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Health Care Reform in Perspective

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A ‘Post Mortem” in the midst of health reform hysteria courtesy of the New England Journal of Medicine (Note: this is NOT for those craving sound bytes for emotive grand standing at ‘town halls’; will require active cerebral engagement):

President Barack Obama has placed U.S. health care reform at the top of his domestic agenda, and months of legislative work on the issue have resulted in five bills — three in the House of Representatives and two in the Senate — that proponents believe will move the country in the direction of universal coverage, a fairer insurance system, and slower escalation of health care costs. On September 25, in a symposium cosponsored by the Journal and the Harvard School of Public Health, four health policy experts — Henry Aaron, Katherine Baicker, Jacob Hacker, and Mark Pauly — explored the promise and limitations of the bills and the outlook for reform. The discussion was moderated by Arnold Epstein of the Journal and the Department of Health Policy and Management at HSPH.

What follows is a portion of the transcript of the program featuring:  Arnold M. Epstein, M.D., Henry J. Aaron, Ph.D., Katherine Baicker, Ph.D., Jacob S. Hacker, Ph.D., and Mark V. Pauly, Ph.D.

For the complete transcript click here. Page one only is pasted below:

Perspective Roundtable: Health Care Reform in Perspective.

Introduction

DR. ARNOLD EPSTEIN: Past, present, and future. That’s the sequence, that’s how it unfolds. Let’s look back. When President Obama was candidate Obama, just a year ago, when we did our last forum here, he was very clear about his domestic priorities. The economy was number one, and after that was health care and energy. And he has not wavered one bit. And if you look at how health policy has unfurled from the White House, I wouldn’t be the first one to comment that it looks like a redux of reverse Clintonism. For if you go back to 1993, President Clinton wrote the first textbook. He came out in January, and at the end of the month, created a task force of federal bureaucrats, advisors, and counselors to ultimately produce a 1300-page document called the Health Security Act. Enormous in its scope and complexity, and what was remarkable about it is it came totally out of the executive branch. Not a whit out of Congress. It took until September before it was even introduced to the populace, leave alone going through the committees. And the President, to demonstrate his commitment to it, said, with a typical Clintonian gesture, it will be universal coverage and not one bit less. And he appointed his wife to head the task force putting the bill forth as an additional sign of his resolve, not to mention her own formidable ability. And despite that ability, and his resolve, it did not work, and we did not get health reform last time. No legislation.

So this time, we see President Obama really following a totally different script. No executive task force, just the opposite. This is Congress’s job, to propose the laws and make them. And it was the executive’s job, at least until 2 weeks ago, to merely espouse eight very broad principles and to partake in a very modest public relations campaign — getting information, regional forums, things like that. And Mr. Obama made it clear that he wanted something simple, not with labyrinthine complexity. Let’s stick to what we’re familiar with. He made it clear that he was ready to compromise — I have eight principles, but I’m ready to give in. And, oh, yes, please get on it, time is of the essence.

And so now we’ve come full circle towards the endgame. It’s September, and 2 weeks ago today, President Obama took eight principles and started to hone in on some of the things that he thinks are most important. And in Congress, we’ve seen the Congress do its job, still doing its job. Five committees of jurisdiction, three of them in the House, Ways and Means, Labor, and Energy and Commerce, have produced HR 3200, slightly different variants out of each committee, but basically the same bill. The HELP Committee — Health, Education, Labor, and Pensions in the Senate — has produced a bill on the delivery system, but they can’t touch finance. And the Finance Committee is marking up as we speak.   Cont’d

