View from Washington – Brace Yourself

Brace Yourself
What’s a little healthcare reform mutiny among friends?

At no time outside or inside the Capital Beltway has there been such hope about the possibility of systemic health reform. Nor has there ever been more fear about what it might mean – assuming it actually happens.

The FY 2010 federal budget proposes a “reserve fund” of a little more than $630 billion over 10 years to be spent on healthcare reform. However, the budget states, “$630 billion is not sufficient to fully fund comprehensive reform,” but represents an “initial step.” What might be the ultimate price tag beyond this “initial step”? The initial cost of reform is huge, and the promised cost reductions are in the distant future. This may be the biggest “trust me” in modern political history.

In the greatest U.S. economic downturn since the Depression of the 1930s, President Obama has identified health reform as an essential element of overall economic reform. Obama wants a broad coalition to forge agreement on major changes in the healthcare system. On March 5, the president hosted a White House Forum on Health Reform. This forum provided an opportunity for nearly 150 stakeholders and key members of Congress to discuss their broad vision for health reform. After remarks by President Obama, forum participants broke into several smaller focus groups. These breakout sessions focused on discussing healthcare costs, expanding coverage and improving quality. Despite initial statements of cooperation, expect these interest groups and members of Congress to scatter once we get down in the weedy details.

Who’s really in charge of the reform
This forum was an initial step in prompting stakeholder discussion. Theoretically, this group will help develop a plan, and then deliver it to Congress for action, with Obama’s blessing. Here’s where it gets sticky. If significant health reform happens, it is going to be happening at the other end of Pennsylvania Avenue.

Since the release of the 2010 budget, five congressional committee chairs have begun the budgetary process by questioning aspects of the Obama plan. These committees are where the real political sausage will be made. Senate Finance Committee Chairman Max Baucus (D-MT) has voiced praise for Obama’s determination to fix healthcare. However, Baucus already has drafted his own plan to reduce costs and expand coverage. This potentially puts him in conflict with Obama and other important chairs such as Senate Budget Committee Chair Kent Conrad (D-ND); Senate Health, Education, Labor and Pensions Committee Edward Kennedy (D-MA); House Ways and Means Committee Chair, Charles Rangel (D-NY); House Budget Committee Chair John Spratt (D-SC); and “Mr. Healthcare,” House Energy and Commerce Committee Chair Henry Waxman (D-CA). All of which have significant budget and/or policy issues with the administration’s health reform proposal. As Hillary Clinton learned the hard way when she tried to reform healthcare in 1993, the heavy lifting has to be done by the committee chairs.

To complicate matters, the Democratic leadership in Congress has been surprised by the pushback they are receiving from some of their own party over the costs of the $630 down payment on reform, and the inability of the administration to calculate what the total costs of health reform might be. Calls for setting aside pay-as-you-go budget rules for health reform are sending some Democrats over the side. No one likes a mutiny – especially within a family and – their new best friends.

About the Author

Robert Betz Ph.D.
Robert Betz, Ph.D., is president of Robert Betz Associates, Inc. (RBA), a well-established federal health policy consulting firm located in the Washington, D.C. area. Additionally, Dr. Betz is an adjunct professor teaching at The George Washington University where he specializes in political science and health policy. For more information about RBA, visit
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