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Time to Unite

Posted By Ben Miller, Friday, September 11, 2009
Updated: Wednesday, June 1, 2011

It appears that the infamous "Gang of Six" are emerging with a health reform bill sometime early next week (Senate Finance Committee). Will this Bill from the Senate side be more comprehensive? Offer a public option? Many speculate that this Bill may be the one that is most likely considered as a contender in the race for health reform. The Gang of Six is an anomaly of sorts. First, they are bipartisan, and have been from the beginning. Second, they are the Finance Committee. Let's construct these two points for a moment and consider their implications:

1) Collaboration and compromise: There is no doubt that this group had to simultaneously collaborate and compromise to get anything out the door let alone a complex Bill for health reform. Think of who is in this group (Enzi, Grassley, Snowe, Baucus, Bingamen, Conrad), there are some real political difference here. The take away is that there had to be some level of collaboration to get anything done. President Obama has tried to have bipartisan support for health reform, but this has not worked as well as he would like; however, this group may be the lone exception. Now there will be significant compromises here, but it is a product isn't it?

2) Finance Committee: Some of the most significant arguments for and against health reform have come down to money. As we all know, healthcare is expensive. As we all don't know, if we don't change healthcare (and fast) no one will be able to afford it (see HERE and HERE for examples). Oh, and most of us have read and seen Gawande's New Yorker article on cost by now (but if you haven't HERE). So cost (read financing) has everything to do with health reform hence the reason this coming from the people who talk about financing in government is important.

So, if a group of six individuals, representing different states, political ideologies, and interests can come together and deliver a product on health reform, why can't we? Why can't different professional associations sit at the same table and talk about reform? Why can't different disciplines collaborate around a united cause? Not to say this doesn't happen (CFHA as an outlier), but it should happen more!

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Comments on this post...

Randall Reitz says...
Posted Friday, July 8, 2011
To your first point, I share the frequently stated position that both sides are in 80% agreement, but that the debate has grown very heated on the last 20%. In considering Senator Kennedy's legacy, I applaud his incremental approach to legislation. It would be great to get the omnibus health bill that many of us have yearned for, but it would be soul crushing to get nothing.

I was pleased to hear President Obama voice his willingness to include a discussion of malpractice reform, but I'm pretty convinced that this volley was disingenuous. I hope that it wasn't because were they to add serious malpractice language, it would 1) bring along a few Republicans, 2) add cost containment, and 3) strengthen primary care.
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Peter Y. Fifield says...
Posted Friday, July 8, 2011
I think one crucial element we are missing is data that supports our cause. As Randall stated in the last blog; the IMPACT model has some significant traction already but it may undermine our overall cause to get more experienced clinicians (MH counselors and psychologists) in a clinician role. What would be advantageous to our cause would be data that shows integration/collaboration reduces overall cost and/or improves actual health outcomes. Ben could this be where the CCRN could play a role?
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Ben Miller says...
Posted Friday, July 8, 2011
I would hope so that is why we created it. As I have said elsewhere, we are not in the CCRN business for another publication (though they are nice and needed), we are in it to advance the notion of health beyond where it currently stands! I would highly encourage folks to check out DIAMOND.
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Daniel Mullen says...
Posted Friday, July 8, 2011
Not so fast.

The issues getting all the press on this compromise are preventing coverage for undocumented immigrants and abortion. This Times article reviews more significant, albeit less headline grabbing, obstacles that have yet to be overcome.

I for one support expansion of public coverage but I am skeptical that it can be accomplished without a significant increase in expenditures. Pushing some of that cost onto states seems disingenuous and problematic.

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Peter Y. Fifield says...
Posted Friday, July 8, 2011
Ah, touche Dr. Mullin. As with all policy, sometimes movement moves you towards your goal, and sometimes movement moves you away. The article updating the "Gang of Six" can be read here
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