The Pruning of Reform Christmas Tree and Castration of Santa Claus

I do not understand all the machinations of this lame duck congress when it comes to health reform. I do understand, however, two things.

One, the stage is being set for the monumental health reform-repeal debate, which will take place starting in January 2011.

Two, because they cannot repeal the reform law with a Democrat Senate and a Democrat president, Republicans will seek to slow implementation by starving the law of funds.

You can see this starvation strategy at work with defeat of the $1.1 trillion Omnibus spending bill on December 16. Senate Majority leader, Harry Reid, elected to ditch the bill. It included $8.3 billion for 6000 earmarks and more than $300 billion in health-related funds. Reid caved after Republicans threatened to read aloud its 1924 pages and to delay other bills by 50 hours.

Health-related expenditures included these additional funds above current spending levels.

• $750 million more for NIH research, partly outcomes research for treatment effectiveness.

• $565 million for a public health initiative to reduce and prevent chronic disease related to obesity

• $160 million to combat Medicare and Medicaid fraud and abuse

• $577 million for OSHA

• $224 million for health training networks

• $ 5 million for collaborative care networks, such as medical homes

• $750 million for a new Prevention and Public Health Fund

• $176 million for CMS Program Management Account to implement Medicaid Expansion and Medicare Advantage cuts

• $81 million for new mandates and regulations

• $3 million for a national health care network

As the late Everett Dirksen, the Republican Senator from Illinois, might say, “A million here and a million there. Pretty soon, we’re talking about real money.”
What we’re talking about here is the power of the purse to slow reform by throwing sand in the reform machinery gears until Republicans can get a handle on how to repeal or modify sections of the law. More astute political analysts are saying Republicans are bowing to the wishes of the Tea Party, which was dead set against earmarks and other forms of federal largess.

As for me, I look upon the defeat of the Omnibus Spending Bill as pruning of the Congressional Christmas tree, or, if you look upon the bill's downfall as painful for the reform cause, as castration of Santa Claus.