Lessons Learned / Mike Turpin
Published 1:02 am, Thursday, April 1, 2010
I got your messages about health-care reform and your concerns over the future of Medicare. Sorry I did not call you back. A gigantic tree fell on our entire town during a recent Nor'easter and our local utility, Connecticut Light and Power, lost power. They kept waiting for someone to come turn on their lights.
About four days into the blackout, a middle manager asked, "Isn't that supposed to be our job?" Within 24 hours, the trucks were rolling. More about utilities and Cablevision later.
A quick answer to your most urgent question: I have read the Patient Protection and Affordable Care Act -- (all 2,400 double spaced pages ) and there is no "Zhivago" clause that will require you to house an entire family of illegal immigrants in the first floor of your home. I think that was a rumor started by Rush Limbaugh or someone else on Oxycontin.
How could Congress pass sweeping legislation at a time when we are supposed to be entering the age of austerity? How did this happen, you ask? Politics has trumped policy. This is more about claiming the moral and legislative high ground than it is about tough love change. Yet, don't panic. This reform is just the beginning and it will usher in a new universe borne out of intended and unintended consequences. It may actually save some lives and eliminate some practices that have lead to massive inequity and imbalance in the system. Like it or not, reform has become the raison d'etri of this administration and Congress.
We all agree the health-care system is broken. Just ask all the men who now have glowing prostates from irradiation treatment. One day they are being told their PSA counts are high and that they should count their lucky stars that it was detected early. The next day, the test's founder Dr. Richard Ablin criticizes that 30 million men undergo PSA testing at a cost of $30 billion and "the test is hardly more effective than a coin toss." He goes on to lament, "I've been trying to make clear for many years now that P.S.A. testing can't detect prostate cancer and, more important, it can't distinguish between the two types of prostate cancer -- one highly invasive and the other unlikely to spread." Given the risks for impotence and incontinence, just thinking about it makes me need to go to the bathroom.
Now, where was I? Oh, yes, Barack Obama actually started his 2008 Presidential campaign talking about health-care reform -- not health insurer reform. He was talking policy and that captured the imagination of industry insiders who felt someone finally understood that you cannot fix the problem of covering more Americans without attacking some of the underlying cost drivers -- fraud, oversupply, consumer demand, chronic disease, lack of primary care providers and cost shifting to the private sector by Medicare and Medicaid. And the waste! Heck, my cardiologist has a toy drawer with Philippe Patek watches. And he is "in network." Reform looked like it might have some bi-partisan legs.
Yet, the Republicans wanted no part of Obamacare. It was not as if they had an actual comprehensive plan themselves. They intuitively understood that if the President's reform actually succeeded, the GOP would probably not be back in charge of Congress until the Knicks had made it to the NBA finals. GOP Minority leader John Boehner was heard to remark, "Damn it, if we are going to further sell our souls to the Chinese, I would prefer to do it with tax cuts."
The House Democrats preferred to mortgage our kids' futures by launching a health-care plan that expanded coverage but avoided the harder conversation about cutting costs. The President initially kept away from the partisan food fight, choosing instead to sit outside Congress smoking a cigarette with Michigan's 15th District Representative John Dingell who would amuse him with stories about the good old days when Dingell was a freshman legislator under U.S. Grant. The fact that Dingell kept calling the President "Osama" did not bother him. The fact that Dingell was not wearing trousers did.
On Dec. 24, the Senate passed a more conservative version of reform aided by flinty Republican Olympia Snowe. There were concerns from liberal Dems that the Senate bill did not go far enough. It did not include a public option, free diet soft drinks in the Senate kitchen, or a cosmetic surgery tax that would generate an estimated $50 billion but could cause California to lose it buoyancy and sink into the ocean.
Somewhere along the way, an ex-male model Republican named Scott Brown got elected Senator in Massachusetts replacing recently deceased Ted Kennedy (Ted did not look very good in swim trunks and in fact, learned to swim much later in life). With the new GOP underwear model, the Senate Democrats lost their precious 60th vote that had given them a super majority capable of defeating any GOP filibuster attempts. Health care and other grand legislative ambitions were suddenly on life support.
The White House quickly abandoned health policy for health politics. An angry populism was swelling among overweight and jobless Americans and it needed a flint and steel to ignite. The steel would be the obscenity of 45 million uninsured in America. The flint must be a universally loathed symbol of bold-faced greed and social indifference. No, we are no talking about AIG. We are talking about -- the health insurance companies. The troika of President, Pelosi and Reid proceeded to tear a page from the Lenin and Trotsky polemics playbook. In a brilliant audible, the President understood that to unify a people, you must create a common enemy.
Over a period of months and with the help of his brass knuckled Windy City capo, Rahm Emanuel, the President launched an amazingly effective push to galvanize Congress and the American people around tackling health care in two phases. The first phase would be expanding access to all Americans and convincing them that we could pay for it with a series of stakeholder taxes and financial cuts that would not impact seniors, consumers, or increase the overall public debt. At one point, he even promised free Cialis to anyone who was experiencing impotence-inducing fiscal anxiety. Phase one would seek to curtail the nasty practices of those greedy, soulless insurers. Many of those who agreed with the President ironically owned health insurer stocks in their retirement portfolios but were angry at the poor returns. The goal would be to punish insurers making them less profitable and turning them into happy, hamstrung utilities -- just like Connecticut Light & Power.
