Health Reform Without Health Reform

March 1, 2010 / Michael D. Miller MD / Health System Reform, Politics / No Comments

With a few weeks to go before the President’s March 26th deadline for agreement on a comprehensive health reform bill, the likelihood of that occurring is diminishingly small. However, even without a comprehensive bill, or even several incremental Federal laws passed this year, health reform will be happening in the States and the private sector, while the Federal government may also pull a few of the strings it has available to shift the operation of our healthcare system:

State Level Health Reform
“State-Level Health Care Reform” is the title of an article in the Feb. 20th issue of the National Journal. …

Congressional Accomplishments for 2009

February 9, 2010 / Michael D. Miller MD / Information & Communications, Miscellaneous, Politics / No Comments

Why the Democrats are increasingly becoming politically vulnerable is a topic that pundits are dissecting in great detail. A general consensus is that the root cause of the public’s growing discontent is a lack of progress on the economy and jobs.

While the economy and the job market have stabilized somewhat – even if they haven’t rapidly rebounded – the President and Congress haven’t gotten much credit for not letting the ship sink. In addition, most of the President’s and Congress’ major accomplishments occurred in the first part of 2009, while towards the end of the year the focus shifted to the very slow moving health care bill – which also included many real and concocted controversies.…

Miscommunicating the Government’s Powers for Health Reform

February 8, 2010 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Politics / 1 Comment

The Virginia state legislature recently passed a law making it illegal “to require individuals to purchase health insurance.” This action reminded me how commonly the extent of governmental powers are misperceived.

The Virginia legislature’s action follows those in other states, and are in line with the “tea party” groups’ opposition to the general direction of national health reform. But what exactly it means for a government’s actions to be “illegal” is also unclear. And as Tuesday’s Washington Post article on the Virginia bill states, “it would have little practical impact because it would be preempted by federal law.” Thus, the actions in Virginia and other states are more political than substantive, and seem to be more about the states’ laying down markers should they later want to take the Federal government to court over any individual mandates for buying or having insurance.…

The Path Forward for National Health Reform

January 31, 2010 / Michael D. Miller MD / Delivery of Healthcare, Health System Reform, Medicaid, Medicare, Politics / 2 Comments

The path forward for health reform is becoming clearer now that the dust from the Democrats losing their 60th vote in the Senate is settling. While a freestanding, comprehensive law now seems very unlikely, achieving the core goals of health reform are possible via the regular order of a Reconciliation bill, demonstrations and pilot programs, waivers, existing authorities, and the appropriations process.

It’s the Stupid Economy
First, the President has appropriately reraised jobs and the economy to be his highest priority. This shift may both help defuse the hyperpartisaness that has enveloped health reform, and increase action to improve the economy and create jobs since they are the source of the public’s ongoing angst and frustration. …

Playing Poker with Health Reform

December 16, 2009 / Michael D. Miller MD / Federal Healthcare Reform, Health Policy and Communications Blog, Health System Reform, Politics, State-Level Healthcare Reform / 3 Comments

The National Journal’s December 5th issue has a very interesting article comparing President Obama’s approach to key issues to his poker playing style. (The issue cover states, “Obama as Poker Player.”)

Having played poker for over 45 years, I find the article’s discussion of his cautious approach and preference for standard games very enlightening. For many people today, poker is about Texas Hold’em, a game that is great for TV but rather simplistic in some ways because each player only has 2 cards and shares 5 others. The National Journal discusses the intellectual, strategic, and personality difference between this game, and more sophisticated games such as five-card draw and seven card stud – as well as more “wild” games such as baseball, although it doesn’t mention my crazed favorite, midnight baseball.…

End of the Beginning for Health Reform

November 29, 2009 / Michael D. Miller MD / Federal Healthcare Reform, Health System Reform, Politics, State-Level Healthcare Reform / No Comments

This week’s Economist has an article titled “The beginning of the end” about the coming Senate debate. But I think they have it exactly wrong. The passage of legislation through the Senate – and then ultimately through a Conference Committee and by both houses so it can be signed by the President – would be the end of the beginning for health reform.

