January 19th, 2010
01:47 PM ET

Massachusetts vote pivotal in health care reform

By Caleb Hellerman
CNN Medical Senior Producer

While our reporters and many of our resources are still in Haiti, there’s other big news today. Massachusetts voters are picking the replacement for Senator Ted Kennedy. The latest polls suggest Scott Brown, a conservative Republican, had nosed ahead of state Attorney General Martha Coakley. That would leave Senate Democrats with a 59-41 majority, instead of the 60 seats they have now.

Why talk politics in the Paging Dr. Gupta blog? Because the Massachusetts vote has an outsize impact on the fate of the health care bills. Refresher: The Senate and the House of Representatives have each passed a bill to overhaul the health care system. They’re largely similar: Each would expand insurance coverage by requiring individuals and businesses to purchase policies, and offering subsidies to help pay for it. Each would put new requirements on insurance companies, so they can’t turn people away or charge outlandish rates.

But the two bills have their differences. To become law, they need to be merged into a single version – which each chamber of Congress would have to approve, before sending to the president for his signature. In the Senate especially, it’s close. Senate rules allow a minority of 41 senators to block the vote. Since the 40 other Republicans are unanimously opposed to the health care bill, a victory by Scott Brown would let them block the bill.

It’s ironic: The nail in the coffin of the health care bill could come from the seat that for the past 48 years was held by the country’s most famous champion of health care. And from the state that already has near-universal health insurance, under a system much like the one proposed in Congress.

Still, if Brown wins today, the debate isn’t over. Aside from scrapping the whole effort, Democrats could:

* Try to pass the bill before Brown is seated. Considering the differences between the two bills, and the passions involved, that would be a tall order.

* Try to pass a bill using the budget reconciliation process. This is complicated, but basically, it requires only 51 votes instead of the 60-vote supermajority. However, it can be used only for items directly affecting the federal budget. Taxes and subsidies – yes. Other provisions, such as the requirement for insurance companies to cover people with pre-existing conditions – maybe not. Expect a lot of controversy if Democrats try this route.

* The House could pass a bill identical to the Senate’s version, eliminating the need for a re-vote. That is pretty unpopular with many House members, who want to fight for changes – especially on abortion and taxes. But those members could decide that the Senate bill is better than no bill, and push for changes later, perhaps through budget reconciliation.

Do you want to see a health reform bill? What would you like to see happen next?

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soundoff (7 Responses)
  1. Domingo Stern

    I would like changes to prevent what happened to us.
    My wife has post-polio syndrome and in 2000 she basically stopped walking and the doctor ordered a type of motorized wheel chair. The cost at the time was close to $20,000.00.
    The premiums increased and the coverage actually decreased. In 2009 we needed to replace the chair. In the meantime the negative effect of the postpolyo syndrome increased. The doctor ordered a new chair with additional features. The cost of the new chair was $36,000.00 but the insurance capped coverage for Durable Medical Equipment to $2,500 i.e less than 10% of actual cost.

    January 19, 2010 at 14:21 | Report abuse | Reply
  2. raymond

    i live in canada where we are provided with health care, it goes to any canadian who is sick,rich or poor. we pay for this with our taxes but it works,also when buying wheelchairs or motorized chairs it is best to bypass the insurance companies and pay for it yourself you will save in the long run,in canada the goverment pays 75% of the cost and the private insurance pays 25%, my wheelchair was $5200 that cost the insurance company ,i could of bought the chair for $1500 right from the manufacturer which is in the states,it pays to shop around even if you have insurance,anyone selling healthcare products are in it just for the money,maybe you can make a deal with your insurance company.

    January 19, 2010 at 15:06 | Report abuse | Reply
  3. scott

    With all the bad things that have happened in the last year I found a blessing when I discovered a free discount prescription card that gave me and my loved ones a discount at the pharmacy. After I was layed off and could no longer afford COBRA the price of our prescriptions was CRAZY. We saved anywhere from 15 to 55% on average and this was a true blessing. Here is the website if anyone is interested http://www.yourdrugstore.us

    Hope everyone finds a job soon!

