Four Wild Cards for Health Care

by Tim Foley

categories: Doctors and Nurses, Obama and Congress, State and Local Efforts

Published March 17, 2009 @ 09:43PM PT

Universal health care is going to require strong policy, even stronger political acumen, grassroots support and more than a little luck.  Hoping to impart the chances of quality, affordable health care for all in 2009 with the luck of the Irish, we’re going to break the scene down, shamrock-style.  Here are four wild cards to watch this month.

1.)    Sen. Orrin Hatch

The conservative bona fides of the senator from Utah can’t be denied, and he’s burnished them all the more by voting against the expansion of SCHIP, denouncing the stimulus bill’s health care provisions as a Trojan horse for socialism, and similarly blasting Obama’s budget.  In 1993, Hatch was a stalwart against Bill Clinton’s health care plan.

And yet, to read Suzy Khimm’s article “Teddy’s Bear” in The New Republic (sorry, no link yet), Orrin Hatch is more than willing to work with Ted Kennedy to get health care reform done this year.  The friendship between the two goes back decades and has already yielded some tremendous bipartisan accomplishments including, not for nothing, the original SCHIP bill in 1997.  But more particularly, the influence of Hatch cannot be overstated.  For one thing, he’s on both relevant committees – Finance, and Health, Education, Labor and Pensions – and wields influence with both.  For another, he’s been in on Kennedy’s health care plans from the beginning and was recently named as one of the senators involved in the legislation’s markup.

But even more importantly, Hatch does not come by himself.  When it’s legislation that he has had a hand in crating, Hatch has been tremendously persuasive to his fellow Republicans.  If the bill is to bipartisan, it’s hard to imagine it succeeding without Orrin Hatch.

2.)    The American Medical Association

The sudden flurry of news stories about the chances of tort reform being part of this year’s push on health care reform has the AMA’s fingerprints all over it, down to the frequently cited anecdote of OMB advisor on health policy Dr. Ezekiel “Brother of Rahm” Emmanuel at the AMA conference saying, “I just can tell you I've been thinking long and hard about that.  It has not gone unnoticed.”  Why’s it coming up now?

The AMA has actually been outspoken in its support for urgent health care reform, even launching the site Voice of the Uninsured to advocate for their solution (which bears a striking resemblance to the Wyden-Bennett plan).  Still, it’s hard to forget that for nearly every major health care push of the past century, the AMA was first to the ramparts to fight against it.  If reform requires strong cost controls or an emphasis of primary care compensation to the detriment of specialist care, will they stick with their current level of cooperation?  Or is their injection of tort reform in the discussion a sign of things to come?

3.)    Minnesota

Not to put too fine a point on it, but how the heck does the Senate race there get resolved?  It’s much easier to figure out how to get to 60 votes in the Senate to cut off debate when you actually know who all 100 Senators are!

4.)    San Francisco

We’ve talked a little about the Healthy San Francisco Plan.  It’s like watching a real-time experiment of Obama plan’s public competitor – a plan based on Medicare that competes with private insurance – and the pay or play provision for employers needed to help finance generous subsidies for those who can’t afford insurance.  Indeed, the Healthy San Francisco Plan has subsidies beyond reformer’s dreams – up to 500% of the Federal Poverty Line for individuals and families, and very reasonable co-pays.

Today, we learn that not only has San Francisco managed to dramatically extend coverage, the Healthy San Francisco Plan has even more dramatically trimmed costs.  The current average per person cost in the U.S. is a little over $8,000.  For Anthem Blue Cross in California, it’s a little over $7,400.  For Kaiser Permanente, it’s about $4,700.  But for the publically operated and financed San Francisco plan, it’s a stunning $3,360 per person!  You can believe others will be poring over the data from the San Francisco Department of Health.  If so many of the ideas for cost and coverage in the Obama plan are getting their test drive in the City by the Bay and found to be successful, you can bet that will change the political calculus for the efforts of Congress and the White House.

What can I say, but stay tuned!

(Photo credit:  musicFIRSTcoalition on Flickr.)