Sen. Grassley says compromise on public-private option health care system will be difficult

Mar 23 2009

Senate Finance Committee ranking member Chuck Grassley (R-Iowa) on Thursday at the Kaiser Family Foundation told reporters that although congressional Democrats and Republicans likely will not reach an agreement on health care reform legislation with a provision that would establish a public health plan to compete with private plans, he could not dismiss the possibility, the Wall Street Journal reports (Yoest, Wall Street Journal, 3/19).

He said at the event -- which was sponsored by the Foundation, Families USA and the National Federation of Independent Business -- "This is a deal-breaker for Republicans if it's in, and it's a deal-breaker for Democrats if it's not," adding, "Is there a compromise in between? I don't see one today. There might be one" (Armstrong, CQ Today, 3/19).

According to Grassley, the establishment of such a public health plan could create an unfair market that would force private plans from the market (Vitez, Philadelphia Inquirer, 3/20). Such a public health plan would represent a "step toward single-payer," he said (Young, The Hill, 3/19).

Taxing Health Benefits, Physician Issues

Grassley indicated that he might support taxing health benefits to help reduce unnecessary utilization of health care services and reduce costs. He said the current exclusion of health plans from taxation "is a contributing factor to the inflation of health costs by maybe two or three percentage points."

Grassley said that health care reform legislation must include proposals to make the field of primary health care more attractive to physicians. He said, "We've upset the whole practice of medicine to such a point that we don't have many primary caregivers," adding, "That has driven up the cost of medicine itself with emphasis on specialists, and it has reduced the quality of delivery particularly in rural areas." In addition, Grassley said, "The government policy has driven doctors and it's encouraged over-utilization, it's encouraged abuse of the system, it's encouraged gaming of the system, and we're going to take the gaming of the system out" (Yoest, Wall Street Journal, 3/19).

Grassley also said that he seeks to shift from a health care system that reimburses physicians for the number of services provided to a system that pays physicians based on quality of care.

Prospects for Reform

Grassley said that he and Senate Finance Committee Chair Max Baucus (D-Mont.) hope to introduce comprehensive health care reform legislation this summer (Philadelphia Inquirer, 3/20). He said, "If we do something incremental this year, you're never going to get health reform," adding, "Now, I'll back up a little bit from saying incrementalism is entirely out. As long as we adopt an overall health care reform, you could have a little bit of incrementalism by phasing in certain aspects of it" (Edney, CongressDaily, 3/19). Grassley said, "I think if it isn't done this year, it won't be done for the next four years" (CQ Today, 3/19). He added, "If we don't set an aggressive agenda, it's not going to get done this year" (The Hill, 3/19).

Grassley said that he would prefer not to use the budget reconciliation process, which allows legislation to move through the Senate without the threat of a filibuster, to pass health care reform legislation. He said, "Politically, to have a bipartisan agreement, it's got to be done through regular order and not reconciliation" (CQ Today, 3/19).

Video of Grassley speaking at the Kaiser Family Foundation is available online.

Budget Reconciliation

The Obama administration and House Democrats on Thursday decided to delay use of budget reconciliation to pass health care reform legislation until at least September to allow time to reach a compromise with Republicans, the Washington Post reports. After a meeting with senior White House officials on Wednesday, House Democrats decided to include a provision in their version of the budget that would trigger the use of reconciliation in absence of a compromise on health care reform legislation. Senate Democrats have not decided whether to include such a provision in their version of the budget.

According to the Post, congressional Republicans "have blasted the idea of reconciliation, saying it would severely undermine bipartisanship" (Montgomery/Connolly, Washington Post, 3/20). "Employing the tactic would almost certainly lead to more partisan clashes" as the debate on the budget begins, the Wall Street Journal reports (Weisman/McKinnon, Wall Street Journal, 3/20).

Dentzer Discusses Health Care Reform

Susan Dentzer, editor-in-chief of Health Affairs, on Wednesday at an event in Topeka, Kan., said that, although the current U.S. health care system is not sustainable, prospects for comprehensive reform remain uncertain, KHI News Service reports. At the event, the third part of a four-part Advocacy in Health series sponsored by the Sunflower Foundation, Dentzer said that President Obama and congressional Democrats have made progress on health care reform through the recent enactment of CHIP expansion legislation and the economic stimulus package, which includes funds for health care programs. She said, "There is nobody in a key group of stakeholders who thinks the status quo can continue to exist."

