A day before the President’s promised “way forward” on health care, the White House sent a letter to Congressional leaders today that highlights four ideas brought to the table last Thursday by republicans that he considers at least worthy of further exploration. (I read that as scoring by the CBO) “I said throughout this process that I’d continue to draw on the best ideas from both parties, and I’m open to these proposals in that spirit,” the letter explains, then lays out the points he is considering:

1. Although the proposal I released last week included a comprehensive set of initiatives to combat fraud, waste, and abuse, Senator Coburn had an interesting suggestion that we engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs.

If Coburn is talking about something along the lines of the CLIA inspections for clinical laboratories that I have both participated in and been subjected to, where teams of working professionals who have been trained as inspectors are assembled from several facilities to go inspect another one, frequently unannounced, then yeah. I could live with that. Because waste, fraud and abuse happens. Just ask former Senate Majority Leader Bill Frist, republican of Tennessee HCA. Healthcare Corporation of America, his family business, paid the largest fine in history for Medicare fraud. Bust every one of them – there is a lot of waste, fraud and abuse. I know there is. I’ve seen it. I’ve wasted myself. The President is right. This idea could have merit.

2. My proposal also included a provision from the Senate health reform bill that authorizes funding to states for demonstrations of alternatives to resolving medical malpractice disputes, including health courts. Last Thursday, we discussed the provision in the bills cosponsored by Senators Coburn and Burr and Representatives Ryan and Nunes (S. 1099) that provides a similar program of grants to states for demonstration projects. Senator Enzi offered a similar proposal in a health insurance reform bill he sponsored in the last Congress. As we discussed, my Administration is already moving forward in funding demonstration projects through the Department of Health and Human Services, and Secretary Sebelius will be awarding $23 million for these grants in the near future. However, in order to advance our shared interest in incentivizing states to explore what works in this arena, I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants will be funded.

This, too, I can live with. The people who deliver your healthcare are just that…they are people, and people make mistakes. On top of that, equipment malfunctions. We have all had our moments. No one bats 1.000 all the time, that’s for damned sure. Acknowledging this fact, sucking it up and apologizing instead of circling the wagons can work wonders. It can work so well, in fact, that at the University of Michigan Medical School it is now official policy.

3. At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states, and that if Medicaid is expanded to cover more people, we should consider increasing doctor reimbursement. I’m open to exploring ways to address this issue in a fiscally responsible manner.

Here I agree too. Medicaid reimbursements are far too low, and it is a huge problem. Coverage is meaningless without access to care. On this point, I don’t give a rat’s furry ass what you do to fix it, just fix it, so doctors can afford to see and treat poor people, who suffer from the so-called “lifestyle diseases” that require continuity of care to manage and that occur with far greater frequency the farther down the economic ladder one gets.  

4. Senator Barrasso raised a suggestion that we expand Health Savings Accounts (HSAs). I know many Republicans believe that HSAs, when used in conjunction with high-deductible health plans, are a good vehicle to encourage more cost-consciousness in consumers’ use of health care services. I believe that high-deductible health plans could be offered in the exchange under my proposal, and I’m open to including language to ensure that is clear. This could help to encourage more people to take advantage of HSAs.

I can even agree with this one. I have three twenty-somethings. The only time any one of them has ever been hospitalized was when our oldest daughter had a baby. My son has that awesome Union insurance that he gets as an IBEW member, and my oldest daughter and granddaughter have good coverage through my daughter’s employer. But my youngest – I worry about her because she aged out of our coverage and is currently uninsured. If we lived anywhere besides Kansas City, this would terrify me. But because she lives here, she is able to get care via our public health system – the same one I rave about constantly and use voluntarily. Anyone under thirty who doesn’t have any preexisting conditions is probably just fine with a catastrophic illness or injury plan and an HSA for an annual exam and routine viral or bacterial infections, prescriptions and OTC medications. It is at least worth the CBO scoring it to see what the effect of taking these young healthy people out of the shared-risk pool would have on premiums.

The special deals bribes are out.

No one is simple enough to believe that the republicans are going to come around. But considering their ideas, openly nand publicly, gives the President and the Democrats a hell of a talking point. They know this. That is why every media outlet in the country, including little ole me got a copy of the letter.

But setting all that aside, the damned fools did manage to, in spite of themselves, bring four ideas worth considering to the table. If the numbers work, and any one of these ideas will save money and not adversely affect the number of people we can cover and what it will cost them – well, I am not so trite, petty and downright assholish as to  ignore them simply because I don’t like the source. I’m not a purist. I am, at the end of the day, still a 22 year old field medic who just wants to keep people from dying. However we do that, it doesn’t matter to me.

Here is the analogy I can’t shake. Passing nothing means that at least 45,000 people die every year for lack of coverage. Passing the Senate bill willreduce that number by nearly half. Doing nothing is akin to an ambulance crew arriving at the scene of a crash in which four people are involved. No matter what they do, they can only save two of them. If they walked away and did nothing because if they couldn’t save them all, it just wasn’t worth their time, they would, quite rightly go to jail for a very, very long time.

Congressional failure to pass the bill would amount to a difference of degrees rather than distinction as far as I am concerned.

Pass. The. Damn. Bill.