So many health care reform proposals are flying around the nation’s capital it’s nearly time to bring in the air traffic controllers. There are draft bills, option papers, proposals, outlines, and about any other kind of document you can name whirling around like jets over O’Hare.

Michael Johnson of Blue Shield of California and I gave a presentation on health care reform Wednesday to a group of health insurance brokers. We were reading up on one of the latest ideas issued a few hours earlier literally minutes before the panel got underway. It’s only going to get worse as some stake out (somewhat extreme) negotiating positions while others offer up potential compromises.

Here’s some of the more recent health care reform proposals to be launched — or about to be:

1.  The web site The Hill is reporting that moderates in the House of Representatives from both sides of the aisle are meeting in private to fashioning a compromise package. Among those meeting are part of the GOP’s “Tuesday Group,” the New Democratic Coalition and the Democratic Blue Dog Coalition. Fearing retribution from party leaders, neither side is offering the names of participants. The meetings are significant not just because they are likely to produce yet another health care reform package. The negotiations also underscore the reality that while the media tends to portray both Democrats and Republicans as monolithic parties of extreme ideologies, there are a significant number of lawmakers who eschew the hardline ideology of their colleagues and search for pragmatic solutions.
2. Former Senate majority leaders unveiled a health care reform plan they hope will provide a middle ground in debate. The plan was developed by Republican former Senators Howard Baker and Bob Dole along with Democratic former Senators Tom Daschle and George Michell. (Former Senator Mitchell is credited by the Boston Globe with having contributed to the document, although it is signed by only Senators Baker, Daschle and Dole). It weaves around the middle on a number of issues, although it does lean to the left. For example, while the proposal does not call for a creation of a federal government-run health plan it would permit states to create them. It also calls for taxing the value of health plans an employee receives to the extent it exceeds the cost of coverage provided to members of Congress. According to the Boston Globe this would amount about $5,000 for an individual and $13, 000 for a family.
3. The House Republican leadership unveiled their health care reform plan on Wednesday, too. Among other features it would allow states, small businesses and other group to come together into “pools” to offer low cost health plans that, at a minimum, is provided in a majoirty of states. It also would offer lower-income Americans refundable tax credits they could use to purchase coverage and would make individual health insurance premiums tax deductible. It does not require consumers to buy coverage, but the GOP plan would encourage states “to create a Universal Access Program by establishing and/or reforming existing programs to guarantee all Americans, regardless of pre-existing conditions or past illnesses … access to affordable coverage.” Development of the GOP plan was led by Representative Roy Blunt.
4. Last week the Chairs of the three House committees with jurisdiction on health care reform released a framework for reform. The Tri-Committee Health Reform Draft Proposal, put forward by House of Representative Chairs Charles Rangel of the Ways and Means Committee, Henry Waxman of the Energy and Commerce Committee, and George Miller of the Education and Labor Committee outlines the key provisions of a unified Democratic reform package. The framework calls for creation of a government-run health plan to compete with private carriers, requires all Americans to obtain coverage (with exemptions in cases of financial hardship), requires most employers to either provide coverage or pay a fee, and provides subsidies for Americans households with incomes up to 400 percent of the federal poverty level.

There will be many more proposals coming soon. As it is relatively early in the legislative process, most will stake out relatively pure ideological positions. Neither party has an incentive to offer compromise solutions yet. So House Democrats, along with Senator Edward Kennedy and his Health, Education, Labor and Pensions Committee, will anchor the left and the GOP Leadership and conservative Senators will anchor the right. As in most negotiations, the goal is to establish a starting position so far to one extreme or the other that the middle shifts in their direction.  

There will be some pragmatic proposals put forward as well. The most anticipated is that expected to be coming soon from the Senate Finance Committee. It’s Chair, Max Baucus, and its Ranking Member, Charles Grassley, seem to be sincere in their efforts to put forward a bi-partisan solution. In the meantime, President Barack Obama will keep up a drumbeat in support of getting comprehensive health care reform legislation through Congress before the end of the year. Although the White House continues to let Congress take the lead in fashioning the final reform package, the Obama Administration is beginning to get more engaged in the legislative process.

What the final health care reform legislation will look like is, as yet, unknown. It may resemble one of the ideas already put forward. Or perhaps something new to the mix will gain momentum. I’m betting that something will pass this year. The process of getting to one bill will be messy, but eventually, a consensus will form.

