With the Tuesday vote of Senate Finance Committee, all the committees have a version of healthcare bill passed.  But now comes the difficult part.

These bills are quite different from each other.  Some with public options, some not.  Reconciling these differences into an agreebale bill is hard enough.  There are still strong external noises.

Unions are running ads in several states as they do not like several provisions in the bill such as taxes on cadilac version of health benefit, hefty penalty for those who can not afford to by insurance, and of course the lack of public option.  On the otherside, all of sudden insurance companies are playing hardball.  They suggest that the bill will raise premiums by upto $4000 in less than a decade. 

With all the external pressure, now comes the task by several key leaders from executive branch as well as from both houses of congress to negotiate and create a final bill for debate on the senate floor.

With all that need to happen, it is unlikely to have any thing ready for signature till December and that too in the optimistic case.  The only republican who voted for the bill is not too happy as she beleives there are not enough cost cutting measures and also there are not enough provisions for affordable health coverage.

We, here at THT have said consistently that all the discussions are missing the key ingradient of a successful healthh reform and that is the cost reduction. Current savings are more artificial from spreading the risk as well by negotiating the cost down.  The key would be to achieve these through dillgent process – we advocate use of a combination of design for six sigma with lean and six sigma.

There is another discussion going on..and that is on the cost of the reform.  I think that is silly.  Because we have agreed that the costs are higher because of lack of insurance by many and them using the emergency rooms etc.  So, if we are solving the problem, there could not be any additional cost.

We are not talking here cost….I think itis about how it is payed and managed.   Either people pay through their pocket, through insurers, or through goverment channels; it is still them who would have to foot the bill.

Given the historical facts of healthcare cost rising 3 fold hire than the rate of inflation, goverment may have as good chance to keep a cost control as any insurer-if not better.

Currently, a bill is under development based on all the bills from different committee.