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There was a funny moment during the floor speech of House Minority Leader John Boehner (R-OH) during the final healthcare reform debate on Sunday just prior to the vote.  It was when he was eliciting responses from members of Congress (I’m guessing the responders were largely Republicans).  Anyway, the funny moment starts at the 3:18 mark.

Boehner: Look at how this bill was written.  Can you say it was done openly?

Audience: No!

Boehner:  With transparency and accountability? 

Audience: No!

Boehner: Without backroom deals, and struck behind closed doors, hidden from the people?  Hell no you can’t!  Have you read the bill?

Audience: Yes!

Boehner: Have you read the reconciliation bill? 

Audience: Yes!

Boehner: Have you read the manager’s amendment? 

Audience: Yes!

Boehner: Hell no, you haven’t!

 I actually think he almost started laughing at this point.

Eli Lilly chairman and chief executive John Lechleiter speaking about healthcare reform and the need for innovation to improve quality and access while reducing costs:

Innovation is not a panacea for the challenges facing our health care systems, but it is hard to see any way out of the current crisis – and I don’t think that’s too strong a word – without innovation.  Indeed innovation needs to be the purpose of health care reforms.

Not by much, but still a new Gallup/USA Today poll shows that 49% of Americans think passage of the healthcare reform bill was a “good thing,” 40% think it was a “bad thing,” and 11% had no opinion.  The poll was based on telephone interviews with 1005 adults.  Democrats overwhelmingly favored passage (79%), while Republicans were overwhelmingly opposed (76%). 

Overall results are shown in the chart below from Gallup.  The specific question was as follows:

As you may know, yesterday, the U.S. House of Representatives passed a bill that restructures the nation’s healthcare system.  All in all, do think it is a good thing or a bad thing that Congress passed this bill?

Aetna chairman and CEO Ron Williams on healthcare reform:

Millions of Americans can look forward to gaining access to health insurance, a significant milestone for this country. The challenge unmet by this bill, however, is how to effectively deal with the critical issue of affordability, which has become a burden for so many people, particularly individuals and small business owners.

I’d say it a slightly different way.  This legislation is mostly about expanding coverage, and that’s a necessary first step toward reforming the U.S. healthcare system.  Now comes the far harder task of bending the cost curve.  At best this legislation “nudges” (Jonathan Cohn’s word) us in the right direction.  But we have a long way to go — and a lot of difficult choices to make. 

Williams goes on to say:

Aetna plays a significant role in helping our members – both employers and individuals – meet the cost challenge. Our role won’t change with this legislation. But, as a nation, we need to come together to bring greater focus on addressing the many underlying factors that are driving soaring health care costs. When the nation inevitably turns to finding ways of reducing this alarming trend, we stand ready to help.

And that’s really the challenge for health plans in this brave new post-reform world.  Can the industry deliver on the promise of truly managing care, i.e., improving quality while at the same time reducing costs.  Now is the time for health plans to prove that spending 10% to 15% of premiums on administration isn’t a waste.

Former General Electric chairman and CEO Jack Welch on CNBC Squawk Box commenting on the outlook for Democrats in the November elections following the passage of healthcare reform:

I don’t think they’re going to get wiped out.  I think the economy is picking up….and freebies are now coming my way.  My kids are now covered….I’m not predicting what it’s going to be, but it’s not going to be the broad-brush sweep blow them out.

Here’s a fun chart (hat tip: Paul Krugman) showing the Intrade.com price on a bet that healthcare reform would pass; the time period shown spans Scott Brown’s election to the final yea vote.

As data from the Congressional Budget Office show, there’s very little difference in the number of uninsured under the Senate bill (31 million fewer uninsured) versus the Senate bill with fixes through reconciliation (32 million fewer uninsured).

Rich Umbdenstock, CEO, American Hospital Assn., March 21:

Today’s vote will chart a new and better course for our nation’s health and health care.  Bottom line: the health reform bill may not be perfect, but it expands coverage to 32 million people, enacts significant insurance market reforms and lays a solid foundation upon which we can continue to build.

