Friday, July 22, 2011

Finally Friday Edition

It's hot but it's Friday, so it's all good. Except maybe the news. Let's see:

Some reports indicate that the President and Speaker Boehner are close to a deal to cut spending and overhaul the tax system, cutting the debt by $3 trillion over 10 years, and raising the debt ceiling. There are big details remaining -- there would be a trigger if the tax overhaul didn't happen in 2012. President Obama wants the trigger to be a tax increase on the wealthy; Boehner wants the trigger to be a repeal of the individual mandate, the core of the health reform law. Both the Dems and the GOP hate it so far -- the GOP due to tax increases; the Dems due to entitlement cuts and the fact that there are no immediate revenue raisers -- it's a tax overhaul over the next year or so. The White House strenuously insists that there is no deal and no progress to report. But something has to happen -- and soon. States are already struggling with the uncertainty. Still, as much as I want a deal to avoid default, it sure does sound to me as though the President is giving up an awful lot, with cuts to Medicaid and Medicare but no new revenue -- how is this not the GOP plan that he rejected already? Apparently, a bunch of Dems are pretty upset and they let the President's budget director know it. It doesn't help when a GOP Senator brags that the President will cave in when the debt ceiling deadline comes upon him. And Speaker Boehner still has to sell it to House GOP, which won't be easy, either. Ezra Klein illustrates the problem -- many programs that could easily be cut are in the tax code, so they would be considered tax increases, which the House GOP won't support. But we are running out of time. Even now, it's really too late to draft legislation and vote on it by August 2, so there would probably be a short term extension of the debt ceiling. If we don't increase the debt ceiling, what happens to Medicaid and Medicare? Anyway, there will be a symbolic Senate vote today on the Tea Party plan to cut spending, cap spending, and create a balanced budget amendment -- something the Senate is likely to reject, and the President has already said he would veto.

And here's a new wrinkle in health reform implementation. There are no subsidies for employees who have employer-sponsored insurance that cost less than 9.5% of the employee's income. However, the Joint Committee on Taxation is saying that 9.5% limits applies only to the employee, not the family, so family plans can cost whatever and there's no subsidy. It's likely that the Administration will fix this through regulations making it clear that the 9.5% limit applies to the employee and dependents, which clearly was the intent of the legislation.

Hospital payments will soon reflect patient satisfaction, so one hospital sent its employees to Disney to learn patient satisfaction. Disney? Disney.

Meanwhile, the top health problem today is the heat. It can be very serious, so please listen to the experts, drink a lot, try to keep cool. Unfortunately, many states have cut energy assistance for the poor, making it harder for them to stay cool.

Going into the hospital is far riskier than flying! It would help a lot if everyone who cared for you would wash their hands, though.

Michelle Obama had a significant victory yesterday, getting a pledge from large chain stores to build in areas where there are no supermarkets and stocking them with fresh produce.

A nice piece on why anybody would choose to be a doctor.

The ExpressScripts take-over of Medco is progressing, creating a huge pharmacy benefit manager that might help drive down costs -- or it might be so big that it poses antitrust problems. But UnitedHealthcare is expanding its own Optum health unit, no longer using Medco as its pharmacy benefit manager, and creating a large book of business for itself. With CVS Caremark, you'd have three pharmacy benefit managers in charge of pharmacy benefits for most of the United States.

And here's a report on stem cell research underway here in Connecticut. Exciting.

And that's where we are this Friday morning. Have a great day! Jennifer

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