Sunday, November 16, 2008

A Round Up of Baucus Plan Commentary - Part 3

The Disease Management Care Blog compared the Baucus Blueprint to its own Principles for Reform. Maybe Senator Baucus didn't read them when they were first posted, but the DMCB suspects the Senator and/or his staff used much of the same underlying logic. There's the overlapping approach chronic illness care, ramping up primary care payments outside the RUC, bundled payments and recognition of the worksite, schools and community as the best locus for wellness, prevention and obesity care.

The DMCB believes the Baucus plan at this time is just a functional stalking horse. That being said, it yields up some interesting insights into the thinking of a leading US Senator, which is probably shared by many of his colleagues; think of this as some important market intelligence.

The two biggest issues for the DMCB?

1) While forcing more persons into the risk pools will lower the average health insurance premium (the same amount of insurance risk is being spread over more persons), as it stands now, it has little hope of controlling health care costs, and

2) The proposed Independent Health Coverage Council is a huge grab of power away from the States and the market.

The DMCB hasn't seen any reaction from the Republicans, but if this proposal gets any legs, it expects the wily Mitch McConnell to raise questions about the affordability and the Council. Let the games begin.

In the meantime, in addition to thinking about it's own blog, the DMCB likes to scan the other postings out there to see what they say. This is another version of market intelligence and it found some interesting stuff:

The 'insiders' line up over at the National Journal Expert Health Care Blog, including conservative John Goodman of the National Center for Policy Analysis (“a rehash… a start”), Len Nichols of the New America Foundation (it takes many paragraphs for him to say he likes this, and lots), Nancy Nielsen of the AMA (they look forward to ‘working with’ Mr. Baucus, like, er, they have any choice), Karen Davis of the Commonwealth Fund (she endorses the ‘building block’ approach and thankfully spares the reader from mentioning how swell healthcare is in Denmark), Ed Howard of the Alliance for Health Reform (is saying the Baucus plan is 'thoughtful, comprehensive and coherent' code for supportive or non-supportive inside the beltway?) Rich Umbdenstock of the American Hospital Association (‘good ideas,’ he says, but the DMCB thinks they'' ultimately like the notion of getting out of the business of charity care), Ted Kennedy (lauds the 'bipartisan' potential - uh huh, sure) and Henry Aaron of the Brookings Institution (he likes the Connector). The DMCB likes quoting all of this and giving the reader that he’s familiar with all these brainy think tanks.

The asute Robert Laszewski notes the proposal lacks detail on a) the size or source of the premium subsidies, b) controlling health care cost inflation, c) getting buy in from the specialist physicians who would be affected by a re-tooling of the Sustainable Growth Formula or d) finding the money to pay for this beast.

For an example of the intricacies of twiddling the knobs on the impossibly complex tax code to change human behavior, see this over at the Wonk Room. Tools of this trade include excluding premiums, income sliding scales, deductions, marginal rates, subsidies and exemptions.

As mentioned in a prior post, the health insurers AHIP and Blue Cross and Blue Shield issued short terse statements. They're still thinking this over.

How about the DMAA? Well, funny you should ask. No statement from them. Ditto the Patient Centered Primary Care Collaborative.

The American College of Physicians Blog (internists are primary care docs that treat adults) asks about the politics of taking money from other specialists and mentions the luster of a sustainable growth rate fix. The KevinMD blog (also from an internist) likes what he reads ("almost sounds like something I could have written") and curiously echos the question about the cooperation of the specialists. The DMCB asks if the internists are spoiling for a public fight inside the House of Medicine as a means to engage their otherwise busy membership?

There's also no underestimating the physicians' distrust of the RUC committee. Medrants likes the Baucus plan proposal to move decisions about primary care reimbursement out from the under the RVS process.

The Liberals you ask......?

Nobel Prize winning liberal Paul Krugman hopes that Obama will agree that the means justify the end in “do[ing] the right thing” and break the campaign promises he made about not supporting mandates. Keeping your word is apparently optional for the conscience of a liberal.

Maggie Mahar savors each morsel in the Baucus plan in delicious detail for the sweet and the bitter and finds it an ultimately tasty but vague dish. Her biggest fear is that this will lead to legislation that resembles the U.S. version of Chinese food: tasty but unfilling.

Folks over at the California-esque Health Access Weblog imply the Executive branch's President Elect Obama should welcome help from the Legislative branch's Senator Baucus. They also distrust the inclusion of any individual mandate in a health care plan, thinking it's better to make one big risk pool. Curiously, they include the failed California Schwarzenegger – Nunez template as some sort of example of how things can go well.

The Physicians for a National Health Program are also uncomfortable with anything less than one big risk pool. Otherwise, if Senator Baucus' position takes us closer to a single payor system, they're for it.

And if you're from Massachusetts and involved with their Health Connector, you gotta like it when the Feds believe in your idea.

Finally, what's liberalism and blogging without Ezra Klein? He points out that it looks like Mr. Baucus is throwing some elbows to establish court dominance under the health care reform basket. He also provides a solid outline of the Senator's proposal and summarizes the principles, including the mantra of if you (are crazy enough to) like your (overpriced for profit) plan you won’t have to change (yet). In addition, the proposed Health Coverage Council would make most of the hard decisions (for you). Interestingly he predicts the Wyden plan is “dead in the water”

How about the Conservatives.....?

The DMCB has just learned Clay Aiken is gay? John Edwards is trying to make a political come-back? Diane Sawyer believes Elliott Spitzer's prostitute is a newsworthy interview? On top of all that shocking ... SHOCKING news, the ├╝ber right Health Care BS blog (which is curiously never mentioned by the New York Times or Kaiser’s weekly blog round up) decries the Baucus bureaucrats and their dysfunctional price ceilings. He suggests docs oughta be allowed to charge what they damn well please.

The home of the father of health savings accounts isn't THAT far behind and predictably decries narrowing choice, unaffordability and growing government interference.

And to continue this conservative theme, CATO points to far darker implications of the Bauchus proposal for the Republican right. Man the barricades! This is not health care, this is a plot that will win over portions of the South and the West into the Democratic camp with a new public program that promises and improvement of the social safety net.

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