What to Expect After the First 100 Days

This week the Senate confirmed President Obama's nomination for Secretary of Health and Human Services, Kathleen Sebelius. The Senate confirmed the Kansas governor, 65-31, despite Republican efforts to delay the vote based on her stance on abortion. However, the potential swine flu pandemic made the Senate confirmation more urgent. Although her primary focus will be on the current flu threat, Sebelius will eventually advocate for controlling health care costs, expanding coverage and increasing access.

A former president of the National Association of Insurance Commissioners, Ms. Sebelius is an expert on insurance regulation, which is sure to be a focus of the legislation that Congressional Democrats hope to pass this year.

Sebelius was sworn in on Tuesday, marking the beginning of many health care reforms to come.

Wednesday marked an important financial turning point in President Obama's health care strategy. Congress advanced a $3.4 trillion federal budget that "prevents Republicans from blocking his proposed trillion-dollar expansion of government-provided health care over the next decade." The funding sends a clear message to Republicans that the Democrats hold a majority. While Democrats will not move Obama's health care plan through Congress without bipartisan support, they do have the power to do so without the threat of a Republican filibuster. Republicans criticize advancing the federal budget and cite it as another example of excessive Democratic spending. The federal budget does not answer how President Obama will fund the adminstration's health care coverage plan, however, which may exceed $1 trillion over the next decade.

Stuart Altman, a health care expert from Brandeis University, commends the President on creating health care policy objectives and principles that will help guide the health care reform strategy. According to Altman, the true test is imminent: how will President Obama fund a health care overhaul? Thus far, the Obama has successfully expanded health care coverage to more children and provided funding and resources to various health care initiatives in the economic stimulus package. President Obama has also called on health care representatives and members of both political parties to create multi-group support. Unfortunately, not all of the players support the proposed agenda. For example, whereas most of health care representatives support requiring employers to cover employees and do not support a government run coverage plan, politicians favor the opposite.

As the first one hundred days draw to a close, only time will tell what direction health care reform will take.

This week I found three articles that address health care reform. The first author shares her personal story as an eample of why the current health care system does not work for average Americans. The second author opposes a public coverage plan and critiques many of the proposed health care reforms. The third article is a compilation of different ideas that health care reform supporters suggest based on President Obama's health care address. Author Kate Michelman of The Nation, experienced two major crises within a short period of time. Soon after they occured, the medical crises became financial burdens, even though Michelman and her husband has excellent health care coverage. Based on her experiences, Michelman now advocates for health care reform. She argues that millionsof Americans share her predicament and many more are only one crisis away from medical and financial failure. According to Michelman, this can happen to people in any social or economic bracket and will force all citizens into a similar plight no matter what socio-economic status one initially falls under. Michelman also argues that the health care crisis is not a "series of isolated problems," that only require individual attention. Those that suffer should not suffer alone and would benefit from uniting forces. Finally, she places responsibility on the health care industry for "nominally cover[ing] long-term care but [failing] to cover its actual cost." She believes that the public is mislead in assuming how much they are truly covered.
Sally Pipes of the Washington Examiner opposes President Obama's public coverage plan. The reporter predicts that the plan will be a disaster that will ruin America's health care system. Pipes fears that the proposal will lead to a "single-payer, government-run health care system." She argues that the Obama administration will impose restrictions on private insurers, which puts them at a disadvantage. As a result, private companies will have to drive up costs to break even or make a profit. I disagree with Pipes' arugment. If a public plan supplements the private industry, it will most likely cover citizens who cannot afford the current coverage plans. The plans will operate in different spheres. Pipes claims that insurance premiums will have to charge the same price to all members of a particulr demographic group regardless of illness. While this may be a problem for states that have low insurance rates per person, many states pay a substantial amount for health coverage per person. Therefore, it might actually reduce how much money is allocated per person for health care coverage. Pipes fears that when private insurance companies raise premiums they will become less competitive with the public sphere. While this may occur, perhaps eliminating some of the private sector will not have many significant negative consequences.
Finally, the "Room for Debate" section of The New York Times hosted several health care officials and experts and published their views. Professor Elliot Fisher of Dartmouth Medical School suggests that the reforms target the "fragmented care system, lack of accountability for the overall costs and quality of care, and a payment system that rewards growth and unnecesary care" present in the current system. Karen Ignagni, president and chief executive of America's Health Insurance Plans agrees that the reforms should focus on cost, access and quality of care. Doctor Kevin Pho proposes that universal coverage go hand in hand with training more primary care medical professionals. He argues that a universal coverage plan would fail because there would not be enough primary care medical professionals to see the influx of patients. It is evident that there is some consensus as to what flaws need to be addressed in the current health care system. While plans and proposals vary, the problem definition phase is becoming more clear: The current health care system is wasteful, not available to many, inconsistent and ill-equipped to service Americans. Although I have become slightly more moderate in wanting universal health care, I agree with these authors. Something must be done soon to address these issues.

