Thursday, December 18, 2008

“Irrational Exuberance” and Health Care Reform—Slow Down!!!

I think Pete Stark has it right. In a story in The Hill, Stark calls for waiting until later in 2009 or 2010 to move on a big health care reform proposal. The House Ways and Means Health Subcommittee Chair also points out that there are a number of "deferred maintenance" issues that will need to be dealt with sooner—SCHIP renewal, the upcoming Medicare physician fee cuts, and the pending health information technology bill.

The excitement about the potential for health care reform is palpable these days here in Washington and among advocates across the country that have been waiting years for this opportunity.

The Obama health care team has been quoted as pointing to what they reportedly perceive as big mistakes the last time we tried health care reform in 1993—the Clintons waited too long while their fresh political capital dissipated, they did the process in too much secrecy, and they didn’t push the bill through under budget rules that would have avoided the Senate 60-vote rule.

I will suggest that none of these was their most serious mistake.

I have a friend who President Clinton invited to the White House to get a preview of the Clinton Health Plan. He got to read the plan in a room, wasn't able to make any notes, and then went into the Oval Office to give the President his reaction. He tells me he said, "Mr. President, your health plan is a turkey and when you send this up to Congress they are going to gut it, stuff it, and cook it."

They sure did.

The Clintons most serious mistake was not in these things like moving quickly or maneuvering around the 60-vote rule that really constitute the politics of health care reform, but in the policies their health care reform bill attempted to enact.

More than having the politics wrong they had the policy wrong—or at least they were too far out in front of what the country could accept and as a result, they left the door wide-open for their opponents to "gut it, stuff it, and cook it."

Trying to ram a health care reform bill through the Congress before enough of the key stakeholders have been brought onside and voters have been properly prepared for the significant change any real reform would entail would be exactly the same biggest mistake the Clintons made.

And I believe we may be going down that road again.

We do not have consensus in this country on what a real health care reform bill should look like, we do not have enough of the major stakeholders in the loop, and we sure don’t have an environment that, when powerful opponents start the negative advertising, the bulk of our people will still be behind a bill.

And we won’t in just a few months—health care house parties or not.

We do have a lot of “irrational exuberance” over health care reform and that is on its way to setting us up for another really big failure.
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