Politically, 2009 and 1993 will share some similarities.  A new Democratic President takes over after years of a Republican White House. The new president will be able to work with a Congress firmly in Democratic control. Both soon-to-be President Barack Obama and then President Bill Clinton entered office during difficult economic times. And as candidates both made health care reform a top issue in their successful campaigns.

But 2009 is far different from 1993 in many ways. Concerning health care reform the political environment are strikingly different.  In 1993 President Clinton asked First Lady Hillary Clinton to take the lead. As I’ve noted previously, her insular and heavy handed approach helped doom that effort. But she had lots of help. There was broad disagreement about the nature of the problem, let alone the solution. Interest groups fought the Clinton Administration reforms vigorously and effectively. Given the lack of consensus and clumsy politics, it’s eventual defeat, in retrospect, seems inevitable. 

In 2009, the political environment will be far different. That there is a crisis in America’s health care system is broadly accepted. Out-of-control medical costs, and the ever increasing health insurance premiums they cause, are harming the financial security of families and the economic viability of companies. Tolerance for the large number of uninsured in the country is near an end.

There’s not only wide agreement that there is a problem, there’s a growing consensus on what the solution might be. The several proposals already circulating in Washington overlap with one another and the approach advocated by Candidate Obama. Interest groups and academics who waged pitched battles in 1983 are finding common ground as 2009 approaches.

This was strikingly clear in a recent broadcast of NPR’s To The Point. Host Warren Olney interviewed representatives from Families USA (generally considered a liberal health care reform advocacy group, America’s Health Insurance Plans (the carrier’s trade association),  the United States Chamber of Commerce and an academic from UC Berkeley. Their perspectives differed, but what was striking was the amount of agreement they expressed. True, there were no representatives of medical care providers on the show, but the common ground expressed by these four may not have been possible in 1993. And, as is usual when Mr. Olney is conducting the interviews, the show was very informative. (I recommend making the time to listen: To The Point, \”Barack Obama and \’Universal\’ Healthcare Reform\” December 23, 2008.

Consensus in December 2008 does not guarantee a smooth and easy process to enacting comprehensive health care reform in 2009. The debate will be vigorous and heated. There will be winners and losers — and the losers will not take their lumps quietly. But unlike in 1993, when the top priority of many stakeholders was to stop health care reform, in 2009 their approach will be to help develop the right reform. Now that is a big difference.

Posted in Health Care Reform, Health Plans, Healthcare Reform, Politics   Tagged: AHIP, Barack Obama, Bill Clinton, Chamber of Commerce, Families USA, Hillary Clinton, To The Point, Warren Olney   

Whether comprehensive health care reform is needed is no longer debated on Capitol Hill. The only question is when it’s coming. I’m among those who have been predicting that the Obama Administration and Congress will move quickly to enact comprehensive health care reform. I’m far from alone in this: incoming Secretary of Health and Human Services Tom Daschle thinks so, too. In fact, so does incoming President Barack Obama. Throw in several leaders in the U.S. Senate, including Senators Ted Kennedy and Max Baucus and you’ve got a growing conventional that universal coverage will be coming sooner or later.

But this consensus is not universal. Representative Pete Stark will have a big say on health care reform as chair of the Health Subcommittee of the Ways and Means Committee. And, according to The Hill, he’s saying Congress is unlikely to be ready for a vote on health care reform until “the end of 2009 or the beginning of 2010.”  The problem, according to Rep. Stark, is that there are simply too many competing priorities, including the economy, to get to comprehensive reform. This doesn’t mean less grand reforms won’t happen early in the new Administration (e.g., expansion of the State Children’s Health Insurance Program (”SCHIP”)), but even those could cause a delay in working through a major reform package, according to Rep. Stark.

Rep. Stark, a California Democrat who has served in Congress for 35 years, encourages a deliberate approach to comprehensive reform. According to The Hill he believes the House “needs to build toward health reform through the regular order. ‘I think you have to give everybody a chance to have a hearing,” including interest groups. Of note, Rep. stark pointed out the need to hear from the American Medical Association, the American Hospital Association and the Pharmaceutical Research and Manufacturers of America. He dismissed the need for the health insurance industry to buy-in to the reforms, however. Predicting they would never support a Democratic health care reform package, Rep. Stark said the industry’s opposition won’t change much. “They’re going to be easy to roll because nobody likes insurance companies.”

Rep. Stark is not the only voice suggesting health care reform will take some time. Senator Charles Schumer, who sits on the Finance Committee, in April told The Hill, “Health care I feel strongly about, but I am not sure that we’re ready for a major national health care plan.”