    January 19, 2010 at 20:37 | Report abuse | Reply
  4. ben

    Maybe the people in Mass voted this way because A. they are not happy with the cost controlling problems their system has produced and.or B. they already pay for universal coverage for people in their state and don't want the additional tax burden to also pay for it federally.
    I know that the most articles I read in the general media can't fathom why anyone would be opposed to this legislation but on Tuesday we got a small window view into the angst the American people feel about the Obama administration and Democrats in congress ramming this legislation through and down our throats. I think they are in for a rude awakening when November comes around. Think of this as a preview of things to come.

    January 23, 2010 at 01:24 | Report abuse | Reply
  5. T. Rafael Cimino

    I’m sorry to say that we, as Americans, may have missed the window of opportunity to not only reform healthcare, but to save our countries economy at the same time. The same crisis that is healthcare can also be the same catalyst for meaningful economic reform. The kind of reform that is not only progressive in nature, but also conservative in principle.

    A single payer system could have saved out nations economy and solidified our financial strength and this is how.

    A single payer system, as originally designed by the current administration, is an extension of Medicare to each and every American, regardless of age or income. Opponents, of course, will call this “Socialized Medicine,” but a single payer system is no more socialized medicine than Social Security is socialized retirement. While many like to belittle our government’s fiscal prowess, one fact stands alone and is undisputed. The U. S. Medicare system is one of the most efficient in the world and serves as a model for hundreds of countries that watch its every move. Medicare spends an average 2 cents of every healthcare dollar on administrative costs where as the average for profit Health Insurance Company spends over 25 cents of the same dollar.

    Let’s face the facts. The U. S. Government is already paying seventy two percent of the healthcare bill. All of the debate; the tea parties; the town hall brawls; the bitter national polarity, is over the remaining twenty-eight percent. And it is this twenty-eight percent that remains the most expensive healthcare coverage in the world; and the most profitable.

    The key to solving the healthcare puzzle while at the same time giving our country an economic stimulus that we really need is in the numerous overlapping coverage redundancies. At any given time we are covered by literally thousand of different healthcare policies. Think about it. If you drive to work, you auto policy has a personal injury protection component, better known as PIP, built into it. Once you get to work, you are covered by your employer’s worker’s compensation policy. The building you work in has a liability policy and embedded into it is something called MRC. The initials “M-R-C” are probably the most expensive letters in the English alphabet. They stand for “Medical Risk Component” and cost the American consumer over 300 Billion dollars a year. MRC accounts for some of the highest profits for insurance companies and is an embedded tax that is stitched into everything we touch, drink, drive, eat, fly on or wear. If a product’s manufacturer has a liability policy they are paying for MRC.

    If we were to wave a magic wand and cover every citizen with our current Medicare system, while at the same time mandate immediate reductions within State and local government this is what could happen.

    * States could not require drivers to carry PIP insurance. It’s a redundant policy and would not be necessary saving the auto owner an estimated $ 138 per vehicle per year.

    * Our Medicaid system could be abolished saving hundreds of millions of dollars in duplicated efforts of maintaining two separate government systems.

    * If you were a homeowner your property tax bill would be reduced significantly as State and local governments would not have to make their prescribed local contributions to Medicaid.

    * As a business owner your worker’s compensation premiums would be reduced dramatically. This is an added benefit to the ailing construction industry that pays some of the highest rates in the country.

    * The free market system would lower the price of consumer products because the price of liability insurance would be significantly reduced.

    * Realistic Tort reform could take place because medical payments, one of the great stumbling points, would be off the table.

    * Our struggling automakers could reduce the price of their cars by as much as $ 2,500, the amount that is built into every Ford, Chevy and Chrysler car/ truck to cover the company’s past and current healthcare obligations.

    * Many who maintain menial employment for the healthcare benefit would simply quit, creating more jobs for an already scarce market.

    * We could abolish the redundant Veteran’s Administration healthcare program and give our nations finest the same great medical treatment that we as civilians enjoy.

