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Saturday, June 27, 2009

Health Care Reform’s Moment Arrives — Again

Kevin Sack in NYT 6/19/09 makes interesting observations about the challenges of implementing Health Care reform.

What separates this year’s initiative from past health care expansions is that it would attempt to address the system’s shortcomings in cost, access and quality all at once. It would do so with intricately interlocking components aimed at making health care affordable, ending discriminatory insurance practices and redirecting treatment toward prevention.

Whether any individual piece will produce its intended savings or improvements is impossible to tell; when judging how they might work in concert, the uncertainty is compounded.

Seeking broad popular support, the president and congressional leaders have played within the 40-yard lines of the health policy spectrum. Those who favor a single-payer, government-run insurance system have been marginalized, along with those who would unleash the system to the free market.

Mr. Obama and the Democrats began by using the stimulus package to direct new money toward the computerization of health records and research on the effectiveness of medical procedures. In the legislation now being considered, there is broad Democratic consensus on mandating that almost all Americans have coverage, expanding eligibility for Medicaid, subsidizing insurance for the working poor, establishing an insurance marketing exchange and requiring insurers to cover those with pre-existing conditions.

But there are profound disagreements on other proposals, including the Medicare cuts, tax increases to pay for the subsidies, and the public plan option, which insurers regard as a threat to their existence. The chairman of the Senate Finance Committee, Max Baucus, Democrat of Montana, has been searching for a compromise that might attract Republican support.

Although the Democrats may be able to pass bills without Republican votes, bipartisanship is important to Mr. Obama because it would set the tone for the rest of his term. The essential tension of the coming few weeks will revolve around whether the Democrats can maintain momentum while working to satisfy Republican concerns. Mr. Obama is leaving the nitty-gritty to Congress while pronouncing that he is “open to” particular compromises, like substituting member-owned insurance cooperatives for the public plan.

At a comparable stage of the Clinton health care push of 1993, “it seemed that health care reform was unstoppable,” former Senator Tom Daschle has written. The Clinton administration’s subsequent tactical failures have become the antimatter of Mr. Obama’s strategy, persuading him to move quickly, stay out of the weeds and share ownership with Congress.

In addressing the doctors this week, Mr. Obama argued that whatever the cost of revamping the system, “the cost of inaction is greater.” But he also made clear that he understood the most enduring lesson from past efforts.
“As clear as it is that our system badly needs reform,” he said, “reform is not inevitable.”


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