Lanny Keller: Health care has risks politically, even if GOP’s Cassidy succeeds this year

Advocate, The (Baton Rouge, LA)

Jul. 12--If there's a bipartisan winner in Congress this year, it's health care.

If there's a potential loser for Republicans in Congress, it's health care.

Few should know that better than U.S. Sen. Bill Cassidy, of Baton Rouge, the physician who saw his far-reaching plan to "repeal and replace" the Affordable Care Act -- aka Obamacare -- scuttled by Democrats and some Republicans in 2017.

It was a defeat that still rankles, not least with President Donald Trump.

But threading his way among the rocks, Cassidy is working with Democrats to fashion some sensible ideas to improve the health care system short of a general Obamacare repeal. Among others, he is pushing the very popular idea of ending the "surprise" billings that shock consumers after emergency-room visits.

America's expensive and administratively complex system includes insurers struggling to control costs, in large part by negotiating lower fees for services, such as in-network doctors and hospitals. But if an out-of-network specialist, say an anesthesiologist, provides care for a patient, the resulting bill can be large.

In justice to hospitals, they work in a market where physicians sell their services, and if the care is needed and out-of-network is the answer, it must be provided.

Both Cassidy, R-Baton Rouge, and his Louisiana colleague, John N. Kennedy, R-Madisonville, are backing legislation to fix that problem. Kennedy told the Press Club of Baton Rouge that he expected such fixes, although "nibbling around the edges" rather than Obamacare repeal, would be bundled into a bill this year.

What are the politics of all this? It would be a legislative success for Republicans, even if not as far-reaching as "repeal and replace." And final passage is not a sure thing.

But if passed, it would come at a time when Democrats have a cacophony of voices calling for everything from Medicare for all, to Medicare for some, to pure "socialized" medicine like the National Health Service in Britain. A narrow fix would be a key win for Republicans.

Such a narrow bill, good for Cassidy's party so long as it does not nick too deeply into the finances of influential players in today's system, would also represent a victory for one of the president's key insights.

As Trump understood in 2016, his voters are not necessarily enamored of complex policy solutions about health care. What they care about, and deeply, is the constant rise in deductibles and out-of-pocket payments.

While let's not underestimate the political appeal of policies and programs -- Hillary Clinton got almost 3 million more votes, and she seemed to have just as many programs she was pushing -- it is that key insight that fueled Trump's rhetoric on this issue. He can, rather unfairly, blame "the system" without creating alternatives. Senators like Cassidy are trying to do better. The senator, for example, worked across the aisle with Louisiana's Democratic state administration to enable wider access to life-saving hepatitis C medications.

Whether with drug prices or physician fees, the GOP could very well claim credit with voters by focusing on day-to-day costs. That's a win. But what the "nibbling around the edges" doesn't do is tackle the underlying complexities that continue to bedevil today's system. Nor does it repeal Obamacare as Republicans promised.

For a GOP spokesman like Minority Whip Steve Scalise of Jefferson Parish, Medicare-for-all is a "pipe dream." But if the day-to-day problems of navigating the health care system continue to get worse, with Medicare itself more complex and involving piles of forms and annually changing paperwork, any "nibbling around the edges" won't be enough to lighten the load of consumers, those that Trump targeted.

Anyone who has cared for an aging parent, for example, is aware that Medicare -- in theory the simpler part of America's system, or rather multiple systems, of health care -- involves tremendous paperwork and difficulties, including co-payments and other issues.

A striking contrast was reported by two professors at a visiting teaching job at Oxford University. They enrolled their daughter in the National Health Service in 10 minutes, filling out just a few forms.

Maybe that won't work for America's privatized health care, although one can find very few Canadians who would give up their blended system of provincial insurance and private providers. Still, promising health care fixes backfires politically if holding out against Medicare options makes them more attractive to those who, despite everything Cassidy and others do, face bills that break their personal bank.

Bill Oliver: The former head of AT&T in Louisiana, as well as board chairman of Greater New Orleans Inc., died at 71 in an accident. He was a civic leader known across the state and will be missed.

Email Lanny Keller at lkeller@theadvocate.com.

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