Not yet, but eventually.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics Tagged: Blue Dog Coalition, Charles Grassley, Charles Rangel, Edward Kennedy, George Miller, George Mitchell, Henry Waxman, House Education and Labor Committee, House Energy and Commerce Committee, House Ways and Means Committee, Howard Baker, Max Baucus, New Democratic Coalition, Robert Dole, Roy Blunt, Tom Daschle, Tuesday Group

There’s a chicken and egg aspect to health care reform which often frustrates lawmakers and policy makers. To achieve universal coverage the cost of health insurance must be affordable. To make coverage affordable you need universal coverage. So which comes first?

My take is that affordability has to come first. You cannot require people to buy something they cannot afford. When a pen is out of ink, all the regulations in the world won’t fill it again. This means the government has to make coverage affordable, most likely through subsidies of some kind. Subsidies are expensive And the budget, already groaning under the weight of the recession, two wars, an economic stimulus package, existing entitlements, and much, much more. Congress will be hard pressed to find the funds needed to provide the premium support required to get close to universal coverage.

Consequently, affordability needs to come first. This explains, in part, Director of the Office of Management and Budget Peter Orszag’s consistent focus on the as much as $700 billion in medical spending each year that goes towards services which do not improve health outcomes.  He began pushing lawmakers on this issue when he was Director of the Congressional Budget Office and he continues in his new role at the OMB.

The opportunity for health care reform to reign in medical costs received a substantial boost recently with the publication of an article in The New Yorker by Dr. Atul Gawande, a Boston surgeon who is also a staff writer for the magazine. Titled “The Cost Conundrum,” the article described Dr. Gawande’s exploration of medical practices in McAllen, Texas. That community spends more per person on health care than anywhere in the country with the exception of Miami, Florida which has higher labor and other costs. McAllen’s spending is twice that of nearby El Paso, Texas, even though the two areas have similar demographics and similar outcomes. The explanation, Dr. Gawande discovers, is the entrepreneurial culture of the community’s physicians. They maximize their incomes, but fail improving the health of their patients.

The article has been cited by President Barack Obama (who, it is said, has made the piece required reading for his staff), members of Congress, pundits and policy wonks. Few magazine articles have had comparable impact on the health care reform debate.

Those wanting to learn more about what he discovered in McAllen will enjoy an interview with Dr. Gawande  on Public Radio’s Fresh Air. During the nearly 30 minute segment, the doctor expands on his article providing insights from his own practice.

Dr. Gawande has made a valuable contribution to the health care reform debate by shedding light on the correlation between community medical practices, health care costs, and health outcomes. For anyone interested in health care reform, his Fresh Air interview is well worth the investment of time.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, medical cost containment Tagged: Atul Gawande, Congressional Budget Office, Cost Conundrum, New Yorker magazine, Office of Management and Budget, Peter Orszag

Among the duties of the Congressional Budget Office is determining the financial impact of legislation proposed by lawmakers. Their highly credible analyses is given great credence within Congress. Which means today’s preliminary report on the health care reform package crafted by Senator Edward Kennedy and other members of the Senate Health, Education, Labor and Pensions Committee is especially important.

The CBO Preliminary Analysis of the Affordable Health Choices Act, released on Monday, underscores the challenge Congress faces in attempting to insure the uninsured without breaking the federal budget. Before discussing the finding, it is important to note: this is a preliminary analysis of draft legislation. The CBO analysis focused on “major provisions on health insurance coverage,” leaving several important elements out of their review. There are elements of the draft bill that have not yet been modeled, for example, allowing children through age 26 to be considered dependents on their parents’ policies. There are a host of other caveats involved. So it is best to treat the findings of this report as broad and directional.

Considering the sincere commitment Senator Kennedy and his allies have for universal coverage, the direction of the Congressional Budget Office’s conclusions must be disappointing.

Without intervention, the CBO estimates that by 2019 approximately 228 Americans under the age of 65 will have health care coverage, but from 50-to-54 million people — about 19 percent of this population — will not. If the HELP Committee’s health care reform package were enacted, the CBO estimates the percentage of uninsured would fall to 13 percent of the non-elderly population would still be without coverage — approximately 36 or 37 million.

The net increase to the federal budget for covering these 13-to-18 million Americans would be $1.o trillion between 2010 and 2019, most resulting from the subsidies the legislation would offer to individuals earning up to 500 percent of the federal poverty level purchasing coverage through a government-run Exchange.

In the CBO Director’s blog posting on the analysis, Director Douglas Elmendorf points out that while the study estimates that 39 million Americans would obtain coverage through the Exchange, “the number of people who had coverage through an employer would decline by about 15 million (or roughly 10 percent).” He pegs the net decrease in the nation’s uninsured at about 16-to-17 million people.

