Tuesday, December 26, 2006


It was either the November elections with control of both Houses of Congress taken by Dems and 6 "pickups" by Dem Governors and or the realization that the states and the nation are rapidly going broke with the status quo "healthcare" (really disease care) system that makes me believe that finally, after all these decades of bickering, that 2007 will be the year that real healthcare reform will take place in the US. Do we really have a choice?

I last wrote about the key role that US Governors will play in March on this blog citing the Virginia Gov. Tim Kaine and Illinois Gov Rod Blagojevich (say his name bla-GOYA-vich). I also cited our nation's only Hispanic Governor of New Mexico,Bill Richardson, whose DGA tagline then was "Won't Wait for 08".

But most importantly I cited two former Governors whose ideas about Health Care reform are worth very serious re-consideration. Former Gov. of Oregon Dr. John Kitzhaber's program makes the most sense to me. His work can be found on www.archimedesmovement.org and former Gov of Colorado Richard (Dick) Lamm, while focusing less of Health Care issues recently wrote a book in 2003 entitled The Brave New World of Health Care by Richard D. Lamm (Paperback - Aug 2003. These two leaders are not just nibbling around the edges like most others but are going to the heart of what makes US Health Care so moribund and who also offer tangible but tough solutions.

Well in my blog post of March 3, 06 I posed the question where were the powerful mega- states like New York, Pennsylvania. Massachusetts, Texas and California to name a few on Health Care? I didn't hear much then to my surprise and dismay.

Little did I know that the following month (April ,2006) outgoing Massachusetts Gov. Mitt Romney(R) would send shock waves through his own state and the nation by signing a landmark (albeit complex-145 pages) health care bill that would provide nearly every citizen of ,what my blog partner Cervantes calls the Peoples Republic of Massachusetts, with some level of health care.

Building on what was viewed by many other Governors as a master stroke of compromise other states began to move quickly including Vermont, Maine, Minnesota ,Michigan, West Virginia and Kentucky. It seems that every state is jumping on the bandwagon in some form or another. And a year earlier the now notorious Maryland "Wal-Mart" law forcing large employers to contribute some health insurance to its workers- was overturned and now in appeal

A good summary can be found on http://www.stateline.org/live/printable/story?contentId=166268 "States Think Big on Health Care Reform" (Thank Stateline.org)

I've got my own eyes on three key states.

-One is where I and my family live and work. The Commonwealth (not common wealth) of Pennsylvania where healthcare is a huge business. Gov Re-Elect Ed Rendell is being very careful not to embrace a Massachusetts "Universal Health Care model" nor "A Single Payer model"

-I'll be listening carefully to what California Gov. Arnold (leg in a cast) Schwarzenegger will say on Tues January 9 at his upcoming State of the State address where he promises to explain how he will push the Golden State closer to Universal Health Care in the coming year.

- New York Governor Elect Eliot Spitzer has already shown his hand as an aggressive reformer of healthcare. This was not only reflected by his recent relentless pursuit of health care fraud as NY Attorney General but his recent support of the the New York Commission on Health Care Facilities in the 21st Century which called for the closure of 9 hospitals and the restructuring of 48 other institutions- still a drop in the bucket in Gov. Elect Spitzer's whopping $45 billion dollar Medicaid budget(ouch!). Be bold Gov. Spitzer- you cannot afford otherwise.

In the end with all the plans put forth by Governors and Feds alike (Rep Pete Stark D-CA, a staunch Medicare-for-all advocate is expected to be named chairman of the House Health Subcommittee) most are still emphasizing payment mechanisms and cost-shifting which still misses the mark. Pay for Performance, Gain-Sharing and IT- Information technology are getting some long overdue attention but not nearly enough.

Former Governor Kitzhaber says correctly we already have a de facto system of universal healthcare- expensive emergency room medicine. Kitzhaber goes on to say "about 40% of what affects people's health status are behavioral choices and lifestyle decisions. About 30% has to do with your genetics. About 15% are social factors like whether you have a job, a house or a healthy neighborhood. 5% are environmental factors" What all this means is that the $2 trillion dollar plus US health Care Industry has only about a 10% impact on US citizens overall health? What??? Could that possibly be true??? This is clearly unsustainable! Undeniable demographics, says Kitzhaber, is really what is driving us over the edge.

But let's face it a $2 trillion dollar plus industry doesn't roll over easily. Big money -real big money is on the line. Real battles lay ahead. But I am convinced the heyday of greed is over. 2007 is the pivotal year when America chose not to go bankrupt over healthcare anyway.

Dr. Rick Lippin
Southampton, Pa


Blogger losrivas said...

I recently posted an entry about Health Care Reform in California. I support SB 840, a bill based on the single-payer model. The Terminator vetoed it after it passed in the State Senate and Assembly, and it will likely pass again, and likely be vetoed again (is it possible to veto-proof the bill this time around? I don't know...) Hopefully the Schwarz's plan won't be just another ploy to get more money into the hands of private insurers, Big Pharma, and the like.

