There's been an ad featuring Mike Huckabee about the recently passed healthcare reform bill that's been bugging me. It accuses the Democrats of using "backroom deals" to pass the bill. I only wish George W. Bush had used similar deals to pass his landmark healthcare legislation.
The Medicare prescription drug benefit program (the new Medicare Part D) passed under the younger Bush, while an important program, was an u
nnecessary windfall for drug companies, HMOs and
pharmaceutical benefit managers (PBMs). All of these companies (and their shareholders) benefitted tremendously from the $700 billion taxpayers will spend over 10 years to pay for drugs for seniors.
What's more, HMOs were in no way encouraged to push seniors into using generic drugs. Quite the opposite, the formularies offered in the plans feature robust brand-name drug offerings. If you look at formularies offered to our veterans, they are filled with generic drugs, but not Part D plans as the HMOs were encouraged to use these plans to grab new customers at our expense.
The corporations benefitting from this program were never asked to pay a tax, adhere to many new regulations, or face reduced Medicare reimbursements to pay for the program. Instead this program, along with the Iraq and Afghanistan wars and the Bush tax cuts took us from surpluses to sizeable deficits.
Now to Obama's "backroom deals". He went to insurers, doctors, hospitals, rehab facilities, nursing homes, etc., and said, "we're going to pass a bill giving you guys 30 million new customers. I'm going to ask you to pay for the subsidies that will get us there." Obama, to be sure, could have just socked all these groups with new taxes, lower reimbursements and new regulations without even a discussion. But he wanted them on board--after all, they are the healthcare system. He didn't want to overly damage the providers that are essential to our health, so people from his administration sat with them
indivdually and said, how do we get this bill paid for without killing you?
Obama also took the opportunity to make health insurers act more responsibly. Before this bill, people who had less access to healthcare were people of modest means and sick people. That's right--sick people! Insurers could deny coverage (or charge an arm and a leg) to someone based on their health status. Part of Obama's backroom deal with the insurance companies is that the actuarial assumptions they use to set premium prices have to represent the ultimate truth Republicans want us to ignore: healthcare in the U.S. is viewed as a right.
Ask any Republican representative if the provision in Medicare that requires hospitals to take all comers is a good one. Ask them if it's ok for a car crash victim or a seizing diabetic to show up to a hospital and be turned away because they are uninsured. Of course we can't do that, but Republicans want us to ignore that truth--just during the debate over Obama's new law of course. I'm sure it was a critically important point when we were debating Part D. They scream about the new mandate that everyone have health insurance, but the reality is that we already have it. Who pays for the hospitals to take all comers? We do in the form of higher fees and Medicare and Medicaid reimbursements. We also do in the form of indigent care funds many doctors' offices have because they took an oath to treat everyone.
But rather than sticking with our crazy, inefficient healthcare system that leads to more costs and more people getting sick (and therefore becoming an unproductive worker), Obama negotiated a solution with providers to pay for a better solution. There's your "backroom deal", Mr. Huckabee. I'll take it.