First amendment to pass, first to fail

First I must apologize for not having yet read the Senate bill. I've been busy reading the 669 pages of the Federal Register that updates the Medicare outpatient prospective payment system for hospitals for calendar year 2010. Since this piece of executive rulemaking has direct impact on my everyday job, it had to take precedence. It took me a long time to read because I kept it at my bedside. Best sleep I've gotten in years.

The Baltimore Sun reported today that the Senate passed the first amendment to the health care reform bill currently on the floor, that amendment requiring all insurers to cover women's preventative health and screening tests with no copay. I suspect the impetus for this amendment arose from the backlash to the US Preventive Services Task Force's recent publication of relaxed breast cancer screening recommendations in the Journal of the American Medical Association.

Truth is, the amendment, as I understand it, won't really prevent any deleterious changes to insurance coverage arising from such research. What it will do, however, is increase access to diagnostic services, hopefully allowing us to find cancers earlier and thereby decrease mortality from these diseases. At least that's the conventional wisdom. Ironically, what the USPSTF discovered is that screening women in their 40s by mammography doesn't have an impact on breast cancer mortality.

Overall, though, I think it's a good thing to improve access to preventive care and screening. In fact, in my experience, most insurance plans are migrating to coverage of preventive care and early detection and exempting these interventions from patient financial responsibility. The reason: it's good business. Insurance companies have already discovered that they save money by treating disease earlier.

The other amendment - the one that failed - was sponsored by John McCain and attempted to restore funding to Medicare that was being shifted to expand coverage to the 31 million or so uninsured the bill proposes to cover. Those of us on the provider side would have loved for that amendment to pass. It would mean little or no money being taken out of our pockets. It means we're going to have to figure out how to be good business operators, reducing waste and spurring innovation in order to adapt to the significant financial hit we're going to take when the bill passes.

If you look at this from another angle, however, you realize that the provider community isn't losing as much as it initially seems. Even though we'll lose some Medicare reimbursement, we'll offset that by significant reductions in unreimbursed care provided to the uninsured. If the math works out as it should, two-thirds of folks who currently do not have insurance will be covered when the bill passes.

Tonight I'll start reading the Senate Bill, so that I can speak half-way intelligently about it. Don't expect me to be blogging by the weekend. The bill is 2,074 pages. And judging by my experience with the Federal Register, I'll be sleeping like a baby until the New Year comes.

Senate Finance bill will become the centerpiece of reform

The health care reform bill being crafted in the Senate Finance committee, chaired by Sen. Max Baucus, will become the core of whatever bill ultimately passes both houses of Congress. We will all need to read the bill (I haven't started yet) so that we know for ourselves what the bill puts forth, rather than trusting the pundits to explain it for us.

By now everyone should realize that virtually everyone has an axe to grind when it comes to health care reform. You're not going to get a straight presentation from any major information outlet. So read the bill for yourself.

What I have picked up from reading the Wall Street Journal (still, in my mind, the most objective and accurate reporting on health care reform), as well as other news sources, is that the Finance bill has effectively killed the public option. As I have said before, I think that's a good thing, because the public option was going to start at Medicare payment rates. Most physicians aren't very good businessmen, but those who are will undoubtedly have refused to contract with the public option plan. They are already losing money on Medicare patients and can't afford higher volumes of patients at those payment rates.

Hospitals are even less adept at business than physicians, so most of them probably would have signed on with the public option. The hospital where I work is losing money on Medicare patients. For every dollar we spend to care for a Medicare beneficiary, the government is reimbursing us 90 cents. We can't afford more health insurance plans that pay at Medicare's rates.

Nancy Pelosi and other liberal Democrats will raise cain over the Senate's rejection of the public option, but in the end they will not be able to reverse the direction that Congress is moving.

There is a moderate possibility that the public option will be retained as a "trigger" option; that is, the public option will be retained in reserve and will be activated if the market fails to provide an acceptable level of coverage at a reasonable price for lower income individuals. I would support using the public option as a "poison pill" of sorts. Without the threat of austere action, the players in the health care market will not be sufficiently incentivized to produce the necessary reductions in cost (and economic profit) required to bring health care spending in line.

Let me be so bold as to suggest that you write your senators and ask them to support a delayed public option health plan to be activated only upon the failure of the market to generate the necessary reforms.