An Alternative Direction

This week, former congressman and 2004 presidential candidate Richard Gephardt shared some advice with the Obama administration regarding health care reform. The universal health care advocate who vehemently campaigned for universal coverage during the 2004 presidential race is now cautioning the Obama administration from making vast and extensive changes to the system. Gephardt predicts that any health care reforms will not pass this year and "is urging the White House to defer that goal until it enacts cost-saving reforms in health care delivery." He believes that President Obama is facing several looming obstacles, most notably how to finance universal coverage or simply health care reforms. As seen during former President Clinton's administration, the health care system comes down cost savings. This may seem ironic given that the United States pays much more in health care coverage than comparable industrialized countries with universal health care coverage. Unfortunately, the current economic situation places an even greater burden on the burning question: How does the president plan on financing health care reforms? Thus far, it appears as though President Obama is incorporating reforms into the economic recovery plan by casting it as "controlling the 'crushing cost of health care'" for those most affected by the poor economic situation. Even if the Obama administration can provide a convincing financial plan, Gephardt fears that universal coverage will meet opposition from both political parties. Despite Democratic majorities in Congress, Gephardt predicts that Republicans and moderate Democrats will not be receptive to a universal coverage plan. Health care reform will require strong leadership, patience and perseverance. Gephardt also advises that the President take incremental steps, such as implementing universal coverage for low-income workers. These small victories could pave the way for more sweeping reforms in the future.
Until a more efficient health care system is implemented, there are some steps that the health care industry could take that would improve the quality of care and reduce service costs. For example, many medical offices are switching to electronic medical records. One family doctor found that the electronic medical records made her office more productive and enabled her staff to spend less time searching for records and more time meeting the needs of the patients. She can also better monitor specific patient conditions. Another doctor reported that the electronic medical records system forced costs down by as much as 75%. Electronic medical records also make it easier to share patient information across medical offices. Unfortunately, some medical professionals are unwilling to make the switch because they cannot afford the start-up costs. Others have had negative experiences with the new technology and favor the traditional record keeping method. President Obama is encouraging the switch to electronic medical records as seen in the stimulus package, which allocates some money to transferring medical records to an electronic system. Most of the money will benefit "undeserved and rural areas." Despite its many advantages, the electronic system does not eliminate unwilling insurance companies that "use delaying tactics to avoid paying for care," a common frustration felt by many medical professionals. Still, it is evident that the electronic medical records system may be one incremental step on the way to cheaper health insurance that does not compromise the quality of service.
Successful health care reform will require more than material changes. According to a Yahoo News article, the uninsured population have not shown "collective power" or organized a united front against universal coverage opponents. If the constituency does not vocalize their opinions, lawmakers will be dissuaded by the cost of universal health care without factoring in the need for it. Not only do uninsured citizens not mobilize or lobby, most of the uninsured population is not represented in elections. "In the last election, only 10 percent of registered voters said they were uninsured." Historically, politicians respond to the needs of constituents that will help them secure reelection. If the uninsured population does not exercise the right to vote, politicians will be less receptive to their plight. There are several reasons why the uninsured do not show "collective power." First, many believe that being uninsured is a personal problem. Those with the misfortune of losing health coverage "often struggle alone instead of turning their frustration into political action." Second, many uninsured individuals are too busy trying to stay afloat and do not have the time or resources to mobilize politically. Third, research suggests that most uninsured middle class Americans will eventually find some medical coverage within several months. Therefore, the uninsured population does not have time to politically mobilize. Until all uninsured citizens become active in the political sphere, some grass-roots groups are lobbying in Washington for guaranteed coverage. However, those represented are typically insured and do not share the same plight as uninsured citizens.
Based on readings from the book, I understand that most citizens are not active in politics, particularly those that cannot afford to. If any progress is to made towards universal coverage, the uninsured population will have to vocalize their plight. I also agree with Gephardt regarding incremental steps. At this point, universal health care will only come to fruition if the idea is introduced gradually. I am hopeful that some of these changes will occur under the Obama administration.

Switching Topics...

