Noise In The System: Health Care Reform and The New CFO

Noise In The System: Health Care Reform and The New CFO


Leonard Zwelling

As I write this, I am watching the GOP members of the House of Representatives take a victory lap around the White House Rose Garden with the President and Vice President in attendance. It has no meaning.

The awful legislation that these Members just passed still must go to the Senate where the margin of victory, if every Republican supports the bill, would be only 52 to 48, and that is only if the bill is passed using the reconciliation process that precludes the use of the filibuster. That would require only 51 votes.

To do that, the Congressional Budget Office financial score has to be a net negative to the budget and the Senate parliamentarian must agree. That is possible as many Americans with coverage now (e.g., Medicaid) may lose insurance under the GOP plan and thus cost the government less. The Republicans still need to get Susan Collins of Maine, Cory Gardner of Colorado, Ron Portman of Ohio, and Lisa Murkowski of Alaska to go along, something that is not at all guaranteed.

If the CBO score shows the bill would add cost to the budget, the Democrats will likely be able to filibuster the bill and the GOP will never get the 60 votes needed to invoke cloture and unstick the bill from the Democratic blockade.

But let’s say the bill goes to the Senate and on to Senate Committees like Health, Education, Labor and Pensions and Finance. It is likely the bill will be amended such that it will not match the House bill. Then, if eventually passed by the Senate in some way, it must go back to the House and the Senate version could be adopted as is (as the ACA was) by putting aside what was passed by the House today, or a conference committee of Dems and the GOP from both houses will be formed to iron out the disagreements in the two versions of the bill. After that, the common version would have to go back to each chamber for passage prior to going to the president’s desk.

So, you can see what I mean when I say this victory lap is a bit premature and that there is still a long way to go to get the ACA repealed and replaced by the AHCA.

But let’s say that all that gets done and the bill is signed into law by the president. Will it matter?

Probably not.

If anything, the new bill reinforces the effects of the market economy on health care. Since the demand for health care is insatiable and no one will ever say no, and the supply of providers is never enough, prices will rise and the whole system will go on in the way it has been for years. It is driven by high-priced technology; an aging population; the high cost of end-of-life care; and the rapacious nature of the pharmaceutical industry, the hospitals, the insurers and the providers. It’s a death spiral.

No one wants to give up even a cent of what he or she currently earns. So how will costs drop? Who even knows what quality looks like and won’t the market forces just crowd out the poor and those not insured at their work places? Won’t these same forces cause the prices of American products to rise in a globalized world and increases in pay for American workers to be limited? Of course they will.

The only good thing about this bad bill is that if passed into law, it will probably bring about the single payer system that much faster as more people lose coverage and demand Medicare for all. It is inevitable.

This brings me to the new announcement that Ben Melson is coming back to MD Anderson as Chief Financial Officer. This is a great thing for MD Anderson. Ben is a good and honorable man with tons of experience that will be vital to getting the Anderson’s financial house in order.

But it won’t be enough.

For MD Anderson to right itself from the downward spiral of the past 15 years will necessitate a new leadership team and a new strategy for the institution. Please MD Anderson, welcome back Mr. Melson. He can only make things better, but he cannot cure what ails the body politic of Anderson. That will require new leadership establishing a new direction that both sets a course to success and expunges the memory of the past decade and a half.

If morale is to improve, the players on top need to change.

Anything else is just noise.

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