"Some Democrats, including members of President-elect Barack Obama's circle, have begun to view expanded [health care] coverage as a longer-term goal."Is the new administration trying to send a message to its health care eager constituencies that given the economy and all of the challenges we face it would be best to settle expectations down a bit?
If it is, I would suggest, that would be a smart thing for the incoming administration to do.
As I have recently posted, it is not apparent to me that we have either the consensus on what a mega health plan would look like, the solid voter support for real health care change, or the money to do it.
Many longtime health care reform advocates are calling for the Obama administration to move quickly on comprehensive health care reform while their political capital is strong--do it now or lose the opportunity goes the argument.
Actually, I would argue that if Democrats do go for the whole deal they are likely to run into a political buzz saw and possibly squander the ability to do a more modest bipartisan list of health reform accomplishments that could be the first important steps in a longer-term strategy.
Do you know how many pages were in the 1993 Clinton Health Plan?
1,462.
That number will be with me forever!
An Obama campaign-like comprehensive health care reform proposal converted to legislative language would easily exceed 1,000 pages. You think we have a consensus on what health care reform would look like? Put 1,000 pages of health care policy minutia on the table and watch the vultures attack.
Without a strong consensus going in, I've always said that a 1,000 + page health care bill will afford the opportunity for every man, woman, and child in America to find at least 300 pages each they disagree with--and they won't be the same 300 pages!
There is a heck of a lot more work for President-Elect Obama and health care reform advocates to build the kind of consensus necessary to lift something so big as health care reform across the line.
What can be done is to look to the places we do have bipartisan agreement and take some very important steps that begin the ultimate health care reform structure we will need. Maybe we can build the foundation over the next couple of years and we should try.
In these problematic fiscal times, it will be just as important to pick some steps that either cost little or can be funded under PayGo rules that require upfront money.
That foundation of bipartisan steps might include:
- Expansion of the State Children's Health Insurance Plan from 6 to 10 million kids and paying for it with a cigarette tax.
- A Medicare bill. We desperately need physician payment reform. Something we are nowhere near getting agreement over. But everyone does agree we need to try. It is also generally agreed that primary care physicians need to be better paid. It is also agreed that there is $62 billion in five-year private Medicare HMO payments that can be used to grease the skids toward a Medicare provider payment system that is more sustainable.
- Cost and quality initiatives. A cost and quality board to arbitrate and set the standards for a whole host of items to improve cost and quality outcomes that were in both the Obama and McCain health plans--health information technology standards and requirements, transparency in provider pricing, and health outcomes research, and many others.
- Assistance for small businesses and individuals in getting health insurance. Conservatives and liberals alike think insurance exchanges make a great deal of sense as a means to help individuals and small business be able to access coverage. If there is money to be found, there is also bipartisan support for modest premium assistance, likely in the form of tax credits to help small businesses--the place our employer-based system is in the most distress--to be able to pay for coverage for their workers.
- Federal budget assistance for state Medicaid programs as part of a stimulus bill. The Congress is likely to do this one anyway and it might as well be part of a package the Democrats and Republicans can take credit for.
No doubt that even these things will be controversial. But I do expect they are the kind of things that could be passed with strong bipartisan support.
Or, Democrats could go for the 1,000-page bill and risk starting a food fight that would set health care reform back once again.
What will they do?
My guess is that no one is going to tell Ted Kennedy he can't try. Presuming Senator Kennedy can't get traction with the big bill, I look for Plan B. In the meantime, look for President Obama to call for comprehensive health reform but be cautious waiting to see how things develop.