While there is broad consensus that reform is needed, the debate will grow contentious as details of a plan emerge. Current allies may find themselves on opposite sides when the nitty meets the gritty. Or as Michael Cannon of the Cato Institute put it in USA Today, the interest groups “all want to be at the table because they don’t want to be on the menu. Sooner or later, someone is going to be on the menu. You can’t do comprehensive reform without goring someone’s ox.”

Beneath all the flying metaphors is the realization that achieving comprehensive health care reform won’t be easy. It’s also vitally important. The Obama Administration and Congress should take the time needed to get it right. Because there are no do overs when you’re tinkering with 16 percent of the nation’s economy in the middle of a recession.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics   Tagged: Max Baucus, Pete Stark, SCHIP, Ted Kennedy, Tom Daschle   

In case there was any doubt, President-elect Barack Obama made clear today that reforming the nation’s health care system will be an early priority for his Administration.  Hhealth care reform won’t wait while President Obama first focuses on fixing the country’s economic mess, but will instead be an integral part part of that effort. As he said during a press conference announcing the creation of a White House Office of Health Reform, to be led by his nominee for Secretary of Health and Human Services, former Senator Tom Daschle, “If we want to overcome our economic challenges, we must also finally address our health care challenge.” (Here’s a  video of the press conference – the comment is made at roughly the 2:40 mark).

The need to move quickly on health care reform was a central theme of the press conference. After reciting the usual litiany of the current health system’s shortcomings, President-elect Obama said, “We’re on an unsustainable course. The time has come, this year, in this Administration to modernize our health care system for the 21st century, to reduce costs for families and businesses and to finally provide affordable, accessible health care for every single American.” (This statement begins at about the 1:40 mark).

He then directly tied health care reform to addressing the current financial meltdown.  “Now, some may ask, ‘How at this time of economic challenge we can afford to invest in reforming our health care system’. And I ask a different question: ‘How can we afford not to?’” (About the 2:00 mark).

The creation of a White House Office of Health Reform, and the appointment of Senator-soon-to-be-Secretary Daschle as it’s Director is especially telling. By placing the locus of health care reform inside the White House, President-elect Obama elevates the importance of achieving meaningful change. By placing the leadership of the Office in the hands of his HHS Secretary he makes it easier for his Administration to speak — and negotiate — with one voice. By making that HHS Secretary Senator Daschle he assures the reform effort will move forward in a nuanced fashion, sensitive to the legislative process. 

This approach stands in stark contrast to the Clinton Administration’s health care reform initiative.  That fiasco, led by then First Lady Hillary Clinton, was a textbook example of insularity and insensitivity to political realities. It discouraged vigorous debate and excluded Congressional input.

Senator Daschle, who led Democrats for 10 of his 18 years in the Senate and who served in the House for eight years, will take a far different approach. First, he can’t help but reach out to members of Congress — it’s in his DNA. Second, at the press conference he pledged to work with “people from across the country to find a path forward that makes health care in this country as affordable and available as it is innovative.” As a member of the Obama Transition Team he is already coordinating thousands of small meetings across the country on the topic to bring the American people “into this conversation” in order to make “an open and inclusive process that goes from the grass roots up.”  (Beginning at the 7:10 mark).

Senator Daschle is no newcomer to the health care reform debate. He’s studied, and written about, the issue as a Senior Fellow at the Center for American Progress. He is co-author of Critical: What We Can Do About the Health-Care Crisis along with Dr. Jeanne Lambrew, who President-elect Obama named today as the Deputy Director of the White House Office of Health Reform.  Their prescription for reform is not dissimilar from that put forward by Senate Finance Committee Chairman Max Baucus which, in turn, reflects many of the principles put forward by candidate Barack Obama during the presidential election.

During the press conference, both President-elect Obama and Senator Daschle emphasized the many problems apparent in today’s health care system. This shouldn’t be a surprise. When rallying the nation to change a complex and critical component of government service reminding voters of its flaws and the need for reform is standard practice.

It would have been nice, however, if a bit niaive, to hope they would have noted, even in passing, that much of the current system works and is worth preserving. Such a statement would have been as refreshing as it would have been unexpected. And it might even have underscored the new kind of politics President-elect Obama promises to bring to Washington. 

Posted in Barack Obama, Health Care, Health Care Reform, Healthcare Reform, Politics   Tagged: Department of Health and Human Services, Hillary Clinton, Jeanne Lambrew, Tom Daschle, White House Office of Health Reform