No one claims comprehensive health care reform will be easy. The Affordable Health Choices Act is only one reform package on the table. And, as Politico.com reports, the White House made clear it is not the Obama Administration’s plan.  The CBO preliminary analysis on the draft legislation developed by the Senate HELP Committee makes clear just how difficult – and expensive — it will be.  Will the CBO report convince lawmakers to scale back their ambitions for government’s involvement in America’s health care. Perhaps, but I wouldn’t count on it. Health care reform is as much about ideology as pragmatism. 

The CBO study should embolden Congressional moderates, however, to stand firm for comprehensive reform that neither breaks the budget of the federal government nor American families.

Posted in Barack Obama, Health Care Reform, Healthcare Reform Tagged: Affordable Health Choices Act, Edward Kennedy, health insurance exchange, Senate Health Education Labor and Pensions Committee

You spend a lot of time creating great content and attracting an audience for your blog. What if you could use that influence to make a positive social impact? Now you can.

We’ve teamed up with SocialVibe, and now by adding the SocialVibe widget to your blog, you are able to earn donations for the charity of your choice by getting sponsored by a brand that appeals to you.

Each time someone visits your blog and engages with your brand (by rating a video, for example), you’re making a difference. That impact is immediately visible on your badge, i..e., ‘My blog has provided 63 cups of clean water for people in need.’

The money donated comes from your brand, so you and your readers never have to pay a dime.
In addition to earning donations, you’ll also get feedback from your charity about the difference they’re making thanks to you. By clicking the charity logo in the badge, you can find information about your cause and view real-time goal progress.

Setup is easy and only takes a few clicks – just go to Appearance->Widgets in your dashboard, add the SocialVibe widget and pick a cause and a charity. For more details you can find documentation in our support area. If you change your mind about your sponsor or cause, you can easily make adjustments by visiting your widget dashboard.

If you are running a self-hosted WordPress blog, be sure to grab the SocialVibe plugin.

With SocialVibe, our community can pool our individual influences to create positive change in the world.

Sorry for this being the latest wrap-up ever.

May was a fun month for us. We rolled out a ton of new features: the ability to add YouTube videos and polls to comments, stats in your time zone, the VideoPress upgrade (with HD!), post by email, new stats charts, comment search, improved comment reply by email, and VideoPress.com.

May was also the month for our largest-ever WordCamp San Francisco. Mission Bay Conference Center was a packed house, but (amazingly) everything ran on schedule, and nothing went wrong! A round of applause is due to our sponsors, speakers, and everyone who attended for helping to make WordCamp such a smooth success. Thanks for making it all possible.

For post-event coverage of WordCamp, check out the updated site for WordCamp San Francisco 2009.

And now, the stats for May:

• 387,416 blogs were created.
• 411,704 new users joined.
• 5,504,742 file uploads.
• 3,333 gigabytes of new files.
• 826 terabytes of content transferred from our datacenters.
• 8,625,931 comments.
• 6,914,546 logins.
• 1,243,177,638 pageviews on WordPress.com, and another 1,207,143,849 on self-hosted blogs (2,450,321,487 total across all WordPress blogs we track).
• 2,105,723 active blogs where “active” means they got a human visitor.
• 1,728,890,160 words.

Plus:

There were 12,123 post-by-email posts since the release of that feature on May 12.

Video uploads are on the rise after the release of the VideoPress upgrade: 5,587.

WordCamps in May: WordCamp Toronto, WordCamp Richmond, WordCamp Mid-Atlantic, WordCamp Columbus, WordCamp Milan, WordCamp Ed CUNY, WordCamp San Francisco.

WordCamp San Francisco had 739 pre-event registrations (a huge jump from 427 last year), and 789 actual attendees from 32 countries — plus 15 speakers, six sponsors, and lots of volunteers.

WordCamps in June: WordCamp Chicago, WordCamp RDU, WordCamp Brazil, WordCamp Dallas.

Health.com has launched the Ask the Natural Living Experts forum hosted on the new TalkPress VIP service.

We’ve got two Yahoo! related news items today.

The first is that we’ve launched a Yahoo! 360 importer (listed in your admin screens under Tools → Import) to make migration from 360 to WordPress.com super easy. Just upload the Yahoo! 360 export ZIP file, and we’ll do the rest. Yahoo! will be shutting down their 360 service soon, so if you have any friends over there feel free to give them a little help and encouragement to head over to WordPress.com

Second is the release of our WordPress.com QuickPress Yahoo! Application. You can post posts and read and moderate your most recent comments straight from My Yahoo!. (Note to any self-hosted WordPress.org folks out there: the app currently only works on WordPress.com. We’re working on making it .com/.org universal.)

Thanks to Yahoo! for their help with their Yahoo! Application Platform, and thanks to all of you for the best blogs on the intertubes.

If you need help with either of these new toys (or anything else), please contact our support team.