J. James Rohack, M.D., president, American Medical Assn., March 21:

By extending health coverage to tens of millions of uninsured, improving competition and choice in the insurance marketplace, promoting prevention and wellness, reducing administrative burdens, and promoting clinical comparative effectiveness research, this bill will help patients and the physicians who care for them. There are increased payments for primary care physicians caring for Medicaid patients and bonus payments for physicians in underserved areas.

Pharmaceutical Research and Manufacturers of America, March 21:

Throughout this long process, we have been guided by a belief that all Americans should have access to high-quality, affordable health care coverage and services. This legislation, while not perfect, is a step in that direction. Even as we support health care reform legislation, we continue to have concerns about a number of issues including the overly broad powers of a non-elected Independent Payment Advisory Board (IPAB), which could enact sweeping Medicare changes without action by Congress and would not be subject to judicial or administrative review.

Karen Ignagni, CEO, America’s Health Insurance Plans, March 21:

The access expansions are a significant step forward, but this legislation will exacerbate the health care costs crisis facing many working families and small businesses.

Thomas Donohue, CEO, U.S. Chamber of Commerce, March 21:

This $900 billion, 2800 page bill is not health care reform. It fails to fix what is broken and risks breaking what already works. It will drive up health care costs and make coverage less affordable for businesses and families. It marks a major step down the road to a government-run health care system. It will further expand entitlements and explode the deficit, and raises taxes by a half a trillion dollars at the worst possible time. American jobs and growth are at risk thanks to the decision by the House today.

(Note: Revised to include most recent AHIP comment on the legislation).

I’ll have a lot more to say about healthcare reform later today.  Five quick points right now:

1. This is not only historic, it’s also a very good thing.  For all the rhetoric about healthcare reform, the fact is that it will help a lot of people: 32 million to be exact.  These are the people without health insurance who will now be able to get coverage because of this legislation.  Others will have access to much better coverage than they have now.  The sick won’t be denied coverage anymore.  And people who already have coverage through their employer can rest assured they will still be able to afford coverage if they lose their job.

2. The health insurance industry — which played the role of villain in the reform debate — is going to see its profits suffer.  The industry will take hits on its Medicare Advantage, individual and small group business lines.  It will also experience some adverse selection because the legislation calls for guaranteed issue of health insurance without a strong coverage mandate.  Other costly regulations and taxes will take a bite as well. 

3. The managed care industry will survive.  Yes, it will be less profitable (which suggests the need for additional consolidation), but the industry isn’t going away.  The winners will be the companies that take the advice of Aetna chief executive Ron Williams and focus on four areas: products and services that improve quality and control costs; convenient tools and easy-to-understand information to help members make better-informed healthcare decisions; transparency;  and new wellness and prevention programs.

4. You’ve got to hand it to President Obama.  He’s made history — again.

5. I hate to say, “I told you so” (all right, actually I love to say, “I told you so”), but I predicted on that dark day following Scott Brown’s victory in Massachusetts that the House would pass the Senate bill.  If you want to know what will happen next, be sure to pick up a copy of our annual report The Outlook for Managed Care 2010.  Our forecasts were based on the assumption of last night’s yea vote.

UBS analyst Justin Lake says the odds are 60/40 in favor of the enactment of the Senate healthcare reform bill with certain changes made through a budget reconciliation process.  Lake says that House Speaker Nancy Pelosi (D-CA) is building momentum to win the votes necessary to pass the Senate bill in the House.  While she’s not there yet, Lake says, “The power of the Presidency; the power and respect that Pelosi commands with most of her Democrats; and the power of being the majority party and being able to manipulate the rules of the game —  all argue that the Democrats will get it done.”

