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.

8 replies »

  1. 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!

  2. 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 by end of next year), this group still is largely employed and thus has access to health insurance.
    If the unemployment rate among middle class, college educated people does reach near double digits in a year or so, then the ability of Obama and this Congress to enact widescale healthcare reform becomes more realistic as the voting public will decry the lack of healthcare benefits.

  3. . . . 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 the only way we see a huge expansion is it is largely cost-neutral. Are the players in the system ready to make some potentially significant sacrifices to accomplish an expansion in access? I say fat chance.
    If you look at NY (which is going to a great indicator of how states are going to deal with health care spending in the next year or two), there is already a titanic fight shaping up between the SEIU and the governor’s proposed spending cuts to close the ever-widening budget deficit.

  4. 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 been financially secure previously are realizing that the economic problems that their grandparents and great-grandparents faced can also happen to them. Our world is not as financially secure as we would like to think it is, and the costs of health care (for both the insured and the uninsured) is a core contributor. And, as the boomers begin to age, care for parents and realize what their health care future could be, it could motivate change that we haven’t seen in previous efforts.

  5. 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 I believe those who make their beds should lie in them, THAN I think it will not work. All of a sudden Corporate America and politicians have found “social solidarity” to justify our tax money. But abandoning healthcare is not an option either even if you’re into teaching people a lesson. It’s hard to prevent finanical/life loss from healthcare as so many uncontrolled inputs affect it.
    I agree we need a “ruthlessness and singleness” of purpose to cure healthcare, but in a democracy how do you achieve that, even though I see single-pay as the only option? That ruthlessness might be held up in the Senate and to do it would require more pain than the next voting cycle may allow. Is the,”societal change which will benefit the vast majority of Americans” even in sight yet? Have Americans learned enough to realize it’s about all boats floating, not just their boat?

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

  7. 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, will do so yet again about health reform.
    There is nothing “inevitable” about reform this time. What has been missing is not some grand strategy (spare us, please) but, rather, is the ruthlessness and singleness of purpose required to overcome the raft of small objections to a societal change which will benefit the vast majority of Americans.
    We don’t know what the Obama “strategy” is yet, Michael. His campaign platform was an unremarkable pastiche of decade old ideas rewarmed for a tired public and industry. What could be different this time is the wisdom and humility of Obama’s policy shapers. If they move with alacrity, they could pull “it” off. Lord help them and us if they declare “Mission Accomplished” solely on the basis of closing the coverage gap. You and I both know the real problems lie elsewhere.