Perspective Roundtable: Health Care Reform in Perspective.
Introduction
DR. ARNOLD EPSTEIN: Past, present, and future. That’s the sequence, that’s how it unfolds. Let’s look back.
When President Obama was candidate Obama, just a year ago, when we did our last forum here, he was very clear
about his domestic priorities. The economy was number one, and after that was health care and energy. And he has
not wavered one bit. And if you look at how health policy has unfurled from the White House, I wouldn’t be the first
one to comment that it looks like a redux of reverse Clintonism. For if you go back to 1993, President Clinton wrote
the first textbook. He came out in January, and at the end of the month, created a task force of federal bureaucrats,
advisors, and counselors to ultimately produce a 1300-page document called the Health Security Act. Enormous in
its scope and complexity, and what was remarkable about it is it came totally out of the executive branch. Not a whit
out of Congress. It took until September before it was even introduced to the populace, leave alone going through
the committees. And the President, to demonstrate his commitment to it, said, with a typical Clintonian gesture, it
will be universal coverage and not one bit less. And he appointed his wife to head the task force putting the bill forth
as an additional sign of his resolve, not to mention her own formidable ability. And despite that ability, and his
resolve, it did not work, and we did not get health reform last time. No legislation.
So this time, we see President Obama really following a totally different script. No executive task force, just the
opposite. This is Congress’s job, to propose the laws and make them. And it was the executive’s job, at least until
2 weeks ago, to merely espouse eight very broad principles and to partake in a very modest public relations
campaign — getting information, regional forums, things like that. And Mr. Obama made it clear that he wanted
something simple, not with labyrinthine complexity. Let’s stick to what we’re familiar with. He made it clear that he
was ready to compromise — I have eight principles, but I’m ready to give in. And, oh, yes, please get on it, time is
of the essence.
And so now we’ve come full circle towards the endgame. It’s September, and 2 weeks ago today, President Obama
took eight principles and started to hone in on some of the things that he thinks are most important. And in
Congress, we’ve seen the Congress do its job, still doing its job. Five committees of jurisdiction, three of them in the
House, Ways and Means, Labor, and Energy and Commerce, have produced HR 3200, slightly different variants out
of each committee, but basically the same bill. The HELP Committee — Health, Education, Labor, and Pensions in
the Senate — has produced a bill on the delivery system, but they can’t touch finance. And the Finance Committee
is marking up as we speakPerspective Roundtable: Health Care Reform in Perspective.
Introduction
DR. ARNOLD EPSTEIN: Past, present, and future. That’s the sequence, that’s how it unfolds. Let’s look back.
When President Obama was candidate Obama, just a year ago, when we did our last forum here, he was very clear
about his domestic priorities. The economy was number one, and after that was health care and energy. And he has
not wavered one bit. And if you look at how health policy has unfurled from the White House, I wouldn’t be the first
one to comment that it looks like a redux of reverse Clintonism. For if you go back to 1993, President Clinton wrote
the first textbook. He came out in January, and at the end of the month, created a task force of federal bureaucrats,
advisors, and counselors to ultimately produce a 1300-page document called the Health Security Act. Enormous in
its scope and complexity, and what was remarkable about it is it came totally out of the executive branch. Not a whit
out of Congress. It took until September before it was even introduced to the populace, leave alone going through
the committees. And the President, to demonstrate his commitment to it, said, with a typical Clintonian gesture, it
will be universal coverage and not one bit less. And he appointed his wife to head the task force putting the bill forth
as an additional sign of his resolve, not to mention her own formidable ability. And despite that ability, and his
resolve, it did not work, and we did not get health reform last time. No legislation.
So this time, we see President Obama really following a totally different script. No executive task force, just the
opposite. This is Congress’s job, to propose the laws and make them. And it was the executive’s job, at least until
2 weeks ago, to merely espouse eight very broad principles and to partake in a very modest public relations
campaign — getting information, regional forums, things like that. And Mr. Obama made it clear that he wanted
something simple, not with labyrinthine complexity. Let’s stick to what we’re familiar with. He made it clear that he
was ready to compromise — I have eight principles, but I’m ready to give in. And, oh, yes, please get on it, time is
of the essence.
And so now we’ve come full circle towards the endgame. It’s September, and 2 weeks ago today, President Obama
took eight principles and started to hone in on some of the things that he thinks are most important. And in
Congress, we’ve seen the Congress do its job, still doing its job. Five committees of jurisdiction, three of them in the
House, Ways and Means, Labor, and Energy and Commerce, have produced HR 3200, slightly different variants out
of each committee, but basically the same bill. The HELP Committee — Health, Education, Labor, and Pensions in
the Senate — has produced a bill on the delivery system, but they can’t touch finance. And the Finance Committee
is marking up as we speak.
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Written by 2healthguru

October 15, 2009 at 9:09 AM

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