A Historic Health Care Day

Democracy is a great word, whose history remains uncertain, because that history has yet to be enacted.

Walt Whitman (1819-1892), Democratic Vistas

This is a historic health care day.  A new and revised health law is being enacted.

It is the best day and the worst day, depending on your point of view.

It is a day of great compromise.

It is a day of celebration. The Art of Compromise has returned to government.

On the Presidential front - It is no pipe dream – President Obama just  OKed the Keystone Pipeline  so workers can  have jobs and health care coverage, we can become energy independent, we can afford Obamacare, and we can reduce the national debt.    He  agreed to accept the Simpson-Bowles report, which he had commissioned and which includes reasonable entitlement cuts and tax increases.   Through these and other presidential actions,  he has converted a travesty into a legacy.

On the Congressional front -  Nancy Pelosi has  agreed to read the 2700 pages of the health law.   Congress has withdrawn its 20,000 pages of regulation enforcing the law. It  said it will  not need 16,500 new IRS agents to chase down and prosecute those who do not pay for the individual mandate.   It informed businesses they could offer their own health care coverage rather than the more expensive comprehensive government approved plans.  It  would remove  uncertainties  surrounding the law, so businesses could hire full-time workers.   It told the states they could use block grants to care for their Medicaid populations rather than swallow and fund  health exchanges, which will attract millions more Medicaid recipients.  It promised to ease up on the $256 billion in Medicare cuts used to finance the  law.   It  acknowledged that the law may cause businesses to hire fewer employees  and to cancel coverage for as  many as 20 million workers.  It apologized for passing a national law effecting every American without a single vote for the minority party, thus poisoning the political well, and provoking an endless partisan stalemate. It  promised it would move the eligibility for Medicare and Social Security from 65 to 67 and to means test affluent Americans.

On the physician front – Congress agreed to permit and finance the expansion of primary care residences.  It said it would change the rules for membership the Reimbursement Update Committee (RUC) so that codes for primary care could be raised.  It would repeal the Sustainable Growth Rate (SGR) formula for paying physicians as unworkable and unfair. It would no longer punish physicians financially  for not installing electronic health records at their expense.  It would back off its plans for Accountable Care Organizations,   Pay-for-Performance, and an Independent Payment Advisory Board (IPAB) as neither accountable,  nor  performance related,  nor  independent.  It would permit seniors to negotiate private contracts with physicians.  It would pass a national tort reform law, and by doing so,  dramatically reduce total health care spending.

It is April Fool’s day.