Tuesday, February 17, 2009

The Big Stakeholders and Health Care Reform--No More Happy Talk?

For a number of months I have been beating the drum that there is nowhere near the consensus for health care reform we need to get the big one done and that the key stakeholders are no more ready to give up valuable real estate to make it happen than they have been in years past.

I got a call from Maggie Mahar earlier today to discuss an article in yesterday's Chicago Tribune, written by Julie Davis of AP, in which I was quoted, that pretty much reports that the big vested interests', "I'm happy, you're happy, we're all happy to see health care reform," happy talk is predictably beginning to break down.

A few snippets from Maggie's excellent summary over at "Health Beat:"
A story in yesterday’s Chicago Tribune confirms that coalitions between “Labor unions and business groups that have teamed up in a multimillion-dollar national lobbying campaign to pressure President Barack Obama and Congress for big changes in the nation's health care system” are now “quietly at odds.”

(Hat-tip to reader Brad F. for calling my attention to this story. As Brad put it in an e-mail: “Ah, contestants on Survivor are cannibalizing: Shocker”)

Specifically, the Tribune explains that “after spending two years and more than $20 million to promote the idea, collaborators in the Divided We Fail Coalition — a project of the seniors’ lobby AARP, the service workers' union, and groups representing small business and the Fortune 500 — are divided over key elements of how to fix health care. There’s consensus on a vague set of general principles that include making coverage more accessible, affordable and efficient. But they differ over important details, including what roles the government and private businesses should play.”

Today, in a separate phone interview, Bob Laszewski talked about the limits of bi-partisan coalitions in 2009: “Divided We Fail” is a Bush-era thing. Back then, everyone knew that we were not going to get real reform. So Karen Ignagni ( president and chief executive of America’s Health Insurance Plans) and Ron Pollack (director of Families USA) could sit down in a room and agree on some things around the edges,” he explains. “But now, Democrats are saying ‘why should we compromise with these people?’” (As Ron Pollack acknowledged in a recent HealthBeat post "The goal [of making strange bedfellows] is not to establish a consensus, but to see how far the participants can go in trying to find common ground.” It seems they may have gotten as far as they can. Pollack he made it clear: “there are sharp dividing lines.”)

If Democrats seem intransigent it is because, as President Obama puts it, “I won.” And over the past eight years, conservatives rarely held out an olive branch. Indeed, sometimes they literally locked the door, closing liberals out of the deal-making.

Now, liberals want meaningful health care reform, and as I wrote in an earlier post, they are unwilling to compromise on what they see as basic values: “Inevitably, healthcare reform will be partisan because it is all about our beliefs about what is fair. . . . Conservatives believe that “the market ‘can solve our healthcare problems. Progressives believe that you cannot count on ‘the market’ to decide in favor of the public good. In a second post on the topic, I quoted Yale law professor Frank Pasquale: ““we should remember commitment's place in the world of health care reform. For me, that means universality--a strong commitment to a robust baseline of care for all--should be at the top of reformers' agenda.” Meanwhile, as we saw in the battle over the fiscal stimulus package, conservatives remain committed to their agenda...

Laszewski believes that by expanding SCHIP, boosting Medicaid and helping the unemployed continue their employer-based coverage under COBRA (by paying 65% of the cost) Obama already has done “more for healthcare” than most recent presidents. But Laszewski doesn’t think that it will be possible to pass major health reform legislation without bi-partisan agreement. “This issue is too controversial. When it comes to fiscal stimulus—you can get a couple of Republicans, get the 60 votes, and shove a bill through. With healthcare if you don’t have a big consensus that takes you to 65 or 70 votes—if it becomes partisan-- it is too easy to drive a Mack truck through anyone’s plan and scare the daylights out of the American public. In that situation you need more Republicans who will be willing to stand up and say “the scary things those other Republicans are saying are lies. This bill is okay.”

The problem is that those more centrist Republicans who might stand up to Karl Rove’s “framing” of an issue were drummed out of the Republican party long ago.
You can access all of Maggie's analysis here.
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