Back to Budget Reconcilation

The bi-partisan healthcare summit was a bust. Surprise, surprise, surprise. After all — the point of the summit wasn’t to exchange ideas, or to craft a real bill. The point was another photo op that got healthcare back on the front page — precisely whatthe President wants. In case you missed it, Senator Frist had a great op-ed piece in the Wall Street Journal this morning talking about the implications of using budget reconcilation in the Senate to pass this bill. Worth reading. I again urge Republicans to split insurance reform from so called healthcare reform. Insurance reform is a slam dunk. American’s want insurance reform. The Republicans have a great opportunity to fill the leadership gap and to produce a bill that the Dems will be hard pressed not to support. The Dems will argue that it doesn’t go far enough and therefore they can’t support the bill, yet with a proper public relations campaign the American public will quickly see that the provisions that the public wants are now being endorsed by the Republicans and blocked by the Democrats. The bottom line problem with the summit is that the Dems want social reform. The Reps want healthcare reform. …

We Are So Screwed

I saw an article the other day with this headline:  We Are So Screwed. When I saw the national health expenditure numbers which were released this morning by CMS, I remembered the headline. There are a lot of numbers in the release, so to simply the message, I’ve created this table which I think shows the problem far better than words. Rate of Annual Growth Notes 2008 2009 2010E 2009-2019 National Health Expenditures 4.4% 5.7% 3.9% 6.1% +4.7% with doc pay fix GDP -1.1% 4.0% 4.4% Unrealistically high — 4.4% next 10 years?? Healthcare Spending as % of GDP 16.2% 17.3% 19.3% 1.1% change in 2009 is largest in history Medicaid spending 4.7% 9.9% 7.5% Recession caused uptick in 2009 Medicare spending 8.6% 8.1% 1.5% 6.9% 2010 assumes physicians get 21.3% pay cut If docs pay frozen, NHE rises 4.7%; Medicare 5.1% Private health insurance 3.1% 3.3% 2.8% Out of pocket expenses 2.8% 2.1% 4.8% Hospital spending 4.5% 5.9% 6.1% Physician & clinical spending 5.0% 6.3% 5.9% Prescription drug 3.2% 5.2% 6.3% Source: CMS & Villwock Advisory Services LLC In 2009, Medicaid spending grew by nearly 10% and Medicare over 8%. In 2009, healthcare spending as a percent of GDP …

Compare the Bills

The Senate has now passed a resolution allowing debate on the healthcare reform bill.  It is likely that the debate will last several weeks. The New York Times has produced a useful comparison of the House & Senate versions of the bill.  I’ve taken the comparison, put it into Excel and then created a PDF, which is attached.  The document is ready for printing. Compare House & Senate Bills

If Baucus falls in the woods — does he make a sound?

Senator Baucus came out with the plan today and the head of the AFL CIO led chats of “BULLSH.. BULLSH..” Not an overwhelming endorsement. Both the Democrats and Republicans don’t like the plan. It is DOA. Late this afternoon the healthcare stocks started to take off like rockets and this entire market is melting up. I was too negative on the managed care stocks yesterday as the introduction of this plan and the immediate and viciously negative response gave investors greater confidence than ever that no deal will be completed. Not only did managed care jump, but home health and skilled nursing found major buyers. Hospitals continued their several week long march higher. The Dems will need to go this alone and as they do so there will be a great Democratic divide in both the Senate and the House. The House should be able to pass the public option along party line vote, although it might take the President getting on the phone to make sure that House Dems don’t bolt. Assuming it does pass, then even at 50 votes, the Dems will have an interesting time in the Senate. There are several Senators already speaking out against the …

President Speaks Tonight

Tonight the President speaks to Congress and to the nation in his latest attempt to sell healthcare reform. While thinking about the upcoming speech and writing my morning email to my research clients, I decided that this web site needs to have a more meaningful discussion of healthcare policy in the U.S.  I provide regular commentary to my clients but I haven’t used this site to more broadly broadcast my thoughts.  I will be more active in this regard going forward. Tonight’s speech will be pivotal.  Either the President will repeat the same campaign speech, or he has the opportunity to come to grips with what I believe is the political reality and use his muscle to get the more liberal side of the Congress to accept a lesser reform. I believe that if he reiterates his desire for a public option and then tries to rally everyone around that concept, the speech is DOA and all the current bills will fail to pass. If he says he would prefer a public option but will accept co-ops with a trigger, then the speech might move him from a 0% chance to a 20% chance of success — but in the …