Health Reform Earmarks
Everyone knows what an “earmark” is. It is what members of Congress do with your money to buy your election support. It is an appropriations bill language to spend some millions of dollars on your business, your airport, your new highway or agriculture research project – in exchange for your vote. It is how members of the Senate and the House sell their votes to the Appropriations Committee chair in exchange for their support of his bill. Usually health care earmarks are confined to the Labor, Health and Human Services, Education and related agencies Subcommittees of Appropriations. This year, if President Obama insists on a health reform bill, it will also apply to some $2.5 trillion in health care services spending as well. The president decided to let the Congress write the health reform policy bill. Then the Republicans decided to take a stand against new spending, and any reduced old spending on behalf of their medical industry friends (especially medical technology and insurance).
At that point the Democrats couldn’t get to universal coverage without cost savings and couldn’t get to savings by reducing spending on unnecessary and unnecessarily costly medical and insurance services. At that point it became possible to win votes by bartering for modifications in insurance reform (reduce the effectiveness of the public plan); or carving out exceptions to coverage mandates for small businesses; or scaling back the high income surtax; or paying states more to increase Medicaid coverage; or giving PHARMA breaks. And the bartering for votes has only just begun. The hopes for real policy reform will have to come with authorization to CMS to begin to tie Medicare and Medicaid payments to health outcomes.