Wednesday, January 24, 2007

The Bush Health Care Plan and U.S. Health Care Reform

It’s a new day in the health care debate.

Reform is breaking out everywhere.

2007 is shaping up to be the “Year of the Possible” with notable health care reform proposals coming from a number of places almost at once:
  • The new Democratic Congress is setting an ambitious health care agenda as they look to first reauthorize the very successful Medicaid State Children’s Health Insurance Program (S-CHIP) and go beyond that to get more Americans health insurance. Some of these efforts will be bipartisan.
  • Some of the most conservative business groups and the most liberal advocacy groups are coming together with other stakeholders (16 total) over their own proposal to reduce the number of those uninsured by first expanding Medicaid and later creating tax incentives and credits for the middle class.
  • California Governor Schwarzenegger wants to build on the success of legislation last year in Massachusetts to create a comprehensive universal health reform package for his state.
  • President Bush has now launched a major health care reform effort of his own to increase the number of those covered with some new ideas he offered in his State of the Union Address (see next two posts below).
Suddenly, key stakeholders and politicians who have been reluctant, if not resistant, to change have discovered America’s health care problems and look ready to move forward.

While it is instructive to look at each of these very different initiatives, they really spring from the same basic thinking:
  • We cannot avoid dealing with America’s health care dilemma much longer—either politically or economically.
  • Politicians, political parties, and special interest groups cannot afford to just play defense forever—either join the debate with a comprehensive and constructive proposal or prepare to be passed by in what will be a major national debate.
  • We need to focus on the possible instead of the perfect—most new proposals are focused on incremental expansion of existing programs attempting to reduce the number of those uninsured as their first priority--such as expanding Medicaid for those under 300% of the poverty level and income-based assistance for the middle class.
With the exception of the imperative for Congress and the President to reauthorize the S-CHP program this year, none of these proposals are likely to become law in 2007 or 2008. It is no more likely that any of these will ever be enacted exactly as they have been proposed.

However, all are likely to make a measurable contribution to a debate, that over the next two or three years, will result in the country taking a substantial, if only incremental, step forward.

It is likely the next presidential election will be a major part of that national debate--really another catalyst for it.

It's a new day in health care reform.

A train has left the station. Exactly how long it will take to get to the ultimate destination, and just what it will look like upon arrival, is not entirely clear.

But I doubt we are going to go backward from here.


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