Phase two would require the uglier duties of trying to cut costs. This is the political equivalent of french kissing a cannibal -- risky business. This must involve Medicare fee cuts, reimbursement reforms, taxes on junk foods, raising taxes on individuals, means testing to determine relative costs of entitlements, regulating the necessity of medical services to ensure markets are not saturated -- all of which would antagonize powerful stakeholder groups and probably upset the balance of Congress at midterm elections. The mantra became "Get everyone under the tent" (and then if costs get really out of control, we can always declare marshal law).
The strategy would require forcing the House Democrats to accept the Senate version of health reform passed as of Dec. 24. Dems could then pass a second bill that would give the House Democrats a chance at reincorporating certain elements of their original legislation. Ultra liberal and Blue Dog Democrats were wary. After all, it was a mid-term election year. They were not sure they could walk the plank for the party, risking their own reelection for the sake of voting against the wishes of the voters back home.
Meanwhile the GOP grumbled in the corner about "clean sheets of paper" and "starting over." The GOP tendered a late proposal to cover 3 million out of 45 million uninsured. This number just happened to coincide with the number of uninsured Republicans. Sarah Palin even started a rumor that global warming was being caused by excessive methane release from overweight Americans. She suggested a "gas tax" that would charge $100 for every pound a person is over their senior year of high school weight.
The President needed to start "persuading" swing voters in the House. He knew the original House legislation passed with only a five vote margin. No one was sure how many of those Democratic "no" votes were genuine or whether a few Blue Dogs were given permission by the Democratic caucus to vote "no" to manage the optics that they were standing up to the party. Would they take a bullet for the team? There were too many eyes on the legislation to pay people off in Louisiana and Nebraska pork. So, how did so many arms get twisted to push the ball into the red end zone?
I have my own theory. Take my own representative, freshman Blue Dog Jim Himes representing Connecticut's 4th District. Jim voted "yes" for the House health reform package claiming that perfection was the enemy of progress. He registered some concerns about the absence of cost containment provisions. But I think the pressure got to him. Put yourself in his shoes. You're new and don't know anyone. It's like a big dinner party where everyone knows everyone else. Suddenly the days where you were the master of the universe playing paddle at Stanwich Country Club seem a lifetime away.
It started when Nancy Pelosi started staring at Jim in session. As a freshman senator, he did not know that Ms. Pelosi had not actually blinked in 12 years due to excessive Botox treatments. This unnerved him. Harry Reid called Jim to encourage him to do "the right thing." The fact that Reid thought Himes was the Senator from Connecticut and kept calling him Chris is another matter. However, one chilly afternoon, Jim felt four cold fingers on his shoulder as Rahm took him under his wing and invited him for a beer at the White House. It was here that the President assured him that he understood that as a Blue Dog, Jim's constituents needed to see costs brought under control.
Freshman Jim was probably star struck by this point but unconvinced. The President went for the jugular, "You know, Jim, I am sure most voters do not remember that you made your fortune at Goldman." He paused "It would be a shame if in the primary, your own challenger made hay out of that fact. I mean, I am sure that you and many others at Goldman were just smart guys doing your jobs. But hey, the American people don't know that." Jim was getting the drift. Just then, Rep. Dingell shuffles in without his trousers and Rep. Eric Massa from New York jumps out of a closet and tries to tickle Jim. The President realized two things -- Jim was now very confused and he was not ticklish. Jim asked one of his 12-year-old aides to do a straw poll back home and was told people were more concerned about daylight savings time than the affordability of the health reform bill. It would be easier to risk reelection than to cross the party caucus. Besides, the President promised that if he voted yes, that creepy New York tickle monster who invited him to move in with him and his five aides would be "taken care of."
The House ratified the Senate bill and then immediately passed the sidecar bill which amended the Senate version. The Senate used Budget Reconciliation to pass the House version and voila!, you've got the Patient Protection and Affordable Care Act.
The President will sign the companion House bill this week. Nancy will be grinning. Joe Biden will probably say the "f" word again and a lot of legislators will be grinning in the Rose Garden, including Mr. Himes Goes to Washington.
The least our freshman legislator could have done was to hold out a little longer like Mary Landreaux or Ben Nelson and get a few goodies for his vote. I mean a "yea" vote ought to be worth getting Connecticut some money to offset our $ 3.2 billion budget deficit that will only grow with expanded Medicaid obligations. Perhaps we could get a few more cell towers, bigger public beaches, rerouted La Guardia air traffic or vouchers for purchasing electricity from out of state utilities. And Holy George Hamilton, Jim, repeal the tanning bed tax!
Dad, sorry to be so flip about something so important. It is just hard to take Congress or the Vatican serious these days. More shall be revealed. This reform pie is basically baked and I leave it to you to determine whether you find it palatable. I know you are worried about $500 billion in Medicare cuts. If we are not careful Medicare will become like a Diner's Club card with few establishments willing to accept it. Stay tuned. My guess this is just the first two hours in an epic mini-series where America has to learn a tough lesson about the difference between expanding coverage and lowering costs.
I will keep you posted. But remember, if anyone knocks on your front door claiming that native Californians now have imminent domain over your property, call the police.
It's not part of health reform.