Once Obama got elected, I knew it would happen. I knew we would get healthcare reform. This is not said out of some partisan bias. I have simply observed the last 8 years of largely republican rule where the only healthcare reform that occurred - Medicare Part D, was a confusing morass that is more a giveback to pharmaceutical companies than a benefit for seniors. It encompasses everything that is bad about government today.

While the republicans "support" tort reform, I never saw tort reform come to a vote and get signed by W. It simply wasn't a priority.

For the democrats, health care reform is a priority. And the new president is acutely aware that he will be a one-term wonder if he does not enact dramatic changes. Passing comprehensive healthcare reform-something that hasn't been able to happen for >60 years-would be change.

I have heard the naysayers amongst friends, colleagues, bloggers and twitterers. The issue is too political; too locked into lobbyists' interests and influence. The democrats are weak. They'll cave in to pressure. While these arguments aren't untrue, the cynics forget one thing. The healthcare crisis isn't about poor people anymore. When your trauma center closes down and you-a rich person-has to be sent to a facility farther away with less resources, you suffer. When you can't find a neurosurgeon to treat your aneurysm, the rich person suffers. When your ambulance is diverted from your favorite institution because of Hospital overcrowding, the rich person suffers.

And for the average joe with "good" health insurance, rates are skyrocketing, out of pocket costs are increasing, and when you get a serious illness, maximum coverages are reached quickly. Approximately 40% of insurance claims are denied. You were supposed to feel safe having insurance coverage. There is no safety.

Now that the majority of the population is facing this healthcare crisis, there is a mandate, and the president is acutely aware that his support came from people wanting change. If he doesn't get health care reform, the advantage his party has will fall to pieces just as the advantage the republicans' had did.

So my prediction:
The only two people who determine healthcare reform are Max Baucus and President Obama. There are others who might have some influence if they are acting in good faith, such as Olympia Snowe. But most other republicans are simply trying to weaken a democrat initiative so that moderate dems won't vote for it, and those republicans wouldn't vote for it anyway. If republicans won't vote for a bill for political reasons, then they won't have a vote in what it looks like.

Thus, if you want to know what healthcare reform will look like, read the BaucusFramework.pdf. In my next blog I will discuss this further, but read this, then compare it to the Baucus Whitepaper. There are some differences, such as the public option issue. However, the whitepaper is his real views. The framework is his compromise. I think Baucus is making a political move to hide his intention for a public option, and then slip it in at the last moment.

As far as tort reform, Baucus supports it, and Obama supports it as long as there are attempts to maintain quality in the system. Obama NEEDS it if he is to exact cost savings that will make it succeed. So in some manner, there will be tort reform. Maybe not along the lines of what I would like and have suggested, but something will happen on that front.

The cynics will say I'm naive and deluded. I think they aren't looking at the big picture, because if they did, they would see that this is the year. By 2010, we will have healthcare reform passed. It likely won't translate into immediate results as it will take years to enact. But it will happen.