The Ross conundrum UPDATE | Arkansas Blog

Tuesday, July 21, 2009

The Ross conundrum UPDATE

Posted By on Tue, Jul 21, 2009 at 6:03 AM

Here's a pretty good piece, from the Kaiser Health, a publication of the Kaiser Family Foundation, about Rep. Mike Ross' dilemma. He wants to hold down medical costs, but he wants to jack up reimbursement rates. He has so far been uncommitted to providing insurance for all the needy in his poor district. The Blue Dog strategy, and whether it includes universal coverage, might be revealed today.

As is often the case in congressional negotiations of this sort, overarching budgetary principles clash with regional or local interests. In pursuing the Blue Dog agenda, Ross may have a hard time reconciling the competing pressures bearing down on him.

An array of politically powerful interests in Arkansas oppose the House bill. Blue Cross Blue Shield, the dominant insurer with 75 percent of the state market, adamantly objects to a proposed government-run plan to compete with private insurers. The Arkansas State Chamber of Commerce, representing nearly 1,200 companies and groups that employ a quarter of the state’s workforce, strongly opposes this so-called public option and another feature requiring employers to provide coverage to workers or pay a penalty equal to 8 percent of their payrolls.

Ross generally agrees with their positions, but has to decide how far he can go in the pursuit of Blue Dog principles without alienating Democratic leaders and many low- and moderate-income constituents who likely would benefit from access to subsidized health insurance and an expansion of Medicaid, the state-federal program for the poor.

The Ross fallback argument against universal care that insurance is meaningless without readily accessible doctors isn't persuasive. Your choice: travel 100 miles for a covered doctor's visit or have no coverage at all.

UPDATE: Ernest Dumas' column for this week's Times is timely and pertinent on Ross' deceitfulness.

By Ernest Dumas

Of all the flanking attacks on national health reform the most deceitful is the one that says it should be stopped because it will not do enough to rein in rising health-care costs.


But it may be the one that in the end buries the best chance in history for universal health insurance because it is a ruse that conservative Democrats employ in sizable numbers. No more than a dozen Republicans in all the Congress potentially might vote for any serious health-care legislation that President Obama and Democrats embrace, and the votes more likely could be counted on one hand. They are not going to be handmaidens to Democratic accomplishment. It could be like President Clinton’s budget reconciliation act of 1993, when not a single Republican in either house voted for the bill that turned the U. S. economy around on a dime and produced the first budget surpluses in 40 years.


If a bloc of Democrats resist health reform, too, the cause is lost.


Should there be a repeat of 1994, when the collapse of the universal insurance plan drafted by Hillary Clinton brought an end to the Democratic control of Congress and restored the moribund Republican Party to power, Arkansas may again claim a good deal of the credit — or blame. Rep. Mike Ross of the 4th District bids to be the architect.


Ross has a tolerably good record on public health — he voted against the Republican Medicare prescription drug boondoggle in 2003 that advanced Medicare’s insolvency — though not an exemplary one. Now he is the point man on health care for the Blue Dogs, a coalition of some 50 moderate to right-wing Democrats. Last week he claimed he had the votes to stop a far-reaching Democratic health bill in the Energy and Commerce Committee, and he would do it unless they satisfied the Blue Dogs’ agenda.


The Blue Dogs’ big issue: The Democratic legislation does not do enough to stem raging health-care costs. Until it does, they are going to stymie any legislation.


If that were a genuine concern (Ross is eloquent about the scary prospects of skyrocketing medical costs), we should all be cheering them on. President Obama has insisted correctly that a plan must be paid for, every dime of it, and that it must include mechanisms to stop the cost spiral in the medical business. He has been negotiating with the drug companies, hospitals and other providers and has announced some major savings, though no one can bank the industry promises of sacrifice. The health bills in the Senate and House have some cost-shaving features but they are wimpy. They ought to take steps to reshape Medicare’s (and ultimately the insurance market’s) fee-for-service system so that doctors and hospitals are not rewarded just for the volume and expense of medical procedures but for care that is low cost and quality.


But the Blue Dogs and their counterparts in the Senate along with all their backers in the industry are not pushing for anything that would actually force economies and expand coverage to everyone. If anything, they are uniformly promoting greater spending, not less.


They are not going to permit a health bill to pass unless it requires Medicare to pay doctors and hospitals even more than they do now. Ross says medical providers in rural parts of the country are paid far too little. My math suggests that would raise costs, not lower them.


They don’t like the idea of a public insurance option to compete with the health insurance oligopoly because it probably would link hospital and doctor payments to Medicare reimbursement rates, which are 20 percent or so lower than those typically paid by insurance companies. The powerful American Medical Association, which has fought virtually every public health program for the past 75 years, supported the House bill last week only after it was changed to halt a scheduled 20 percent reduction in Medicare reimbursement to physicians and follow a new formula for paying doctors. That is the political dynamic that makes serious medical economies so daunting.


Ross said the Blue Dogs would kill any bill that tied reimbursement in any way to Medicare. It would keep payments to providers so low that insurance companies couldn’t compete. Does that sound like people driven by a passion for economy?
They profess to worry that a government health plan would keep payments and administrative expenses so low that private insurance companies can’t compete. They would have to lower their payments to providers or else bring about administrative or other savings.  There is no history of the industry doing that.


The surest way to rein in medical inflation is a public plan with controls like Medicare that can balance costs with efficient care. Lots of other things can be done, but it is clear that the phalanx of health industry forces are too powerful to let them be done. The Blue Dogs are not going to be caught going against them either.


If the self-styled conservatives are serious about cost controls they should look at any of the other industrialized nations of the world, every one of which insures everyone at costs far lower than the United States.

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