This week, I am deviating from my normal blog topic to talk about President Obama’s recent trip to Iraq. On Tuesday, Anderson Cooper spoke at Elon about his experiences abroad, specifically, reporting from the front lines of various wars. Over the course of several years, Anderson Cooper has visited Iraq several times and on Tuesday, he shared some anecdotes. I was very interested to hear his commentary on how the country has changed and its current state of affairs. As a result, I decided to read articles about President Obama’s impromptu visit to Iraq and find out more about the presidents’ position on the subject. According to White House Correspondent, Jennifer Loven, the President ended his European tour in Iraq, where he addressed an audience at Camp Victory, the U.S. military base in Baghdad. He acknowledged the sacrifices that American soldiers have made thus far and spoke about his diplomatic efforts. Shortly before landing in Baghdad, bombs exploded in a nearby neighborhood, suggesting that violence continues despite democratic achievements. Although, President Obama encouraged the Iraqi Prime Minister to “make quicker strides in reconciling the country’s still-divided factions,” he stated that his role during this tour was to listen, rather than dictate. President Obama suggested embracing the ethnic divisions and incorporating them within government and security spheres.
One subject that the President has made very clear is that the United States will withdraw all American troops by August 2010 to focus on the war in Afghanistan. More specifically, a New York Times article states that, “Mr. Obama’s plan to begin withdrawing the roughly 140,000 American troops in Iraq on strict timetable [will] leave 35,000 to 50,000 by August 2010.” This declaration has drawn sharp criticism from American politicians and officials who believe it is too early to abandon a country with such a fragile infrastructure, as evidenced by the recent surge in violence. However, President Obama is confident that his strategy and fortified diplomatic relations will help maintain security and stability in the area. Before leaving Iraq, the President met with the Prime Minister and other Iraqi officials to establish better relations with the region and begin a more diplomatic approach. Prime Minister Maliki seemed receptive to President Obama’s comments stating, “dialogue should be the only way to resolve any issue, whether if was between Iraqi security components, or in the region.”
According to an NPR article, President Obama called upon the continued support and hard work of American soldiers during the imminent transition period. He acknowledged that this time is critical because of upcoming national elections, which may indicate Iraq’s political stability. And, while the President is not supportive of a war that he inherited from former President Bush, he is unwilling to abandon the cause immediately. Nor is the President looking to prolong American involvement stating that it is time for the Iraqis to “take responsibility for their own country.” In order to prevent collapse and nullify past efforts, the withdrawal procedure must be carefully facilitated.
From what I have read about President Obama’s policy on Iraq and his first visit to Iraq, I think that he is headed in the right direction. It will be interesting to see the results of a complete withdrawal of US troops so quickly. The next Iraqi election will be a great example of whether or not Iraq can function successfully as a democracy. Unfortunately, I think that Obama is not considering the deep ethnic divisions that are plaguing the country. Incorporating the different ethnic groups into the same government and expecting it to work immediately is idealistic and naïve. I hope that the results will be successful and that the War in Iraq will end completely in the near future.

Progress

On Thursday, a New York Times article reported that President Obama's secretary of health nominee, Kathleen Sebelius, will not achieve a quick approval. The Kansas governor fielded a series of questions from the Senate Finance Committee, who will continue to review her responses. Based on the hearing, it appears that Sebelius receives more support from the Democrats than the Republican party, who question her stance on abortion. Another point of contention during the hearing was tax irregularities. Gov. Sebelius also established her stance on a public coverage plan that would compete with private insurers. She supports creating more options for consumers, especially those that only have access to a few options.
According to a New York Times article, "efforts to overhaul the health care system have moved ahead rapidly." The chairmen of five Congressional committees, all Democrats, and the health care industry have made several important decisions regarding potential legislation. The two parties have met consistently to discuss pressing matters. First, the chairmen determined that all citizens should have health insurance, financed partly by employers. Second, the congressmen suggest that the federal government provide a public health insurance option to supplement private insurance plans. Third, the Democrats established an early deadline, the end of July, for the House of Representatives and the Senate to vote on the legislation. Fourth, the health care industry promised to accept all citizens, regardless of their illness, if the government required that Americans have health insurance. The industry also offered to stop charging higher premiums based on level of sickness. However, the chairmen face considerable obstacles, particularly from the Republic party. The Republican camp argues that "a government plan would have unfair advantages and could drive private insurers from the market." And, the chairmen have yet to discuss financing such a coverage plan. One fact is that both political parties and the health care industry will have to make concessions in order to create a successful health care reform. Without the support of each group, a public coverage plan could become a costly failure.
Finally, a third New York Times article outlines some of President Obama's plans for health care reform. According to this article, "Mr. Obama’s strategy is to sell the expansion of access — largely through public insurance programs — as inseparable from serious efforts at innovation and restraint." The article references the incremental health care reform that took place in Massachusetts. One of the main elements of success was the idea of gradual change. Another important element is rewarding those who encourage preventative medicine. Finally, the state of Massachusetts is working toward requiring that all residents be covered by insurance. While the case does provide strong evidence to support a public health care coverage plan, I believe it will be difficult to implement this plan and expect the same results. In my opinion, expanding coverage is a necessity, but there are so many other factors to consider at the federal level.