Its all about health reform

Amidst the sound and fury, there is a central fact in the drive to obtain a long run budget path that is sustainable:

  • the Republican party has no coherent health reform plan. This means they have no means of addressing the biggest long run spending side problem in the federal budget.

In the past 9 months, Republicans have:

  • embraced a $716 Billion over 10 year cut to Medicare in the April 2012 House budget (same as the ACA spending route over the same period)
  • run a Presidential campaign whose central health policy claim was to pledge to do nothing in Medicare for 10 years when Gov. Romney said he would cut nothing from Medicare over the same period (restore the $716 Billion in cuts) and start a premium support plan with a public option in 10 years. Quite a turnaround in a few months.
  • during the fiscal cliff “thing” they reversed course again and said that we needed fundamental entitlement reforms for more taxes. A reasonable position if they had a coherent health reform plan, or were clear about what they meant on entitlement cuts. Of course, they are not.

If we go further back, Obamacare is now nearly 3 years old. Republicans won a great victory in the 2010 midterms saying they would repeal and replace the law. They controlled the House of Representatives for the past 24 months and never got past the repeal part. That was a central part of the past election as well. However, they never did the hard work of saying what they were for. They passed nothing and as noted above, their standard bearer in the 2012 Presidential election pledged to do nothing to Medicare for a decade.

If the House Republicans had marked up a bill in the Commerce Committee, had it scored by the CBO and then passed it out of the full House in the 112th Congress, then you could imagine a negotiation on health reform that could result in some sort of compromise (I imagined such a deal here). During both the 2011 debt ceiling and the fiscal cliff negotiations, Democrats had to essentially negotiate with themselves by telling Republicans “you could be for this”, etc.

To go a bit further, Republicans are saying that this fiscal cliff deal is the last tax increase they will ever vote for, while also saying things like we don’t want to cut Defense spending. That is going to take one helluva health reform approach and they don’t have it.

There is a great policy opportunity for a Republican policy entrepeneur(s) to start painting their vision and logic of health reform. What they are for, given the reality that they will not repeal the ACA. They obviously still control the House, so Rep. Upton as Chair of the Commerce Committee has a big opportunity if he wants it.

However, I think the biggest story of this week is the rise of the Senate to play the “grown ups” in the Congressional room. Sens. Burr (R-NC) and Coburn (R-OK) who were co-sponors of the Patients’ Choice Act (for the under 65 age group; blogging here, here, here, here) in the 111th Congress also sponsored the Seniors’ Choice Act in the 112th (past blogging here, here, here) have talked about health reform, but I have always had a sense that it was just a foil to argue against something. Those two plus Sen. Corker who has been talking about health reform of late, I suspect could initiate some bipartisan discussion of what next on health reform in the Senate that is not based in fantasy. The country desperately needs for this to happen, because the route to a larger/long range budget deal runs through health reform.

update: I agree there are some reasonable reform ideas by Conservative intellectuals, but what is lacking (so far) are elected Republicans willing to push any reform agenda, which will require legislation.

another update: This from Reihan Salam is on point; he is a strong thinker.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

9 Responses to Its all about health reform

  1. amyclae says:

    Looking at how irrepressible the albatross some call the Patient Affordability and Care Act has been around the necks of the Democratic Party, it takes a certain type of obliviousness to argue that the GOP needs to come out with its own fatally flawed piece of legislation. Seriously, who out there looks at the Act and thinks that piece of legislation has been a benefit to the Democratic Party?

    More importantly, considering that the Patient and Affordability Act was essentially a copy & paste of prior GOP legislation it seems particularly dubious to accuse them of having no coherent plan or intention to come up with a coherent plan. They have come up with ideas, flawed ideas (as the execution of the Act has shown),

    To debunk the core of your post, here is a selection of pieces for you to read.

    Now, no one is opposed to the idea that the GOP’s ideas are mediocre, below average or even outright ‘terrible.’ Most of their ideas are. What I, and other citizens of this country are going to take you to task for, is the statement that the Republican Party has “no coherent plan.” They have, in fact, several. Has there been a good deal of horse-trading in the trenches? Yes, of course. The deformed Patient and Affordable Care Act proves how even the best intentions ends up filling the pockets of large pharmaceutical and insurance companies. The same problems that affect the Democrats also affect the Republicans. No surprise there.

    What should not be overlooked, even in your pursuit of proving your agenda, the Republicans, for good or ill, do have potential replacements. Educate yourself, or expect a few more pokes in the eye.

    • Don Taylor says:

      I would love to see any of those ideas marked up in a House Committee. Why do you think House Republicans never did that the past 24 months? There are several thoughtful conservatives with health reform ideas. However, what Republicans/Conservatives are lacking are elected politicians to push the agenda. Here is a vid of me and Jim Capretta debating some of these issues

  2. Brad F says:

    I doubt the GOP would pursue big reform if serious (and I want to assume for the sake of my question) without democratic receptivity. Either they throw a bill out there to piss off the other side of the aisle and stick an illusory marker in the ground OR they have a willing partner. Granted, even willing partners can be miles apart–but the other side knows a serious offer when they see one. Plus, they have the meetings before the meetings.

    Why would any republican suggest cuts at this point only to have Schumer, Van Holland, Reid, etc., call them heretics and play the same games we see daily. On both sides btw, and you know that well.

    So. Who on the left, besides a Wyden type–we need someone senior, serious in HC realm–would grease the skids for deal making? Biden as door opener? Durbin? Who?

    I agree with what you wrote, but to move to next stage, who does a Coburn reach out to? Unless Grassley’s stock recovers (he really disappointed me), who on the senate side brings the juice?

    A less policy here, and more politics.

    • Don Taylor says:

      The political stumbles are hard. The key is that a reform deal has got to put the Republicans’ fingerprints on the ACA and legitimize govt policy to expand coverage, while ramping up cost control efforts. I think it would have to pop out of Senate, and likely would have to be part of a bigger deal (Soc Sec; I suspect Senate close to a chained CPI + raise OASDI cap slowly back to 90th percentile). You could even leave state choice in a deal with something like two years after you do Mcaid expand and state based exchange, then we do comp bidding in Medicare.

      Coburn and Durbin both voted for Simpson-Bowles (4 of 5 Senators yea; 4 of 5 House members nay, which is a signal of perspective), which assumes implement ACA. Wyden later said Ryan-Wyden was only something he was ok with if move ahead with ACA, and he already was long ago for letting in more people to exchanges to move away from job as means of insurance link.I think Corker likely to emerge in all this.

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