Health Care, cost controls, and choice

It's really hard to know what to believe about heath care reform these days.

You read Robert Reich and this much ballyhoo'ed Public Option sounds more like a horse that's been compromised into a camel:

...the compromise that ended up in the House bill is to have a mere public option, open only to the 6 million Americans not otherwise covered. The Congressional Budget Office warns this shrunken public option will have no real bargaining leverage and would attract mainly people who need lots of medical care to begin with. So it will actually cost more than it saves.

But even the House's shrunken and costly little public option is too much for private insurers, Big Pharma, Republicans, and "centrists" in the Senate. So Harry Reid has proposed an even tinier public option, which states can decide not to offer their citizens. According to the CBO, it would attract no more than 4 million Americans.

Yet this is the provision that will be filibustered by the right wing. Because it will destroy private health insurance and turn us into a socialist state.

Uh-huh.

Then you read Ronald Brownstein - and get a totally different perspective on what is and is not happening in the bill when it comes to cost controls:

...the Reid bill's fiscal strategy, and its vision of how to "bend the curve," almost completely follows Baucus' path from September. Baucus' bill was the first to establish the principle that Congress could expand coverage while reducing the federal deficit; now that's the standard not only for the Senate but also the House reform legislation. And, perhaps even more importantly, the Reid bill maintains virtually all of Baucus ideas' for shifting the medical payment system away from today's fee-for-service model toward an approach that more closely links compensation for providers to results for patients. In the Reid bill, there is some backtracking from Baucus' most aggressive reform proposals, but not much.

Almost everything Baucus proposed to control long-term costs have survived into the final bill. And, with only a few exceptions, that's just about all the systemic reforms analysts from the center to the left have identified as the most promising strategies for changing the economic incentives in the medical system. (The public competitor to private insurance companies championed by the Left would affect who writes the checks in the medical system, but not what the checks are written to pay for.)

That post heaps praise onto Sen. Reid's bill for a host of measures that are not part of the current media scream fest.

Then you have Lieberman. No, no - Trudy Lieberman - the one with a soul. She's been dogging this story since the beginning, dredging up all sorts of untidy details. Here's her latest find:

[it's] one of those pesky details embedded in both the House and Senate bills—a clause that lets insurance companies cross state lines to sell their wares. Way before last year’s election, Ronald Williams, the CEO of Aetna, told the Senate Finance Committee that allowing cross-state purchasing of health insurance was a necessary ingredient for reform. The Senate Finance Committee, along with the House, heard his plea.

The provision, euphemistically named the Health Care Choice Compact, would work like this: Two or more states could join together and allow insurers selling health coverage to be governed by the laws and regulations of the state where the policy was issued, not the rules of the state where they’re sold. So a company wanting to sell in, say, Wyoming or South Carolina—which may have weak regulations—could choose to issue its policies in those states but actually sell them in New York or California—where the rules are tougher. If policyholders have problems with their coverage, too bad: the rules of the weaker state would apply, and they could be out of luck.

Insurers, looking toward lucrative new markets, want to fashion their new policies without having to deal with the restrictions and consumer protections required by some states. In other words, the current definition of market reform will mean they have to insure sick folks; in return, they will offer policies with less coverage and fewer protections. Think of it as back-door underwriting—a process that limits these companies’ liability for high-cost claims.

This is the core of the insurers’ business strategy, wrapped in the guise of consumer choice. Remember, this is the Health Care Choice Compact we’re talking about. If consumers want a policy with few benefits or no protections, that’s their choice. It’s kind of like letting a U.S. toy manufacturer sell yo-yos that conform to Chinese—not American—regulations. Take your choice: a yo-yo with lead, or one without?

This is the same crap McCain tried to sell in the election. The same notion that candidate Obama dismissed as something that would lead insurance to follow the pattern of credit cards: a race to the bottom of customer service and value.

Seriously, WTF is going on up there? We're going to have grandstanding about the Public Option and miss the fact that insurance companies are going to end run consumer protection laws? And what about the cost control stuff? If it's good, how come we're not seeing it placed front and center in the discussions?

Instead, we breathless coverage of the vote count, and who's in and who's out. This isn't a horse race - this is the future of how families get health care. Let's nut up and talk policy, now. Otherwise we're going to see a CMFA for the health care industry squeak through while the talking heads blather on about the vote count.