Given the discussions—the pros and the cons—in both parties following President Obama's healthcare reform speech before Congress last week, he does not appear to be wavering from his vision that the votes for passage of reform legislation are there.
On Sunday night, appearing on the television show "60 Minutes," he said in an interview that he believes that "we will have enough votes to pass not just any healthcare bill, but a good healthcare bill that helps the American people, reduces costs... over the long term [and] controls our deficit. I'm confident that we've got that."
He admitted that he was not getting the collaboration he initially expected from congressional Republicans, but "frankly, I haven't gotten the kind of cooperation I'd like from Republicans generally on a whole range of issues," he said. "I think there're some who see this as a replay of 1993 1994. You know, young president comes in, proposes healthcare. It crashes and burns and then the Republicans use that to win back the House in the subsequent election."
Overall, the Democrats and Congress "are not going to get a better opportunity to solve our healthcare issues than we have right now. And that's why I'm confident that in the end we're going to get this done," he said.
In terms of the Democrats, he said that he thinks "there is a unity about wanting to get this done, and there's 98% agreement [but] there are some areas where there are some differences."
One of the biggest differences remains the public insurance option. Senior White House adviser David Axelrod, speaking earlier on Sunday on CBS's Face the Nation, said President Obama is "not willing to accept" that the public option "is not going to be in the final package" of healthcare legislation.
Axelrod said that Obama "continues to believe it's a good idea" and continues "to advocate it." Overall, he added, he's "not willing to accept that it's not going to be in the final package."
Axelrod said the president "believes that it will add an element of competition where there is none in some places in this country where there's a monopolistic situation with insurance companies."
Sen. Kent Conrad (D-ND), one of the six members of the bipartisan Senate Finance Committee group working in recent weeks to devise a healthcare reform bill, agreed that "Democrats are pretty much unified in the Senate around a plan that brings down costs, because that's the central goal here."
In the proposed framework for Senate Finance Committee's reform legislation released last week, though, the public option was excluded. "I don't think [Obama is] giving up: I think he made a very strong case for his support for a public option as an option," Conrad said.
"But I think he also said, 'Look, I'm open to other ideas.' In fact, he spoke favorably about the cooperative [insurance] approach, which would provide a nonprofit competitor, but would not be government run," Conrad said.
Conrad had proposed the cooperative group approach as an alternative to a public option. "I thought he left the door open to a compromise . . . in order to achieve the result of bringing down cost, expanding coverage, and improving quality."
Conrad, though, turned away from the current legislation pending in the House (HR 3200). "It's not going to pass," Conrad said. He said, "The only thing that has a prospect of passing is what is happening in the Senate" with his Senate Finance panel.
"The proposal that we are developing is fully paid for, bends the cost curve in the right way [and] extends coverage to 94% of the American people," he said. He added the panel, working through the weekend, is "close to an agreement."
Health and Human Service Secretary Kathleen Sebelius, speaking before a University of Chicago forum on health and education, said the likelihood that families could lose their employer-sponsored health insurance is increasing.
Sebelius, who commented that the "health insurance system is broken," released a new report on the employer-sponsored insurance market that said that one in six Americans with employer sponsored insurance in 2006 lost that coverage by 2008.
In addition, 32% of working age adults and their families had a gap in health insurance coverage for at least one month in 2006 and 2007, and an estimated 87 million people were without insurance at some point during 2007 and 2008.
"Most of us get health insurance today through our employers. But it's easier to lose than you think," told the forum held on Thursday.
Among the other report findings were:
A family that buys insurance on the individual market pays about 60% more in out of pocket costs, such as deductibles and copayments, than a family that gets insurance through an employer.
About 75% of individuals looking for coverage on the individual market never bought a plan, with 61% of those who did not purchase the insurance citing premium cost as the primary reason.
Young adults (18 34) with employer coverage are more likely to lose coverage than older adults (35 64). One in five younger adults lost coverage over the course of two years.
About 91% of young workers who lost coverage became uninsured, and only 9% of those who became uninsured found insurance on the individual market.
Two thirds of the uninsured (68%) go without needed care—including seeing a doctor when sick, filling prescriptions, and following up on recommended tests or treatment.
As the House moves to finalize its healthcare reform bill (HR 3200)—combining the versions of the 1,000-plus page bill approved by the Education and Labor, Ways and Means, and Energy and Commerce committees in July—a number of legislators on both sides of the aisle will be visible in the debate.
Here are 16 of them that you can expect to see:
House Speaker Nancy Pelosi (D-CA) has stood behind the bill's public option.
House Committee Chairmen Henry Waxman (D-CA), Energy and Commerce, George Miller (D-CA), Education and Labor, Charles Rangel (D-NY), Ways and Means, will continue to have oversight of the bill's progress through the House.
Pete Stark (D-CA), chairman of the Ways and Means Committee's Health Subcommittee, and Frank Pallone (D-NJ), chairman of Energy and Commerce Committee's Health Subcommittee, can be expected to weigh in as well.
House Republican Leader John Boehner (R-OH), House Minority Whip Eric Cantor (D-VA), and House GOP Health Care Task Force Chairman Roy Blunt (R MO) are expected to continue highlighting Republicans' proposed health reform plan that focuses on costs, accessibility, and no public option.
Ranking minority members of the three committees with oversight of HR 3200—Joe Barton (R TX) with Energy and Commerce, Dave Camp (R MI) with Ways and Means, and Howard P. Buck McKeon (R CA)—had questioned the bill's costs during the tri-committee hearings and will likely continue their challenges over costs and the public option.
