It is becoming more and more clear to me that the White House health care strategy this fall is based upon a belief they have been very successful in neutralizing the health care special interests and have therefore prepared the way to a legislative victory…

Health care reform will be very good for the health care business. Insurance companies would benefit from all of the new premiums and even some of the Medicaid money in states where they provide those benefits. Health care providers would receive most of this money as it was passed through by private insurance and Medicaid to pay the providers.

In turn, health care providers and insurers would give up $409 billion in Medicare and Medicaid savings. Insurance companies, drug companies, labs, and device makers would pay $88 billion in new taxes. Insurers would pay excise taxes on high cost health plans which would raise another $215 billion. Both the excise tax and stakeholder taxes would almost certainly be passed on to the customer as new premium or sales taxes….

The President and Democratic leaders have done a masterful job of managing special interest politics.

But they may have overlooked, or taken for granted, the most important special interest of all—the voter/patient.

Robert Reich writes on his blog that Olympia Snowe is now the fulcrum upon which health care reform will swing.

If Olympia Snowe votes in favor of Max Baucus’s plan — which is favored by the medical-industrial complex because it dramatically increases their customer base without a public option that squeezes their profits — the Baucus plan will be the bill that goes to the Senate floor…

That Senate vote will push Pelosi and the House Dems toward the right. That’s because it will embolden conservative and Blue Dog House Dems to threaten to vote against the far stronger bill that’s already emerged from House committees — which, in contrast to the Senate Finance bill, includes a public option, an employer mandate, significant expansion of Medicaid, and larger government subsidies to others with lower incomes.

(But) if Snowe decides not to sign on, history moves in a very different direction. Most importantly, the Senate Dems know they won’t possibly have 60 votes they need. So they’ll have to say goodbye to bipartisanship — perhaps even farewell to Nelson, Landrieu, Webb, and Bayh — and bundle healthcare reform into a “reconciliation” bill that can pass with 51. This new goal post strengthens the hand of Senate progressives on the Finance Committee, like Rockefeller. It also gives more weight to the version of health care reported out by the Senate Health, Education, Labor, and Pension committee — which includes a public insurance option, employer mandate, and more generous subisidies to the poor and lower middle class. Hence, the bill that goes to the Senate floor is much more progressive, and the final Senate’s vote (with 51 votes) better reflects the values of the Democratic base.

The Sentinel Effect, a health policy and business innovation blog written from the perspective that “productivity and outcomes can be improved through the process of observation and measurement, thinks it’s a “really, really bad bill.”

Top 5 reasons the Baucus bill is really, really bad

1. Premium rules that are a giveaway to the insurance companies – I was stunned to see that the bill allows insurers to charge up to five times as much for some enrollees as for others, based on age. (By contrast, the House draft bill only allows them to charge up to twice as much based on age.)
2. The individual mandate is in there anyway – if you’re allowing insurers to charge much more for the (probably) sick than they do for the (probably) healthier, why have a mandate at all? You’re not pooling risk in the manner originally proposed, so this is a heads-I-win-tails-you-lose proposition for the health plans.
3. It taxes benefits, slowly but surely – This plan (taxes so-called “Cadillac” plans), although they’re not likely to be “Cadillac plans” for long. The tax targets plans above $21,000 indiscriminately, regardless of the reason for the added cost. How is this terrible?…First, it will hit plans hardest when they enroll older employees (who, you will remember, can cost five times as much to cover)… Next, it will hurt people who live in urban and coastal areas where medical costs are higher…Lastly, if medical costs continue to increase at 10% per year, $21,000 will be the cost of the average plan in five or six years.
4. No public plan option
5. Co-ops can’t always “cooperate” – …they can’t pool their negotiating ability to get better deals from providers on behalf of the American consumer

The Disease Management Care Blog, “an ongoing forum for information, insights and musings from the world of disease management” thinks it has pinpointed the reason for the AMA’s support.

Wonder why the American Medical Association leadership is gritting its teeth and not opposing huge increases in the Federal government’s role in medicine? It comes down to one sentence in the framework that is remarkable for its unusual clarity: ‘The scheduled 21% reduction in Medicare physician payment rates would be replaced with a 0.5% increase.’ The DMCB guesses that an average doc’s patient population is 50% Medicare. Even though Medicare is not necessarily the best payer, a back-of-the-envelope guesstimate is that this is all about the threat of a 10% pay cut.

The New Health Dialogue Blog from the New America Foundation, a “nonprofit, nonpartisan public policy institute,” writes about some of the “less-controversial” measures in the bill.

Preventive care will get more emphasis, and Medicare patients won’t have a co-pay for certain screening tests and preventive services proven to be effective. Medicare patients would also get a “wellness visit” annually (which isn’t covered now.)

Hospitals with high rates of avoidable hospital-acquired infections and certain errors will face penalties.

New ways of delivering more coordinated care will be tested and/or introduced…Payments to doctors and hospitals will be based, in part, on quality of care over quantity of procedures…

There is also a small but important provision expanding palliative care to dying children under Medicaid, so that they can basically get hospice-type care at the same time they can still be getting “disease-modifying” treatments aimed at slowing down a terminal illness and prolonging life.

NY Times reader comments

Washington Post reader comments: Ezra Klein’s blog