New Republic reporter Jonathan Cohn on health insurance industry profits:

The issue…isn’t the profits that insurers make. It’s the actions insurers take to maximize those profits….The quickest, surest way for insurers to boost profits is to avoid spending a lot of money on sick people. And, particularly in the individual insurance market, insurers can do that in any number of ways. They can charge sick people higher premiums, deny them coverage altogether, or — failing that — revoke their coverage after they start filing claims….They can make it difficult for the chronically ill to get the care they need, by manipulating benefits and provider networks or making it more difficult to obtain authorization for treatments. And they can always jack up rates on blocks of business that have high expenses.

All of which gets at something I’ve been trying to say for some time.  Industry profit margins of 3% to 5% aren’t the problem.  Administrative costs of 10% to 15% of premiums– i.e., expenditures aimed largely at maintaining the infrastructure needed to do all the things Cohn outlines to ensure profitability — is a big part of the problem.  Cohn continues:

These practices help explain why people with serious medical problems so frequently find insurance inadequate or simply unavailable. But they don’t explain why health care generally is expensive for everybody, even the healthy–and why it’s getting expensive so much more quickly. Those problems are the result of the entire health care sector–doctors, hospitals, device makers, the drug industry–providing too much medical care or charging too high a price for it. The insurance industry likes to point this out and it is right to do so.

Said another way, I can understand when insurers raise premiums — even at double-digit rates — to offset rising costs (sorry Mr. President).  But I can’t justify higher rates simply to support an administrative infrastructure aimed at denying coverage and care to the sick.  Only a highly regulated public-private insurance market or a single-payer system gets at a solution.

From Justin Lake of UBS:

House Leaders Looking At A Tried & True Parliamentary Procedure To Pass The Senate Bill. This is far from certain, as we are at least 9-14 days away from any potential votes, but the House Dem Leadership is looking at avoiding an up or down vote on the Senate passed bill from December 24, 2009 when the House debates the as-of-yet unformulated Budget Reconciliation/FixIt bill. The Leadership is looking to use a procedural maneuver that would be part of a self-executing Rule — a process that has been used from time to time in the House by both parties when they have been in the majority. It would work something like this:

*Before the House takes up the Budget Reconciliation/FixIt bill they would have to adopt a Rule governing the debate as is the normal procedure. The Rule would contain a self executing clause that would state that upon adoption of the Rule and then debate and adoption of the Budget Reconciliation bill that the Senate bill/December 24, 2009 would also be considered as adopted.

*The whole package would then go to the Senate for approval. In this manner, assuming Senate approval, the Senate bill/December 24, 2009 and the Budget Reconciliation/FixIt bill would all be sent along to President Obama at the same time. And nervous House Democrats would be assured that the Senate bill would not move to the President by itself without the Budget Reconciliation/FixIt bill alongside; since many House Dems do not trust the Senate to pass the Budget Reconciliation/FixIt bill once the House has already stuck out its political neck and taken the tough vote.

Understand?

President Obama after his meeting last week with health insurance companies:

They couldn’t give me a straight answer as to why they keep arbitrarily and massively raising premiums — by as much as 60% in states like Illinois.

Here’s a funny spoof from the Onion News Network, which reports that President Obama is bipolar.  Among the signs:

Last week he proposed a healthcare plan that was nothing more than, “If you need a doctor, go see a doctor.”

Actually, that’s not a bad proposal.

President Obama outlined both the far-left and far-right positions on healthcare reform in a speech yesterday:

On one end of the spectrum, there are some who’ve suggested scrapping our system of private insurance and replacing it with a government-run healthcare system.  And though many other countries have such a system, in America it would be neither practical nor realistic.

On the other end of the spectrum, there are those, and this includes most Republicans in Congress, who believe the answer is to loosen regulations on the insurance industry — whether it’s state consumer protections or minimum standards for the kind of insurance they can sell.  The argument is, is that that will somehow lower costs.  I disagree with that approach. 

Compromise — and I’m just guessing here — would be something in between.