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Health care deform

It's a wonder how little accurate information about health care reform is actually out there.

Once again, Republican foes of progressive legislation are showing how much better they are at getting their point across, even if it is not going to help the one interest group that should matter the most: voters. In fact, it seems like all the other interest groups have got their campaign donations in already.

For our health case system to succeed, the reform plan has realize to critical objectives: 1) everyone must be covered, and 2) we can't make the private insurance companies cover everybody. Contrary to what health care reform foes have been saying this does not require the government to manage health care, nor does it even require a single payer system.

But there are some powerful lobbies in the fray. It serves to take a closer look at how they see the problem.

Insurers: The big insurers will most likely be fine, but with the government providing no-profit health insurance to millions more people than it does now, there's likely to be some erosion of profits. Some would say that's not a bad thing, because those profits show up as costs that don't translate into improved health care outcomes. The small insurers that cherry-pick their customers stand to lose more business to the government program.

Employers: For employers, reform is likely to give more predictable health care costs, in spite of the loss of control over employee benefits that large companies want to retain. But there are some powerful progressive CEOs who may step out of line in an effort to shake the death-grip that health care costs has put on corporate profits.

Physicians: Generalists are more likely to support reform than specialists, but the trend among practitioners reflects increasing frustration with the private bureaucracies that have become even more arcane and complex than the public ones. They also want to tie malpractice reform to quality guidelines and get permanent adjustments to Medicare reimbursements so that fees don't ratchet down every year. This could be an excellent win-win opportunity for physicians.

Hospitals: One might think hospitals stand to benefit the most from universal coverage, particularly with reduced emergency-room primary care. But the White House plans also include serious efforts to cut costs that would require hospitals to substantively change how they do business. Since the May summit, the American Hospital Association has been backpedaling. Expect the plan coming out of Congress to be devoid of serious cost-cutting measures if hospital executives get the access to congressmen they're accustomed to having.

Pharmaceuticals: It seems likely that in any reasonable scenario drug company profits will go down. They are certain to oppose any plan that gives the government more bargaining power. However, a pharma-friendly plan might increase the volume of medication sold, so it's quite possible that while profits from exotic high-priced medicines will dry up, the profits from widely needed medicines will benefit from the much larger patient base that is now being denied access to life-saving meds.

Unions: Labor unions are already active and if a plan passes, a share of the credit will go to their efforts. But unions are far from unified when it comes to the details. Public-employee unions and industrial unions don't like the idea of reducing the tax-break on health benefits because it would most likely have an adverse effect on the beneficiaries of older more generous contracts, at least those that have survived the collapse of the auto industry. On the flip-side the Service Employees International Union has labeled this issue as theirs and will do whatever it must to make univeral coverage a reality.

Still, the largest group hasn't yet really chimed in yet: the 3/4 of covered Americans who say they are at least somewhat satisfied with their insurance. They have had to trade higher wages for health insurance and they're ambivalent about making the trade with the government instead of their employers.

Ultimately the success of health care reform will be determined by what individual taxpayers' calculators display when they do the math before and after the plan. But for now, it seems like the momentum is toward realizing President Obama's plan, even if it looks like it will be compromised in its details.