Thursday, April 24, 2008

Health Care Reform Will Be a Long Shot in 2009

Many people, me included, have compared the recent resurgence in calls for health care reform with the big debate we had in 1993 and 1994 and the expectation back then that we would see major health care reform. Of course, all of that focus on the issue ended with the failed Clinton Health Care Plan derailing health reform for at least 15 years--and counting.

Each of the remaining candidates for president--Clinton, Obama, and McCain--have major health reform proposals. Health care continues to register as one of the major issues voters want addressed and expectations are rising again.

But the chance for major health care reform in 2009--or 2010--is a long shot.

The problem is that the country is divided right down the middle on which very different direction to go on the issue. As high as health insurance costs are and as dissatisfied as consumers are with the system there is no consensus on what should change and no real willingness for any of the major stakeholders to compromise.

I don't know who will be elected president in November. But I am confident that whoever it is the vote will be another very close election with about half of the people on one side and half on the other. While the Congress will probably continue to be Democrat controlled, there will be no big majority wanting to take the country in one health care reform direction over another.

Something as big as health care reform requires a clear consensus--among voters and therefore in the Congress. We have nothing close to that today irrespective of the apparently strong commitment to health care change among the candidates for even incremental health care reform.

Jay Rockefeller is a Senate Democrat that has been working on health care reform for 20 years and he's an Obama supporter. About the $100 billion both Democratic candidates want to spend on health reform he says, "We all know there is not enough money to do all this stuff. What they are doing is...laying out their ambitions."

No one is a bigger supporter of Hillary Clinton than fellow New York Senator Chuck Schumer. He doesn't see any consensus on how to get health reform done either saying he's "not sure we have the big plan on health care." He goes on, "Health care I feel strongly about, but I'm not sure we're ready for a major national health care plan."

The next Congress, and likely the new President, will be ready to deal with a permanent extension and expansion of the State Children's Health Insurance Program (SCHIP) and they will be forced to make some necessary decisions about how Medicare pays physicians and potential cuts to private Medicare plans to pay for them. But the $100 billion expansion of health care Obama and Clinton want, or the abandonment of the longtime employer tax exemption and new emphasis on the individual market that McCain wants, are way beyond any kind of consensus we have among voters and in the Congress.

As bad as things are, they aren't bad enough.

Detailed analysis each of the candidates health care reform plans:

An Analysis of Senator Hillary Clinton's Health Plan Proposal

An Analysis of Senator John McCain's Health Care Reform Plan

A Detailed Analysis of Barack Obama's Health Care Reform Plan
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