Obama strategies - Obama: Outside In, Inside Out

For an insurgent politician, being outside looking in is not the same as the inside looking out. Rhetoric is not the same as reality. With a budget deficit of $1 trillion, Obama’s options on health care will be limited.

Obama admitted as much in a CNN interview in which he said his priorities would be,

1. economic recovery
2. energy
3. health care
4. tax restructuring
5. education

No one seems to know how to fix the economy, and when or how recovery will occur. Making the U.S energy efficient will take years, and so far, wind, solar, and biofuel contributions have been meager and disappointing. Tax restructuring on the backs of the “rich” along will do little to resolve the deficit.

According to Bob Laswewski, a blogger who writes “The Health Care Delivery Policy and Marketplace Review Blog, “ Obama’s best bet will be to take a bipartisan approach on those issues already agreed up both parties. He says it would be a big mistake to “steamroll the Republicans,” as Bill Clinton tried to do in his failed 1994 reform efforts. He concludes “ A big $100 billion comprehensive health care reform plan like the Obama health plan is not realistic in these times of financial crisis.”

Instead, says Lasjewki, Obama should focus on agreed upon bipartisan issues that are “affordable” and “doable,” such as.

1. Reauthorizing the State Children Insurance (Plan (SCHIP)
2. Rearranging Medicare spending by equalizing private and traditional payments
3. Crafting new physician payments to avoid the 21% fee cut due on June 1, 2010
4. Expanding health insurance technologies and personal health records
5. Improving transparency on prices, errors, infection rates, and outcomes
6. Developing best practice studies, requirements for disease management, and comparative effectiveness
7. Assisting small businesses with 3 to 9 employees with federal assistance coverage.

As I add up the costs of these suggestions, I estimate they would probably exceed $100 billion. The suggestions may be “bipartisan,” but they are not necessarily “affordable” or “doable.”

• EMRs have already been on the federal table for 5 years with little progress in widespread installation of EMRs or getting IT systems that permit hospitals, health plans, and doctor systems to talk to each other. PHRs, even with Microsoft and Google pushing them, are still in their infancy. Obama says federal subsidies to help put EMRs would cost $50 billion.
• “Equalizing private and traditional Medicare spending” is not a piece of financial cake either. Medicare spending is often 20% to 50% below federal spending. To raise Medicare levels to private levels would probably cost another $50 billion, and lowering private spending to Medicare levels would devastate the private sector.
• As far as using IT to compare effectiveness, insure transparency on prices and improve outcomes, put me down as dubious, as these goals assume a widespread interconnecting IT system.

In the near term, with the financial crisis and the power of health care lobbyists, comprehensive reform is well nigh impossible, but incremental reforms are worth a try. It is also worth noting that health care remains the only growth sector and the single largest employer among U.S industries.

With high hopes for needed change, nothing is impossible, but it helps if the possible is affordable and doable.