Partisan wrangling over health care could be as raucous in the new Congress as the sparring over Iraq, but in the longer run, there’s reason to hope for consensus.
The Bush administration and the new Democratic Congress almost certainly will be at odds over the Medicare prescription-drug program, stem-cell research and funding for the State Children’s Health Insurance Program.
The administration will get nowhere – once again – if it proposes medical malpractice award ceilings to a Congress in which the trial lawyer lobby has gained influence. And Democrats detest health savings accounts, the GOP device to make individuals responsible for controlling healthcare costs.
But it’s possible – not likely, but possible – that an agreement could be reached to expand children’s health coverage.
It’s also possible that Congress could help accelerate impressive Bush administration initiatives on “value-driven” health care – based on computerizing all medical records and providing accurate data on treatment outcomes – and “pay-for-performance” medicine.
And because of leadership by presidential candidate and Massachusetts Gov. Mitt Romney (R), the plight of 47 million uninsured Americans finally may get the attention it deserves in 2008.
In April, Romney signed into law a bipartisan program that mandates that all Massachusetts residents have health insurance while providing subsidies for the low-income uninsured. The Democratic state Legislature also imposed a fee for employers who do not provide insurance for their workers.
The top item on the Democrats’ 2007 health agenda – repeal of the noninterference clause that prevents the federal government from negotiating drug prices for Medicare recipients – will set off a furious partisan battle.
Democrats are ignoring polling evidence that seniors approve overwhelmingly of the Medicare Part D drug program and the fact that private health insurance plans have negotiated savings that make the program far less costly than expected.
Democratic leaders such as incoming Speaker Nancy Pelosi (Calif.), Senate Majority Whip Dick Durbin (Ill.) and the prospective chairmen of health-related committees and subcommittees all favor expanded government authority.
On the administration side, Health and Human Services Secretary Michael Leavitt told The New York Times that “government negotiation of drug prices does not work unless you have a program completely run by the government. Democrats say they want the government to negotiate prices. What they really want is government-run health care.”
Democrats often cite the Veterans Administration as a model for providing drastic drug savings. But Republicans counter that the VA provides what amounts to socialized medicine, requiring veterans to see only VA-employed doctors at VA facilities and using VA pharmacies to acquire VA-approved drugs, limiting choices in a way that Medicare beneficiaries would never accept.
Democrats might merely repeal the noninterference clause. But Leavitt has said he will not authorize negotiations. If the House were to pass a bill compelling negotiations, it likely would be filibustered in the Senate. And if it passed, it almost certainly would be vetoed.
One variation is a plan proposed by Durbin and Rep. Rahm Emanuel, D-Ill., to create a government-run drug plan to compete with private insurance plans. Insurance lobbyists note that Durbin’s bill set a premium ceiling at $35 a month – but that the actual average cost of private plans is just $27 a month.
As part of Democratic pressure on pharmaceutical companies, Rep. Henry Waxman, D-Calif., the incoming chairman of the Government Reform Committee, can be expected to hold hearings on drug pricing, profits and marketing techniques. A move also will be mounted to create a generic market for biologic drugs to parallel the one that now exists for chemical pharmaceuticals.
Another priority for next year is reauthorization of SCHIP meant to benefit 12 million low-income children whose parents lack health insurance and are not enrolled in Medicaid. At current funding levels, however, only 6 million have SCHIP coverage, and 600,000 children may lose coverage this year because Congress has not increased the budget. Covering all 6 million would cost from $30 billion to $40 billion over five years.
The Bush administration is not expected to recommend increases, but Democrats may. “I don’t see it in their ‘first 100 hours’ agenda, though,” said Bruce Lesley, president of First Focus, a children’s advocacy group. “And,” he added, “they have promised ‘pay as you go’ budgeting and have a lot of demands for money. So, we have a lot of work to do.”
Some help is being offered by the health-insurance lobby America’s Health Insurance Plans, which is calling for full SCHIP funding and a tax credit designed to cover all 8.3 million uninsured children – a down payment on covering the nation’s 47 million uninsured.
The Bush administration has been using Medicare and executive authority to advance the cause of pay-for-performance medicine, but Congress could advance it by pushing for a single standard – or interoperability – of health information technology systems.
A recent Gallup Poll showed that 71 percent of Americans think that U.S. health care either has “major problems” or is in “a state of crisis.” And 69 percent think it’s up to the federal government to fix it. That’s a mandate.
(Morton Kondracke is executive editor of Roll Call, the newspaper of Capitol Hill.)
Copyright 2006, Roll Call Newspaper
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