Thursday, July 30, 2009

Walking the Blue Dogs

BlueDogSupersizeIn the House, the deal reached yesterday with the Blue Dogs allows mark-ups of the Tri-Committee Bill to continue in the Energy and Commerce Committee, where hopefully a bill will pass before the August 7th recess and provide some needed momentum. For more on the recent developments, one can go to this article in the Washington Post or the always trustworthy Kaiser Health News. Additionally, the Post also has a nice write-up on Rep. Mike Ross, a leader in the Blue Dog Coalition, as part of its continuing Voices of Power series.

Things are moving to the middle on the health reform front and usually, this is a good thing. Personally, I subscribe to the wisdom of “he/she governs best that governs from the middle.” But, as usual, things are not so simple. As stated before, we do need some fundamental changes in health care that swing the pendulum back toward consumer protections, health system development, simplicity, and common sense. What we do not need is a whole scale health care makeover or at the other extreme, a package of tweaks packaged as reform. In essence, any reform bill needs to be a bit “in your face” but at the same time build off what works…kind of like Aerosmith. [Yes, it is a weak lead-in but I had to find a way to bring in the Aerosmith video below]

Industry leader Bob Laszewski sums of some of the concerns about compromise in a recent post where he states:

And, as I have posted here before, I am concerned that in their efforts to find compromise they are headed for a health care bill that is based on a formula of cost containment “lite,” minor paring of Medicare and Medicaid provider payments, and at least $500 billion in new taxes. I don’t see much changing fiscally if that is the final result in a health care system that is already unsustainable and on the way to spending upwards of $35 trillion to $40 trillion over the next ten years as it goes to 22% of GDP by 2018.

From what we have heard, their bill would hardly "bend" any curves.

Yes, we could well cover tens of millions more people and that alone would be a noble accomplishment. But just loading all of these people onto a system that we can’t now afford seems to me to be ultimately a fool’s errand. The number of uninsured we have in this country isn’t the fundamental problem—it is the most aggravating symptom of our real problem, which is unsustainable cost.

Being good guys and bipartisan doesn’t necessarily lead to the best policy!

48566902_BollWeevilMonument Now, this gets me to my point “What are Blue Dogs?” and “Why do they matter?” Interestingly enough, this is all rooted in the complex psyche of the South – the same part of the country that to this day, pays homage to the thought of secession and the boll weevil.

[Two quick asides. First, the picture above is of the famed “boll weevil” statue in Enterprise, Alabama. I passed it last month and honestly, expected it to be much bigger. It is only about 10 feet tall and is plopped smack dab in the middle of an intersection. Second, in my local paper today, writer Bill Cotterell noted that members of the Florida legislature want to put forth a state constitutional amendment that reinforces the 10th Amendment to the U.S. Constitution, “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." Although interesting to think about, I believe Andrew Jackson solved this issue about 200 years ago and anyway, Florida has little to carp about when it comes to health care. Outside of the exceptions I wrote about last week, the state largely provides high-cost care and is usually ranked in the bottom 10 percent of states when it comes to public health measures.]

Blue_Dogs_LogoNow, back to my point. The Democratic Blue Dog Coalition was first formed in 1995 and refers to a group of 52 moderate and conservative Democratic party members in the U.S. House of Representatives. And yes, the logo at right is their official logo – to me, it kind of looks like a very depressed Clifford, from the popular children’s books, but so be it. The group’s lineage follows the “Boll Weevils” of the 1980s and the “states’ rights” Democrats of the early 1900s. Even though the group has its roots in the southern politics, today its members span the entire country.

The phrase “blue dog” basically follows from the term “yellow dog” Democrat. Yellow dogs historically refer to southern voters who voted democratic down the line in defiance of Abraham Lincoln, a Republican president. Now, it generally refers to someone who votes the party ticket. When former Texas Democrat Rep. Pete Geren explained that his group of conservative Democrats had been "choked blue" by Democrats on the far left of the political spectrum, the phrase was coined.

smokey-mascot--ixAlso interesting is that Blue Dogs are giving the Democratic party a chance in the typically Republican South. For example, in 2006, a former Tennessee quarterback named Health Shuler was elected in a conservative district of North Carolina. That brings me to my favorite Blue Dog of all, Smokey, the blue-tick hound (see picture).

From the Blue Dog Coalition’s press release yesterday:

Blue Dogs believe fundamental reform of our health care system is needed to control rising health care costs, increase quality and value, and improve access to coverage and care.
Comprehensive health care reform must be deficit-neutral and bend the cost curve in the long run. We also believe health care reform must preserve patient choice of provider and maintain
competition within the marketplace.

So, where does this leave us? Well, Blue Dogs matter because they are often a link for bipartisanship…a stated goal for the American public and the Administration. They also give the Democratic party a chance to regain a foothold in the South. The deal reached yesterday with the Blue Dogs in the House provides some needed momentum but we still have a long way to go and the emerging coalitions are fragile. Furthermore, there is a growing concern in some circles that as the bills water-down in the name of compromise (e.g. moving from “sticks” to “carrots”), they will not fundamentally change the incentives in the system and thus, the status quo will continue.

To me, chances are still 50-50 whether a bill is passed. If one passes that includes: expansion of the opportunity for affordable coverage to nearly all legal residents, insurance market reforms (e.g. consumer protections and insurance exchanges), Medicare payment reform (e.g. a strong IMAC and move toward episodic, value-based payment), and incentives for health system development (e.g. ACOs), then we should mark the bill’s passage a success. ~BAA