Health Care Reform At The End of 2009

Posted by Bill Pierce

With only a matter of days and hours left in 2009 to pass a health care reform bill, it looks like the end game is in sight.

Almost everyone who has followed this debate closely knew there was no way the U.S. Senate would pass a reform bill that included a public option. The handwriting was on the wall as early as mid-summer, yet the Senate had to go through a full-throated debate including (with a tip of the hat to Arlo Guthrie and Alice’s Restaurant) a “full three-part harmony.” But here we are, and unless some magic plan arises from the ashes, the public option is dead, and for many people, the sentiment is R.I.P. It was never that important an idea from a policy perspective. Its only value was as a political idea.

What this development does is clear the path for final passage of the bill in the Senate with a slim window that this whole debate could be wrapped up this year, leaving only a signing ceremony for early next year. The only way such a path could be created is through what The New York Times called a ping-pong strategy and what I call a no-conference conference. Bottom line, right now Harry Reid and his team are negotiating with House Leadership over what provisions must be in a final bill that will pass both Houses, and if they are able to complete this negotiation, Reid includes the provisions in a final managers Amendment, the Senate votes on final passage and the bill is sent over to the House for an up or down vote. All of this to be done by the end of the year. Such a strategy has been used in the past, but it’s not easy. It relies heavily on political pressure being placed on the left to not vote no even though the bill would be less than what they want.

If they are unable to do this, and if are only able to pass a bill through the Senate, then a conference committee will be required. This will be fraught with risk as there are some glaring differences between the House and Senate bills that if exposed to a full conference could mean the end of reform. It happened with the Patient’s Bill of Rights. Given this risk, a conference must be tightly controlled and narrow, and the White House must be willing to assert its power over the results.

The next few days should tell us which direction the debate will go.

Whither a CMS Administrator? The most significant health care appointment not yet made by the Obama administration is that of CMS administrator. This is important because a CMS administrator will be the point person in the implementation of the health care reform bill. Whoever gets this appointment will have to be very bottom-line oriented with a get-it-done attitude and ability. There will be no room for lofty thinkers (i.e., academics). For what it’s worth, I’d nominate Dr. Bob Kocher, who is the President’s health care lead at the NEC. He’s a physician, so he gets what this is all about — patients. He’s young – an administrator will need all the energy they can muster. He’s helped build health systems in his previous position at McKinsey and he is a get-it-done person. In full disclosure, I’ve known Bob for at least 15 years.