After more than a year of debates and discussions, last night, in a historic vote, Congress passed the HealthCare reform bill. I must admit that after the victory of Scott Brown in MA, I had written off the prospects of passage of the bill. While I don't like many provisions of the bill (I have written about them in my previous posts), I am glad that the bill passed. As a practical matter, we can not make perfect the enemy of good.
I think the passage of the bill is also a lesson in leadership. It is easy to lead when you have a consensus and strong support for whatever you are trying to do. However the real test of leadership comes when you are trying to do something that is not popular but you believe is the right thing to do. It requires unwavering conviction and tremendous perseverance both of which were at display on how President led this effort. Critics will call it arrogance. They will point to the flawed process used to pass the bill. While it should not always be the case, I think in this case, end justifies the means. Arms were twisted, deals were done but nothing that has not happened before (remember Tom Delay anyone...).
While it was hard to get to this point, really hard work will begin with the implementations of the provisions of the bill. CBO estimates of deficit reduction of $150 billion this decade and almost $1 trillion in the next decade will happen only when Congress can muster the courage to implement the tough provisions like cuts in subsidy to health insurance companies for medicare advantage. With the passage of the bill, Congress has shown its willingness to step up to the plate. Let us hope this continues.
Monday, March 22, 2010
Monday, March 1, 2010
What Comes After the Summit
Healthcare summit is over. Was it worth the all the hoopla surrounding it? Actually I found it quite informative.
In between lots of campaign speeches from both sides, there were moments where the philosophical differences between the two sides became evident.
One big difference was on the priority. Republicans want to tackle cost first and coverage second whereas democrats are primarily focussed on coverage. I wrote in this blog last year that expanding coverage without reducing cost will undo the benefits of the bill in the long run. We will not be able to afford this new entitlement until we reduce cost significantly.
Second big difference was around government's role. For the reason of "protecting the consumers", democratic bill mandates minimum benefits to be included in the plans sold by insurance companies whereas republicans want to leave it to the consumers to decide what benefits they want.
On both these points I find myself agreeing with the republican position. A consumer should be able to decide what he or she is buying. Only proven way to reduce cost is to ensure consumers have a stake in the decisions they make. For example expanding the use of Health Savings Accounts (HSA) will do more to reduce the cost than anything suggested in the bill as has been shown in this experiment in Indiana.
Lately in my discussions with providers, they tell me that when suggested to undergo a test or a procedure, consumers today ask about the cost of the procedures. They try to compare prices and quality of different providers before deciding where they will have the test done because they have a stake in that decision due to the increased co-insurance amount they need to pay. We need to provide tools and information so that healthcare consumer can get the price and quality transparency they are looking for. At hCentive, we have made this our mission to provide quality and price transparency to consumers for all their health related purchase decision whether it is health insurance or a health procedure.
While I agree with the republican positions, it is also clear to me from the summit that Republicans have no incentive to pass any kind of healthcare reform. Their insistance on "start over" is actually Washington Speak for doing nothing. It was very reassuring to see President's grasp of the complexities of this very difficult subject. I may not agree with many of his positions but I feel he is making a good faith effort to incorporate some of the good ideas from the other side. In the end whether it will be enough to bridge this big gap is anybody's guess...
In between lots of campaign speeches from both sides, there were moments where the philosophical differences between the two sides became evident.
One big difference was on the priority. Republicans want to tackle cost first and coverage second whereas democrats are primarily focussed on coverage. I wrote in this blog last year that expanding coverage without reducing cost will undo the benefits of the bill in the long run. We will not be able to afford this new entitlement until we reduce cost significantly.
Second big difference was around government's role. For the reason of "protecting the consumers", democratic bill mandates minimum benefits to be included in the plans sold by insurance companies whereas republicans want to leave it to the consumers to decide what benefits they want.
On both these points I find myself agreeing with the republican position. A consumer should be able to decide what he or she is buying. Only proven way to reduce cost is to ensure consumers have a stake in the decisions they make. For example expanding the use of Health Savings Accounts (HSA) will do more to reduce the cost than anything suggested in the bill as has been shown in this experiment in Indiana.
Lately in my discussions with providers, they tell me that when suggested to undergo a test or a procedure, consumers today ask about the cost of the procedures. They try to compare prices and quality of different providers before deciding where they will have the test done because they have a stake in that decision due to the increased co-insurance amount they need to pay. We need to provide tools and information so that healthcare consumer can get the price and quality transparency they are looking for. At hCentive, we have made this our mission to provide quality and price transparency to consumers for all their health related purchase decision whether it is health insurance or a health procedure.
While I agree with the republican positions, it is also clear to me from the summit that Republicans have no incentive to pass any kind of healthcare reform. Their insistance on "start over" is actually Washington Speak for doing nothing. It was very reassuring to see President's grasp of the complexities of this very difficult subject. I may not agree with many of his positions but I feel he is making a good faith effort to incorporate some of the good ideas from the other side. In the end whether it will be enough to bridge this big gap is anybody's guess...
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