compensated for services.

As Atul Gawande points out in the current New Yorker:

"Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check."

Gawande's entire article is well worth reading. Single payer, public option, none of that matters unless and until we change the delivery system model. Read the article.

Posted by: jpk1 | June 15, 2009 3:49 PM | Report abuse

Take a look at how unions are being exempted. Until the grip the unions have on our government are cut decisions will not be made in the best interest of the People. Getting rid of government unions would be a great start.

Posted by: Bubbette1 | June 15, 2009 3:59 PM | Report abuse

Real health care reform is dead unless Obama is willing to completely sideline the Republicans and the Blue Rats and go for the 51 vote solution.

Too many interest groups have put a stake in the ground saying this or that provision is a deal killer. And we have Senator Baucus from Montana smack dab in the middle saying he won't put forth a solution that does not get wide bipartisan support. He apparently doesn't understand that no matter what legislation is eventually put forth it is only going to get at most 2 Republican votes from the Senators in Maine.

With the must have Republican votes attitude the only health care "reform" that all sides will agree on is providing insurance to the uninsured via private insurers, but subsidized by the government at enormous cost. There will be no serious cost controls that can be measured or enforced. Congress will refuse to find a way to pay for it leaving us with even more debt. If that is the bill that comes out of Congress I hope Obama has the balls to veto it. It's better to let the current system go to it's logical extreme and fail under it's own weight rather than let it simmer for decades as a constant drag on the economy.

All of the industrial nations on the planet have single payer health plans. They have a demonstrable record of success at lower cost. They live longer and generally are healthier than the average American. Republicans decrying long lines and rationed health care are fear-mongering and have no real experience or data to back up their claims.

Posted by: troyd2009 | June 15, 2009 5:03 PM | Report abuse

There never was a point this side of which health-care was a zero-sum game. The insurance industry and providers, that is health-care capitalists and physicians, always stood to lose. Those without insurance stood to gain, but they obviously have no clout.

Never forget that a major reason other countries have lower costs is physician compensation, and real reform would bring this compensation in line with that of other professionals. The AMA is (I think) the 2nd largest lobbyist.

This is simply another class-war issue - those that have want to keep it. If costs are to go down, somebody has to get less.

Posted by: dowty | June 16, 2009 9:14 AM | Report abuse

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