In contrast to the many, many hours of work by Members of Congress, many more by their staff, and probably even more by interest groups and activists across the country, the implementation of a new set of laws will be the real beginning. …

What “Will” Happen With Health Reform

November 29, 2009 / Michael D. Miller MD / Access to Healthcare, Information & Communications, Politics / No Comments

With the Senate scheduled to start debating (and likely amending) health reform legislation this coming week, speculation is rampant about what will happen with health reform. Since the title of this blog is “health policy and communications,” I want to focus on the use of language in discussing health issues, studies, proposals and legislation – specifically the word “will.”

The word “will” is very strong and it implies a high degree of certainty about predicting future events, such as “The Sun will come up tomorrow morning.” And while I have no problem with predicting the future – as my friends know, I have a great reputation for predicting the future, particularly about sporting events like fake punts and winning 8 straight games to win a World Series – but using the word “will” to describe the implications of scientific studies, or legislation and policy proposals, can be misleading.…

Making More Sense of Health Reform’s Politics

November 5, 2009 / Michael D. Miller MD / Federal Healthcare Reform, Health System Reform, Politics / 1 Comment

As expected, it appears that Tuesday’s elections are clarifying the political thinking for some Member of Congress. Specifically, the losses of Democratic gubernatorial candidates in VA and NJ are blamed on independent voters shifting from the Democratic column – where they predominantly voted last year – to the Republican column this year. While some appear surprised by this movement, it seems very natural – after all, that’s why they’re called “independents.”

The implications of this shift for health reform legislation are that Democratic Members of Congress from more moderate districts – where they depend on more independent voters to get reelected – are probably feeling increasingly nervous about the contentious issues in health reform. …

Making Sense of Health Reform

November 2, 2009 / Michael D. Miller MD / Access to Healthcare, Federal Healthcare Reform, Health System Reform, Politics / No Comments

After spending a week in Washington DC talking to lots of people, and reading all sorts of information, I’m still not sure how to simply explain the the current state of health reform legislation – except to say that it is unfolding pretty much as expected:

It is taking a lot longer than planned, i.e. the August deadline never seemed realistic
There are pockets of agreement, but no solid majorities for a single bill
The Senate and House are operating in parallel, with the Senate being more conservative and focused on issues important to rural communities
Costs and spending are defining the framework within which all the ideas and packages are bouncing – like a 1970s video game
And political motivations and calculations are the firmament for many – if not most – positions and actions

Politics with Elections on 12 Month Horizon
On the last point, there has recently been ample evidence. …

Shakespearean Health Reform

October 12, 2009 / Michael D. Miller MD / Health System Reform, Politics / No Comments

With the expected passage of legislation by the Senate Finance Committee this week, Federal health reform prepares to move into the next phase, i.e. merger of bills in the House and Senate followed by a Conference Committee to meld those two versions. While this “process” may seem very straight forward, it probably will have subplots as intriguing and complex as many of Shakespeare’s plays. So below, are some highlight of what may unfold in the coming weeks, (and months), as health reform legislation is finalized and then implemented… perchance.

To Reconcile or Not to Reconcile, That is the Question
The Senate Democrats had set a deadline of October 15th, after which they may use the rules of Reconciliation to pass health reform legislation. …

Healthcare Reform’s Hurricane Warnings

September 17, 2009 / Michael D. Miller MD / Health System Reform, Politics / No Comments

Before the start of the hurricane season, the National Hurricane Center at NOAA issues predictions for how many storms and major hurricanes are expected that year. Political analysts often put forth such prognostications based upon trends in polling winds, the temperature of the electorate and the country’s economy, etc. Healthcare is the biggest storm brewing in US politics, and Charlie Cook and Ron Brownstein are both raising hurricane warning flags for the Democrats.

In the last two issues of the National Journal (9/5 & 9/12) they directly and indirectly discuss the political implications of health reform legislation for Democrats in the 2010 and 2012 elections. …

Miscommunicating Health Reform

August 14, 2009 / Michael D. Miller MD / Health System Reform, Information & Communications, Politics / No Comments

Anyone following the debate about health reform knows that the discourse has become increasingly uncivil. While it is easy to blame those opposing the proposals being developed in Congress for this situation, supporters of the proposals have been validating their adversaires’ messages by repeating the misrepsentative labels in their rebuttals.

Specifically, critics of the overall proposal have mischaracterized a provision that would pay clinicians for discussing end of life care preferences with their patients enrolled in Medicare. (See below for information about the provision.) Unfortunately, in responding to these attacks, health reform supporters have repeated the false claims about the provision, (and the label “Death Panels”), and thus perpetuated the fear their opponents have created.…

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