The fiscally conservative Democratic Blue Dog Coalition's Healthcare Task Force, lead by Mike Ross (D-AR), challenged access and cost issues during the Energy and Commerce meetings on HR 3200.
Lynn Woolsey (D-CA) and Raul Grijalva (D AZ) of the 83-member Congressional Progressive Caucus have called for a strong public option in the final House bill.
Barbara Lee (D-CA), chair of the 40-member Congressional Black Caucus, has called for a strong public option as well.
President Obama continues to face significant public resistance to his drive to initiate healthcare reform, with widespread skepticism about central tenets of his plan, according to a Washington Post-ABC News poll. But opposition to the effort has eased somewhat, and there appears to be potential for further softening among critics if Congress abandons the idea of a government-sponsored health insurance option.
The Joint Commission's newly created Center for Transforming Healthcare is teaming up with eight hospitals to identify and reduce deadly breakdowns in patient care. The center's first initiative is tackling hand-washing failures that contribute to healthcare-associated infections, which kill about 100,000 people each year and cost hospitals between $4 billion and $29 billion annually.
The Joint Commission President Mark K. Chassin, MD, credits the eight health systems that volunteered for the study with understanding that simply posting more signs or demanding that healthcare workers try harder isn't enough.
"A comprehensive approach is the only solution to preventing bad patient outcomes. These healthcare organizations have the courage to step forward to tackle the problem of hand washing by digging deep to find out where the breakdowns take place so we can create targeted solutions that will work now and keep working in the future," he says.
The eight hospitals and health systems in the center's first project to make care safer by being more reliable are:
Cedars-Sinai Health System, Los Angeles
Exempla Lutheran Medical Center, Wheat Ridge, CO
Froedtert Hospital, Milwaukee
The Johns Hopkins Hospital and Health System, Baltimore
Memorial Hermann Health Care System, Houston
Trinity Health, Novi, MI
Virtua, Marlton, NJ
Wake Forest University Baptist Medical Center, Winston-Salem, NC
The center will examine front-line problems that could hinder hand washing, such as a lack of individual accountability, or whether or not soap or alcohol-based hand rubs are convenient for caregivers to use. The center has already determined that many hospitals have been lulled by faulty data into thinking that hand washing is occurring more than is actually the case. In fact, using The Joint Commission-developed enhanced measuring standards, the eight hospitals in the study found that their caregivers washed their hands less than 50% of the time.
To improve compliance, new strategies being tested include: Holding everyone accountable—doctors, nurses, food service staff, housekeepers, chaplains, technicians, and therapists; using a reliable method to measure performance; communicate frequently and use real time performance feedback; and tailor education in proper hand hygiene for specific disciplines.
"Hand washing in hospitals should become as automatic as looking both ways before crossing the street," says William D. Petasnick, president/CEO of Froedtert. "As we achieve successful and sustainable progress in improving this long-standing issue, I'm confident hospitals can apply the same collaborative techniques and process improvement tools to other complex patient safety issues."
The next center project will target breakdowns in hand-off communications. The hospitals involved in that project are: Fairview Health Services, Intermountain Healthcare, Kaiser Permanente, Mayo Clinic, North Shore-Long Island Jewish Health System, Partners HealthCare System, New York-Presbyterian Hospital, and Stanford Hospital & Clinics. Future projects will focus on improving infection control, mix-ups in patient identification, and medication errors.
President Barack Obama, continuing his push to secure support for a healthcare overhaul, reiterated his willingness to address the issue of medical malpractice suits, a Republican priority. But the president suggested that his desire for a bipartisan bill wouldn't trump his ultimate goal of passing legislation this year. "We're not going to get a better opportunity to solve our healthcare issues than we have right now," he said in an interview on CBS's "60 Minutes."
Leading moderates in both parties have retreated further from the government-backed health insurance option, echoing the argument from President Obama that the issue had been overblown and that alternatives, such as private nonprofit cooperatives, might be acceptable. Senator Claire McCaskill, Democrat of Missouri, said the issue had become a "distraction" and Senator Jeanne Shaheen, Democrat of New Hampshire, voiced support for a public option but said Democrats should keep the big picture in mind. Senator Olympia J. Snowe, a Republican from Maine, said the public option is politically out of the question.
Although the government regularly pays $100,000 or more for kidney transplants, it stops paying for anti-rejection drugs after only 36 months. The healthcare bill moving through the House of Representatives includes a little-noticed provision that would reverse the policy, but it is not clear whether the Senate will follow suit. The 36-month limit is one of several reimbursement anomalies that many in Congress hope to cure.
Key members of the Senate Finance Committee moved to quell the latest furor over President Obama's healthcare overhaul, discussing added identification and enforcement requirements intended to prevent illegal immigrants from receiving federal benefits. The concern is whether the proposals being worked out by congressional Democrats with Obama's support would make benefits available directly or indirectly to people who are in the United States illegally.
Among the many hurdles facing President Barack Obama's plan to revamp the nation's healthcare system is a shortage of primary care physicians. As Massachusetts' experience shows, extending healthcare to 50 million uninsured Americans will only further stress the system and could force many of those newly insured back into costly emergency rooms for routine care if they can't find a primary care doctor, healthcare observers told the Associated Press. To keep up with the demand for primary care doctors, the country will need to add another 40,000 to the existing 100,000 doctors over the next decade or face a soaring backlog, according to officials from the American Academy of Family Physicians.
