The Inevitability of Health Care Reform: This Time, the Politics Have Changed

Rummaging through my extensive files (i.e., drawers of paper), I came across this
January/February 2001 issue of Healthplan, the magazine of the old American Association of Health Plans before it gobbled up the Health Insurance Association of America and became AHIP. It heralds the results of the 2000 election as an opportunity for Republicans and Democrats to work together on health care reform.


Of course, while George W. Bush did run for president as a
compassionate conservative, Texas led the nation in the percentage of
uninsured throughout Bush’s term as governor. Even pre-Sept. 11, health
care was never a burning issue for Bush.

As Inauguration Day 2009 nears, talk of bipartisan reform is again
in the air. Those with long memories are torn between giddiness and
caution. Reform  was “inevitable” in the early 1970s — a former boss of
mine was told by the health plan where she worked that her task was to
help manage the impact of universal health insurance.

Two decades later, AMA editor George D. Lundberg famously wrote in
1991 that there was an “aura of inevitability” surrounding health care
reform; in 1992, “the aura of inevitability intensifies; and in 1993,
“the aura of inevitability becomes incarnate.”

The aura was real; actual reform was another matter. “Incarnate” or
not, health reform died stillborn — never even put to a vote – in 1994.
The cause of death was GOP attack politics abetted by Clinton
administration political mismanagement.

Following last week’s choice of former Sen. Tom Daschle to be both
Secretary of Health and Human Services and head of a new White House
Office of Health Reform, the New York Times
examined the politics of health care reform in the incoming Obama
administration. The president-elect is already positioning reform as an
economic necessity, not just a moral one, arguing that health care cost
containment and universal coverage constitute both a safety net for
today and a critical engine of economic growth tomorrow.

Despite the strength of this administration’s commitment to change,
Obama and Daschle must show they can handle the political
opposition that will inevitably emerge once details of their plan are
laid out, according to Jonathan B. Oberlander, who teaches health
politics at the University of North Carolina at Chapel Hill.

“The history of health reform is replete with instances of reformers
believing this time it’s inevitable,” Mr. Oberlander is quoted as
saying. “Those prior tipping points all turned out to be mirages.”

Maybe I’ve been in the desert too long, but I think the Obama
strategy has a strong chance of succeeding. Back in June, before the
stock market plunge turned paper profits into confetti, I wrote this
for The Washington Post:

The major obstacle to change? Those of us with insurance simply
don’t care very much about those without it. It’s only when health care
costs spike sharply, the economy totters or private employers begin to
cut back on benefits that the lack of universal health care comes into
focus. Noticing the steadily growing ranks of the uninsured, the broad
American public — "us" — begins to worry that we’ll soon be joining
the ranks of "them."

Today, in the midst of deepening recession, growing unemployment and
financial turmoil, a fast-growing number of “us” fear becoming one of
“them” – or have already had it happen. The powerful political
self-interest of the middle class should give health care reform the
clout it needs to come to pass at last.

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Deron S.MGMatthew HoltJane JacobsPeter Recent comment authors
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Deron S.

Many talk about how it’s going to be difficult to get healthcare reform moving because there’s not enough $$ to fund it. My question is, why are we funding a system that is already overfunded to the tune of hundreds of billions of dollars? I’m not sure reform should require big up front costs, unless we go the single payer route of which I am not in favor.
Let’s start by getting more value from the $2 trillion+ that we’re already spending!


Agree though with the general premise will be that it will be college-educated, middle class that ultimately determine the fate of healthcare reform through their votes. If you look at the economic stats, their the unemployment rate and other employment numbers though just are at a real pain point yet. “Unemployment” (by the manipulated BLS numbers) for this group was still below 5% in November. While their 401ks may have evaporated and their mortgage may be approaching the “underwater” point soon (25% in the US already and likely to reach 40% if you read the numbers for Schiller and others… Read more »


. . . Follow the money If Obama goes through with his potentially record stimulus plan based primarily on infrastructure spending, where is the money for health care reform going to come from? We are already on record to exceed the record 6% GDP deficit from the 1982 budget. I guess the US Treasury can sell more 30-year bonds and convince investors to give them money for free but at some point there is going to be a tipping point. There is plenty of current “waste” (just as in nature though one organism’s “waste” is another organism “substance” though) but… Read more »

Matthew Holt

“this time it’s different”…. (quote from Matthew Holt to himself when he joined a dotcom in January 2000)

Jane Jacobs

A great post — thank you, Michael. I think there is hope this time around for a couple of reasons. Through the process our Mayo Clinic Health Policy Center has been involved in, I’ve seen leaders from all sectors acknowledge that they will have to give something up in order for change to occur. What that will mean will depend on what proposals come forward. What will help reform succeed this time is to continue a collaborative, consensus-driven, transparent, patient-centered process. We’ve seen that happening so far, and I believe it can continue. I also agree that people who have… Read more »


tcoyote, given the options congress had (once treasury and Barney Frank said it’s all going to hell); let it all collapse, keep putting fingers in the dike, or spend even more, it’s no wonder they’re ambivalent. I’m not convinced what they’re doing WILL work, especially with how little control (fraud?) they have over the bailout money. The last depresssion (if we’re getting there) took a world war to fix. I have been opposed to all these bailouts from the beginning, MORE because (1)I didn’t participate in the creation of the mess (2)I have buttressed myself against it, and (3) because… Read more »

bev M.D.
bev M.D.

Gak! There’s actually a college course in “health politics”??!! How sad…….


Fear of loss of insurance doesn’t automatically translate to faith in the government’s ability to provide it. The real damage of the Bush and Clinton years was the growing sense that government was either grossly incompetent, impotent or preoccupied with minute political gamesmanship when facing major social problems. If you think there is a huge “mandate” for public take over of private functions, look carefully at the major ambivalence from both parties and, more importantly, the general public, about the bailouts of our financial and automotive sectors. Congress has acted reluctantly and uncertainly to these challenges, and given the chance,… Read more »