Reconciliation Is Next

At the end of the seven-hour health reform summit held on February 25 in Washington, D.C., President Barack Obama clearly laid out the path for health reform debate in the next six weeks—and that path is reconciliation. While they ponder their next moves, I have a suggestion for Congress (see the end of this post). .

Oh, there did appear to be a few areas of general agreement at the summit, including these:

• preventing waste and fraud in Medicare and Medicaid;


• addressing medical malpractice reform;


• reforming the insurance market;


• giving individuals more choices in coverage, and giving small businesses the opportunity to pool coverage for their employees.

However, even within these areas of agreement, there remained at least two fundamental differences. Mr. Obama and the Democrats want a comprehensive approach and the Republicans want an incremental step-by-step approach.

More importantly, Republicans believe that insurance reform can be done by individual states, and Democrats believe that there needs to be a minimum set of national standards for insurance reform to be effective.

Mr. Obama said that “There is a legitimate debate about who should be in control –states or federal government.

“The general idea has been that we should set some minimal standards that anyone should know that if you get sick you will treated and won’t be left with high expenses—the principal of pooling is at the center of both Republican and Democratic proposals—that is not the issue—the issue is how much should government set the baseline.”

He went on to say that the Congress and federal workers have a plan with baseline coverage.

Rep. Eric Cantor (Vir.) said that “We have a philosophical difference—if D.C is the one to define health benefits we [Republicans] have a difficulty with that.

Mr. Obama noted that the most contentious issue was “how do we provide coverage for those who don’t have coverage and for those who have preexisting conditions?”

He also said that “We cannot have another year-long debate,” and he set a maximum of six weeks to make a serious effort to resolve differences. He noted that “There may not be any reason for Republicans to do anything—this would be very hard politically.”

He concluded the summit, attended by more than 50 Congressional members and staffers, with a clear reference to the likely use of the reconciliation process  to move health reform along, and said that Democrats would have until the November elections to test out their “visions of the country.”

The entire seven hours is available for viewing in here.

My Suggestion

At one point at the summit, Mr. Obama asked Sen. John Barasso (Wyo.) if he thought it would be better if every member of Congress should just have catastrophic coverage. Mr. Barasso said, “Yes I think we would be better if we had skin in the game, especially if we had a [health] savings account.”

I think we should up the ante a bit.  Because Congress apparently agrees that imposing preexisting condition exclusions is a bad idea in general, let’s strip all 535 members of Congress of their current health care coverage (no COBRA because they still have their jobs) and let them all go out and get individual coverage on their own. Of course almost half the Senate and 60 members of the House are at least 65 years old, so they can hop on the Medicare bandwagon.  But for the rest, watch out preexisting conditions.

Sure, most of them are wealthy and can probably pay out of pocket for many expenses, but what will happen when a spouse of a child has a serious health event?  They will be in the same position millions are in now.

And maybe that’s the way it should be, unless members of Congress would like to extend their current health care access to those of us who put them in office.