    * Local and state governments would not be burdened by the healthcare cost for inmates in prisons and jails. Prosecutors, Sheriffs and Wardens could stop making incarceration decisions based on an offender’s health status.

    * Medical mal practice rates would drop significantly as the MRC of these polices are some of the highest in the insurance industry.

    * Ambulances, Fire Departments and Rescue squads would not be overwhelmed with the burden of transporting the un-insured who merely need a priority status in emergency rooms. The type of status that only comes when an emergency vehicle transports a patient.

    * Emergency Rooms could get back to treating real emergencies and would not be burdened with patients who use these life saving facilities as their primary care providers.

    * We could reduce significantly the estimated 45,000 deaths that occur each and every year, attributed to patients with lacking or no health care coverage.

    * Marriage could once again, be an institution of love, and not an avenue for dependant healthcare coverage.

    The cost is simple. We would have to increase the Medicare tax that is already in place and deducted from earner’s paychecks. The rate is estimated at 9.6% and would be split by the employer and the employee. Employers who are currently providing private healthcare coverage could opt to pay the entire amount as part of a benefit package. Keep in mind that at the 9.6% rate, this bolsters Medicare to a point where it provides 100% coverage with no deductible.

    The repercussions are obvious. We would significantly reduce the profits of the largest, most powerful insurance companies in the world. Could this be why, in late 2008, on the eve of a new presidency- a president with a healthcare reform agenda- America was thrust into a bailout program, essentially marrying government to the insurance industry.

    As a kid I was inundated with science fictions movies that depicted mankind being ruled by its own creation. 2001 and then 2010, the space odyssey movies, and more recently Steven Speilberg’s Eagle Eye with Shia Labeouf, all depicted computers, or robots turning against the very human race that created them. In George Orwell’s book 1984, he warned us of a “big brother” like government that watched our every move. While entertaining, these stories missed the mark because in the end, in real life, the one creation of man that has turned against us is not a robot, or a computer, or even our government. It’s our health insurance companies.

    January 28, 2010 at 10:50 | Report abuse | Reply
  6. kd

    I would like to use T. Rafael's magic wand to stop the following wasteful ER visits and hospitalizations for:

    1. Young patients with self induced vomiting with or without blood in order to get dilaudid IV (potent narcotic). Then we end up having GI doctors to perform repeated endoscopy for the diagnosis.

    2. Patients with both medicare and medicaid, younger than 50 year of age wearing designer clothes ,driving expensive cars, talking on I-phone while making their doctor waiting for them to finish the phone conversation.

    3. Patients with both medicare and medicaid whom able to spend $2000 monthly for "medical marijuana" and own expansive snow mobile.

    4. Patients with " chronic pain syndrome" and only medication will work for their pain is specifically "DILAUDID".

    5. Tooth ache patients in the ER

    6. SOB patients whom is on home oxygen and continue to smoke cigarettes and hospitalized at least once a month for the same.

    7. Intravenous drug abuse patients for infected heart valves and stroke with multiple abscesses.

    8. ER doctors play up patients' symptoms in order to transfer patients to bigger facilities. Patients are ended up paying for long ambulance drive or Medstar for helicopter drive.

    9. Lazy specialists don't want to come into the hospital in the middle of the night of week end. Dumping these patients on "hospitalist service" . These patients ended up getting double charge from there on by seeing at least 2 doctors unnecessarily.

    10. either do away with PAs/ARNPs or their supervised physicians have to physically put a hand and stetstoscope on the patients in order to get pay for their service.

    These are just a few simple examples we could save hundred of millions health care dollars instantly and use the money on people who really needs it.

    February 26, 2010 at 07:31 | Report abuse | Reply
  7. Don Miller

    There are a lot of ideas to reduce healthcare costs. As a retired business man I am surprised that no one has mentioned speeding up hospital billing. Anytime I have been in the hospital I have never received a prompt I was discharged!

    No other business would survive a month doing this. Businesses usually look for payment within 30 days.

    I realize that bills must first be submitted to medicare, and maybe other organizations. But, I year!!!

    March 2, 2010 at 09:28 | Report abuse | Reply

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.