Saturday, February 18, 2017

Health Care, a Process That Might Work to Get to a Bi-Partisan Solution

Republicans have the votes to pass a uni-party solution. Democrats see the Republican repeal and replace strategy as a way to bring their supporters to a disruptive frenzy in town halls. Both sides have a lot to lose if they can't reach a consensus-driven solution. The health care market is a major factor in the economy. Having access to affordable health care is a major factor for each family and many single people. The current strategies used by both sides do not guarantee a particular outcome, a sure winner.

Twenty years ago this month an unorthodox strategy was tried to reach consensus on the reauthorization of the Individuals with Disabilities Education Act. Republicans and Democrat members of the House and Senate and the Clinton Administration agreed to have the appropriate staff meet and draft a bill to be considered by both the House Education and Workforce Committee and the full House, and the Senate Health, Education, Labor and Pension Committee and the full Senate. In late May 1997 that happened. The House and Senate passed the same bill. Two weeks later President Clinton signed it.

The process used to achieve this miraculous conclusion was the following:

1. Staff meetings on Monday through Wednesday for 4-6 hours a day through mid-April.
2. Notes from negotiations shared with staff in a chart every Thursday by noon every week.
3. An edited version (reflecting clarifications from staff who read the Wednesday chart) was shared with stakeholders around the country by email every Thursday night.
4. On every Friday an open mike meeting was held by staff with stakeholders from throughout the country. This input was considered the following Monday.
5. The staff started negotiations with text that was easier on which to agree. Then the staff took on the tougher issues. By then, they respected each other and saw that the process was working. Everyone -- staff, their bosses, and stakeholders were operating in good faith.

Perhaps a process like this could work to develop consensus on health care policy. I was the note taker in 1997.  David Hoppe, who was then Chief of Staff for Trent Lott, was the convenor in chief for and the architect of the process I just described. Until recently he was Speaker Paul Ryan's Chief of Staff. Perhaps he would elect to help once again.

Something to think about.

Thank you.
Common Grounder

Friday, February 17, 2017

Health Care, Where Do You Stand?

There are two things that I have chosen to avoid in my professional life — trying to figure you how to make sure people with mental health challenges are fairly and adequately treated by society, especially with regard to making choices about what happens to them; and trying to develop smart health care policies. Why? Because, doing either is very complicated and there are tons of better equipped people to tackle these challenges.

That said, I must weigh in on the health care debate. I have read the 19-page paper the House Republicans have put out (, two articles from the New York Times (, and talking points put together by the Association of University Centers on Disabilities (

Here’s what I have deciphered: Republicans know how to make the case for change without giving you all the facts. The New York Times points out what is missing in the Republican plans and what the adverse effects will be if their plan were enacted. AUCD points out that Medicaid is the vital resource that allows many people with significant disabilities to live and work in the community.

From other sources I learned that: Republicans are waiting for the Congressional Budget Office to say how much their plan would cost (outside sources estimate the Republican plan will cut Medicaid $1 billion a year for 10 years); putting people with catastrophic conditions in risk pools will cost 10 times what Republican project; and if Medicaid is given to states as block grants or with limits on per-person coverage, states are screwed.

So, the smart thing to do is to contact our governors ( and tell them not to accept a lemon.

Do we need to repair Obama care (the Affordable Care Act)? Absolutely. Some of the facts the House Republicans share are down right depressing. But, we have to consider carefully how we go about it, because everything is connected.

What do I suggest?

  1. Survey young people about how much and for what they would be willing to buy health care if they were required to.
  2. Let people design their own packages of services.
  3. Ask health insurance companies to share their data with Congress on services and costs.
  4. Put a freeze on everything and anything in health care for 18 months.
  5. Create a bicameral bipartisan commission to develop amendments to the existing approach to health care, considering both public and private health insurance plans.
  6. Give the package of amendments to Congress before the federal elections in 2018.

If we don’t do something like I just described to calm things down and move Congress on to topics on which there may be a reason for bipartisan consensus (e.g., tax reform, and rebuilding our infrastructure), this country may unravel and have massive unrest. Who the heck wants that?

Thank you,
Common Grounder