However, political opposition and issues related to the current economic downturn could prevent the passage of comprehensive health care reform legislation, according to Dentzer. She said, "Does everything else just push (health reform) off the table" because Congress lacked the necessary "time, energy and political capital?" (McLean, KHI News, 3/19).

Obama Promotes Budget, Health Care Proposals

Obama on Thursday continued his two-day visit to California during which he cited the need to pass his budget, health care and other proposals, the AP/Boston Globe reports. During a town-hall meeting in Los Angeles, Obama said that the proposals, although expensive, would reduce costs in the long term (Babington, AP/Boston Globe, 3/20). He said, "It's going to cost some money. It's not going to be pretty," adding, "People are going to be frustrated," but "we are going to get it done" (Welch, USA Today, 3/20). In addition, he said, "Change is hard. Change doesn't happen overnight" (Wilson, Washington Post, 3/20).

On Friday, the Congressional Budget Office plans to release a 10-year budget deficit estimate that might exceed the $7 trillion estimated by Obama by as much as $1.6 trillion, the Los Angeles Times reports. According to the Times, the "bad news ... portends a rocky road for the Obama budget, which was initially hailed by congressional Democrats for promoting such liberal priorities as expanded access to health insurance and curbs on global warming" (Hook, Los Angeles Times, 3/20).

In related news, the House Blue Dog Coalition recently released guidelines for Congress to follow when they draft the budget resolution. Among other recommendations, the guidelines seek to ensure that the $634 billion health care reserve fund included in the Obama budget proposal does not increase the deficit (Sanchez, CongressDaily, 3/19).

Opinion Pieces

• Alan Blinder, Wall Street Journal: The Obama budget proposal has prompted a "fusillade of criticism claiming that the president, contrary to previous advertising, is not a centrist, but a 'leftie' intent on leading the country down the path of socialism" on health care and other issues, Blinder, a professor of economics and public affairs at Princeton University and a former vice chair of the Federal Reserve Board, writes in a Journal opinion piece. Blinder writes, "Socialism means public ownership and control of businesses," a proposal that Obama does not support. On health care, Obama "wants to reform the current system so that it costs less and covers more people," not implement a single-payer system, Blinder writes. He adds that, "regardless of whether single-payer is a good idea, it's not Mr. Obama's." According to Blinder, Obama "emphasizes choice (keeping what you have if you like it), greater efficiency (partly by utilizing information technology) and portability (your health coverage will follow you from job to job)." He writes, "So where does all this leave us on the road to socialism? If Mr. Obama is able to get all of these proposals through Congress," the U.S. will have a "uniquely American health care system that covers virtually everyone." Blinder concludes, "If this is socialism, then let's make the most of it" (Blinder, Wall Street Journal, 3/20).
• Tom Daschle, Washington Post: Health care reform will occur because of the "great team that President Obama has assembled" in HHS Secretary-designate Kansas Gov. Kathleen Sebelius (D) and White House Office for Health Reform Director Nancy-Ann DeParle, his "unwavering commitment to this issue," the "broad support for health reform in Congress" and "some new and unlikely allies" in the health insurance and pharmaceutical industries, former Senate Majority Leader Daschle (D-S.D.) writes in a Post opinion piece. He writes that health care reform will "be decided by the American people." Daschle adds, "The people who will decide whether reform happens" are average U.S. residents who are "also the people who decide elections," and "smart politicians should listen to these voices, not to the worn-out slogans and scare lines of old Washington debates." He concludes, "These Americans are telling us we can't wait any longer: The time for health care reform is now" (Daschle, Washington Post, 3/20).

Broadcast Coverage

• CNN's "Newsroom" on Thursday examined the provisions that U.S. residents seek to have included in health care reform legislation (Schneider, "Newsroom," CNN, 3/19). A transcript of the segment is available online.
• NPR's "All Things Considered" on Thursday reported on the expected CBO budget deficit estimate (Norris/Seabrook, "All Things Considered," NPR, 3/19).
• NPR's "Morning Edition" on Friday also reported on the estimate (Seabrook, "Morning Edition," NPR, 3/20).