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Hustle and Bustle

It’s been quite the week here in Washington, with health reform gaining real Republican support and a noticeable momentum building towards floor votes in both houses of Congress. With a ‘yes’ vote from Olympia Snowe in the Finance Committee, reform through the budget reconciliation process looks to be officially off the table. The Senate leadership is currently merging the two committee bills, with the Finance version acting as the ‘base’ bill and various elements being included from the HELP version. After a preliminary CBO score of the merged bill, the Senate will take up floor debates beginning the week of Oct. 26 and that should last a few weeks. Expect a vote before the Thanksgiving recess. On the House side, the three committee bills are being merged and one bill will be brought to the floor by mid-November. The House floor debate will include very few amendments, if any, and should only last a couple days before a vote.

Congress has committed to passing reform by the end of the year and will extend session into December if necessary, which is increasingly looking to be the case; the Conference Committee blending of the House and Senate version and a final vote will most likely take up the first two weeks of December, with a Presidential signature as an early Christmas present.

Attended some wonderful panel discussions this week and I was able to hear from Sir Bruce Keogh, Medical Director of the United Kingdom National Health Service (NHS) who recounted the major positive changes to the UK health system over the last 10 years. This gave the audience an important perspective of the ‘socialized’ system, and debunked much of the ‘rationing’ claims through his convincing data on major wait time reductions. On the topic, see this video from former Majority leader Bill Frist (R-TN) which should put an end (in a perfect world) to the ‘socializing medicine’ claim.

I also had two notable conversations following a panel yesterday, with both Tom Daschle and Richard Gephardt. I asked Daschle how he felt about the state ‘opt-out’ compromise for the public option, and he said it would be a much more favorable provision compared to state-based public options though the latter is more politically feasible. He also made a nice conceptual analogy of health resources, comparing the system to a pyramid; currently the ‘top’ of the pyramid (extremely specialized services like heart transplants and neurosurgery) receives vastly greater focus and investment compared to the ‘base’ (primary care and prevention). He suggests that flipping the pyramid on its head is the key to reducing expenditure growth, but the less-than-immediate results of improving the ‘base’ makes the effort very difficult to accomplish quickly. Gephardt stressed to me the need for personalized medicine, from pioneering efforts like treatments based on your unique genetic makeup, to more simple processes like at-home condition monitoring and prescription reminders.