4:19 PM  
Anonymous Dr. Rick Lippin said...

Thanks Losrivas. On Tues Jan 9,in full casted leg glory, The Terminator alleges he will speak on Health Care in his State of State address. I don't expect much since, like in Pa, (my state) Health Care is really big business in California and Arnold's pockets are overflowing with HealthCare lobby dollars.

But when he can't deliver on basic other services to CA citizens because HealthCare costs are draining the state's coffers he may yield?

Dr. Rick Lippin

4:37 PM  
Anonymous Sheldon Samuels said...

I already owe you one pizza, since I bet that Bayh would be the Dem candidate, and he's already dropped out! So here's a second bet [add mushrooms to the prior sausage and onion extravaganza!]

2007: The states will slow down their scurrying in the rat maze to see what happens in the next Congress [no use getting out on a limb for expenditures if the feds will pay instead!] Check out their support systems, such as the National Association of State Legislators to see what they are sniffing! [Not much! They are on record against 50 different systems, thank G-d!] And the feds will give birth to a position paper!

Here in New Rome, it will take at least a year for the new guys to learn that the best Navy Bean soup is in the Rayburn cafeteria and not on the senate side and you can't pinch the receptionist's tush without getting in the WP! The old hats will all be rationalizing their past in the rush to create new persona, safeguarding pork barrel!.

In 2008, not '07, after the fights on how to pay for deficit reduction, the war and simultaneously minimum wage benefits to small business and other tax breaks, with hearings galore to save or pump up special programs such as EPA, food sanitation, etc. the Dems [and some GOPPERS] will take ACTION! Yessiree, we need some more commissions and 'studies' before grappling with AARP, big Pharma, the insurance companies, and the hospitals [and their millions of voting employees]. There will be a substantive attempt to sharpen knives for the '08 presidential debates. [At least two new position papers are being commissioned while I write this by the Dem progressive [Kennedy] and centrist [Hillary] 'think tanks' alone. AEI, Brookings, CATO, etc, plus the academic groups , are all looking for handles to justify the big daddies funding THEIR plan, which they haven't formulated beyond reiteration of ideology at this point, to guide the candidates. Romney is shopping for some folks to consecrate the MASS law [which has yet to take hold, let alone be evaluated!]

Business as usual? Not really. There is a basis for your optimism, Rick. You are correct about the awareness of the issue and real commitment/desire to put some proposals on the table. But what we are talking about in terms of public system building is more complex than either President Teddy or Franklin Roosevelt encountered in developing our public service safety net. They essentially dealt with a public sector void. In the case of the healthcare system, the void has long since been filled, the systems are in fact over loaded, and massive, fast reform is not politically or economically possible.

My bet is that they will take one or two slices of the baloney, without radical reform. Given the fact that not all of our system stinks, AT A COMMUNITY LEVEL much is very good, and the incredible variation in quality and comprehensiveness within most states, look for a relatively simple extension of Medicaid and Medicare to cover the uninsured plus an attempt to further restrict the use of new [and more expensive drugs] beyond mass distribution through a federal pharmacopoeia associated with federal insurance.

Happy New Year, dear optimist and good friend!!! Shel

5:03 AM  
Blogger Cervantes said...

I agree that there is a fair amount of activity going on at the state level, but I would say that it's not going to amount to much in the end. The Massachusetts legislation is the most aggressive, but it isn't going to work unless the legislature puts in a lot more funding - and that's not likely, in my view. It also creates a strong risk that other states, and the feds, will emulate its worst features while the good parts are not nearly as likely to be imitated. (This is a complex discussion that is probably not fit for the comments.) We have much more superficial "reforms" in Maine and Vermont that aren't going to do much, as far as I'm concerned.

Other states will probably watch and wait to see what happens with the experiments that have been tried so far, and I'm not optimistic that they'll get a lot of inspiration, but we'll see. I'm expecting nothing from the feds, basically. But I'm willing to be surprised.

The main problem is that a single state can't really cut the gordian knot by itself. Multi-state and national companies -- insurers, drug and device manufacturers, hospital and dialysis chains, etc. -- don't have to play with an individual state if they don't want to.

We need universal, comprehensive, single payer national health care. Going part way is going nowhere.

10:42 AM  
Anonymous Dr. Rick Lippin said...

Excellent comments partner Cervantes- But the states can "float" the ideas that the Feds are too politically freightened of. "Can't Wait for 08" is DGA=Dem Gov Assoc tagline.

You are correct-In the end the Feds will have to act - hopefully sooner than later-lest we bust our budget with 20-30% GNP on "health"(disease)care.

Be Well,

Rick Lippin

12:47 PM  

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