Experts debate the fate of health-care bill

Is health reform dead - again?

Joseph Reichman, president of the Medical Society of New Jersey, says he thinks it is, and that's OK with him.

"I look at this as derailing the president's plans," he said of Tuesday's election in Massachusetts, which filled the late Ted Kennedy's Senate seat with Republican Scott Brown. That will make it much harder for Democrats to pass bills in the Senate without Republican support, and Republican support for the current bills has been nearly nonexistent.

"I think the voters of Massachusetts were giving the president a referendum on his policies and particularly his health-reform policies," Reichman added.

Reichman, a plastic surgeon, says he supports an overhaul, but he wants a bill that includes changes in malpractice rules, reductions in administrative costs, changes in Medicare-payment rules for doctors, and more money for primary care.

"I would start over," he said.

But Ron Pollack, executive director of Families USA, a consumer group that supports the Democratic bills, says he thinks the idea that reform is dead "is absolute nonsense. I can't say that any stronger. I think health reform will go forward in a robust fashion, but the process of getting it across the finish line will change." He said he thought a substantive bill could pass by February.

Without 60 Democratic votes in the Senate, Democrats are left with unappealing choices. One option is for the House to approve the Senate version of the bill. Another strategy, which Pollack supports, would avoid further Senate votes requiring a 60-vote supermajority. The House would approve the Senate bill and then make changes with the Senate in a process called reconciliation that does not require a 60-vote majority.

Top lawmakers, including Obama, were already scaling back their ambitions yesterday, according to the Associated Press. They laid out a new approach that could still include these provisions: limiting the ability of insurance companies to deny coverage to people with medical problems, allowing young adults to stay on their parents' policies, helping small businesses and low-income people pay premiums, and changing Medicare to encourage payment for quality care instead of volume of services.

Obama urged lawmakers to focus on "elements of the package that people agree on."

Meanwhile, Marc Stier, Pennsylvania director for Health Care for America Now, an activist group, spent his day plotting strategy with state and national activists.

"We talked about whether there's a way to pass health-care reform, and there is," Stier said. "Now we have to figure out if there's the will, and that's my department - to manufacture the will."

Protests and rallies will need to be accelerated to persuade Congress to act, despite the potential Senate setback.

"It's still something the country demands," he said.

Betsy Ryan, president and chief executive officer of the New Jersey Hospital Association, said it was too early to tell what will happen, but she hopes all momentum is not lost. "It would be a shame to see all the good work done on both sides of the aisle go to waste," she said.

Failure to do anything, Pollack pointed out, likely would lead to even larger numbers of people without insurance. It also would be a big political failure for Democrats, who still hold the presidency and majorities in the House and Senate.

Ralph Muller, CEO of the University of Pennsylvania Health System, said the Massachusetts vote would slow down the overhaul, but that Democrats will pursue something, even if they have to break the legislation up into smaller bills. "I don't think they'll drop it," he said. "They can't drop it."

He said he believed Democrats still had enough power to make some changes. "They do have 59 votes," he said. "They should be able to get something done."

Muller said he thought Democrats should have done a better job of focusing on the uninsured and capitalizing on people's fear of losing their jobs - and hence their health insurance. "There's an old saying," he said. " 'The main thing is to keep the main thing the main thing.' They got distracted."

Robert Field, a health-law expert at the Earle Mack School of Law at Drexel University, agreed that one of the primary drivers of change - the millions of uninsured, underinsured, and potentially uninsured Americans - got lost in the debate. "What people now see is an expensive complicated new program and they've completely forgotten why it was proposed in the first place," he said.

He sees little hope in starting over because health care has become the "third rail of American politics" that burns everyone who touches it. If nothing happens, he said, "Who is ever going to try to address this in our lifetimes?"

"I don't think there is any stomach to start over again," said G. William Hoagland, a longtime budget adviser on Capitol Hill and now the vice president of public policy for Cigna Corp., a national health insurer based in Philadelphia. "We're just flat-out burned out."

Hoagland spent much of his day tutoring colleagues on the twists and turns of budget-reconciliation legislation. His 33-year congressional career began with a stint in the Congressional Budget Office and ended as budget adviser to former Senate Majority Leader Bill Frist (R., Tenn).

The best approach may be to continue negotiating until both sides craft an acceptable bill, he said. It would be best to move the legislation along quickly, even if the result is a more streamlined bill.

Too many businesses, like Cigna, find themselves in a state of uncertainty as debate continues in Washington. "And that's not good for anybody, not the businesses and especially not the uninsured. We'd like to get on with it so we can all plan."