The President  brought new energy and enthusiasm  to Congress last night as he tried to reignite action on health care reform.  Overcoming my anger at a joint session of Congress during a  BIG GAME –a quarterfinal match at the U.S. Open with 1 of only 2 Americans left in the tournament — the speech showed the President taking a firmer stand on reform, attacking the false claims on reform options, and talking of “my plan.”

Obama exhorted Americans to believe in their power—and the power of government—to do good.  He called on Americans to address health care as a moral issue, emphasizing that social justice and the character of the nation are at stake.

That said, what did we learn?  The President said that if we do nothing to slow the costs of Medicare and Medicaid, they will eat up the entire budget.  On the other hand, Obama made of point of saying that if you’re enrolled in Medicare, Medicaid, or the VA, or have employer based health insurance, nothing will change. Does that mean that the government will not cut Medicare and Medicaid payments? 

 The President’s plan will provide more security and stability to those who have insurance, provide insurance to those who do not, and slow the growth of health care costs.  His plan is to “make insurance work better for you.”  Will the insurers just pay for less (especially since they will have to cover pre-existing conditions)? How much will insurers change their pricing with academic health centers?

For those individuals without insurance, they will be required to get insurance (like auto insurance, said the President). The interesting thing is that some states do not make motorists show proof of insurance on routine traffic stops. Insurance is required, but only in the event of an accident. While fines can run to $5000, most are in the $500 range and only a few states impound your car—or send you to jail.  How will the government enforce the mandate?

As for the new insurance exchanges to be established, “customers will have leverage with the insurers,” said the President, who added that he will hold insurers accountable. The President did not say how that would happen.  I hope you’re right, Mr. President, but it sounded a bit like Shangri-la.  

Most importantly, the President will end fraud and abuse in Medicare.  While a worthy goal, it raises concern for academic health centers. The government does little now to evaluate providers (many fraudulent) who apply for a Medicare provider ID and run off with millions of dollars in payments for services never rendered.  So where is there money to be found?  The government is able to collect money by establishing Recovery Audit Contractors and other vehicles to search for supposed billing errors by academic health centers.  Is this the “fraud” the President is talking about?  Will we see some RAC clones established or a new wave of billing regulations? 

The President said the details of the plan are yet to be worked out.  The coming days will show the true impact of the speech and whether we see any change in attitude or action on Capitol Hill.