OP-ED

Op-Ed: Sustainable Healthcare Reform

President Obama made a risky wager when he decided to let Congress take the lead on crafting health care legislation, rather than presenting his own reform package. Congress is not known for taking bold, decisive leadership on tough issues. Normally, it reacts and gridlocks; it doesn’t lead.

As Congress takes its usual August recess without acting, it appears that Obama’s strategy has failed. But, has it? Is there a deeper strategy? What’s really at stake here?

Obama reportedly reasoned that Congress will do better in the long-run if it protects its institutional prerogative as law maker and doesn’t take on the appearance of being the President’s rubber stamp. This is a plausible calculation. The last time Congress was asked to respond to a President’s health care reform proposal during the Clinton years it did so by throwing the whole package in the trash can.

It is likely that there is more to Obama’s calculation than meets the eye. He knows that Congress is entangled with the health care industry’s massive lobbying and campaign finance money machine. Republicans and Democrats alike depend on special interest money to finance campaigns.

The only political force strong enough to persuade Congress to transcend the special interests is an outraged public. It’s all about the money to be sure; but even more so, it’s about what members of Congress really care about: votes.

Obama’s immediate problem is that the public is turning on him, not Congress, for failing to provide leadership. But this will be a temporary diversion of public anger if he now steps up with his own specific proposal.

He has placed himself in a position to press for substantive reform, including a measure at its core – the public insurance plan option. The best informed experts agree that a public option will drive down health care and insurance costs, and give virtually every American a chance to have affordable care. It will avoid simply throwing more money at a system that already costs way more than it should.

Throwing good money after bad will happen because the Congressional proposals add to the numbers of people who will be covered by the same insurance companies that offer coverage now. The proposals don’t offer a public option choice, and will increase the customer-base—and stock value—of insurance companies, whose track record on holding down costs isn’t very good. This helps explain why some insurance interests and their allies are now paying for ads in favor of health care reform; their version of it will produce a pretty good return on their political investments.

The proposals don’t hold down health care costs either. A public option will allow competitive and impartial introduction of the tools required to drive these costs down. The public option is the pathway to reversing the perverse incentives of the status quo which push costs of care and its coverage ever upward.

These incentives are driven by deep structural flaws in the current system, including an emphasis on specialty, rather than primary care, the lack of information technology needed to improve quality and ensure science-based decisions about care, and a fee for service system that creates incentives to drive costs upward. The public option plan provides the platform to launch these essential reforms, and to promote public choice among insurance carriers.

If Obama doesn’t aggressively pursue the public option, he will fall short of the character of leadership needed to ensure quality health care for the American people; and the promise of his presidency. His credibility with his supporters will be severely damaged; and his enemies will rejoice.

If he loses the battle of the public plan after fighting hard, at least he will be around to continue the war against “politics as usual.” Leaders and followers alike learn from battles they lose as well as those they win. Conviction and persistence, traits Obama surely possesses, are what matter most. Unless he presents a specific proposal with a public option and fights hard for it, Obama will be seen correctly as a politician, not a statesman.

The question is whether the public will do its part and whether Obama will do his. The public’s outrage is growing by the day as more and more Americans suffer from the increasing costs of health care and loss of coverage. If public reaction is not channeled in a positive direction, everybody in political power loses.

Those who think health care reform is a show down between the President and Congress or Republicans and Democrats miss the point. It’s a show down between government and the citizenry. Powerful special interests are squarely in the middle, trying to control the outcome as they equate the common good with their own.

It’s fair to conclude that the credibility of the entire American political system is on the line. While the battle is about health care, the war is about preserving, protecting and defending the viability of American democracy. The health care battle will demonstrate to the world the character of the American body politic, and the strength of its new president.

Perhaps most important of all, a hard-fought battle against the special interests will demonstrate whether democracy still works in the nation that first introduced it to the modern world.

Larry Arrington is a Florida-based planning and management consultant. With Herb Marlowe, he is co-author of Sustainable Governance: Renewing the Search (Llumina Press). The book is due out in fall, 2009. Watch for it at http://www.arringtonmarlowe.com/; and at http://www.llumina.com/.

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Pavel GobermanEMRLawrence W. ArringtonDavid C. Kibbe, MD MBAPeter Recent comment authors
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Pavel Goberman
Guest

All politicians with pride are saying: “In the USA is the best health care system in the world”. Oh, yes, they are correct, because this best health care system is for politicans, government employees and the rich. In the USA 18,000 Americans are dying each year because they have no health insurance. 46 million Americans have no health insurance. Why? Because of corruption of elected officials. So many CEO, of so many profit and so named not for profit organizations and institutions get salaries of many millions dollars and are buying politicians. Cut theirs of these lazy, overpaid cats and… Read more »

EMR
Guest

This is a very comprehensive posting on the most debatable subject like the health care reform. Indeed there are lots of different opinion on this subject.

Lawrence W. Arrington
Guest
Lawrence W. Arrington

David Kibbe’s thoughtful comment about my blog questions whether there is a correlation between Obama’s health care reform strategy and the measured approach Lincoln took to the emancipation of slaves during the Civil War. David suggests that Obama’s conundrum about aggressively pursuing a specific proposal of his own rather than leaving the heavy lifting to Congress, “…reminds me so much of the swirling debate about Lincoln’s plans to end slavery, which led up to the Emancipation Proclamation, and ultimately to the 14th Amendment.” David notes that many were angry at Lincoln “…for not taking more aggressive steps to end slavery… Read more »

David C. Kibbe, MD MBA
Guest
David C. Kibbe, MD MBA

Lawrence: You said “If Obama doesn’t aggressively pursue the public option, he will fall short of the character of leadership needed to ensure quality health care for the American people; and the promise of his presidency. His credibility with his supporters will be severely damaged; and his enemies will rejoice.” This is very well said, and I agree with you that he and most Democrats and moderate Republicans understand this. It reminds me so much of the swirling debate about Lincoln’s plans to end slavery, which led up to the Emancipation Proclamation, and ultimately to the 14th Amendment. The so… Read more »

Peter
Guest
Peter

We are seeing now the impossible situation that multiple competing systems create – just what providers lobbyists want. There is no way a public option will work if providers will not participate, and there is no way a public option can bring down costs unless it holds the payment power of budgets and the power of size. If a public option is part of the bill I see it basically neutered by Congress which will limit it’s size, power and budget – It will end up a useless joke and just another failng health option. Medicare should be the public… Read more »

Dr. Philip W. Hughes, D.C.
Guest
Dr. Philip W. Hughes, D.C.

July 22, 2009 To whom it concerns: As a healthcare provider since 1972, I have seen many changes in the system. The biggest problem is that our elected public officials have created so many legal requirements and have created so much paper and electronics processing work just to get paid that I have gone to a cash and check payment only system. I no longer care for patients who want me to bill any third party payer. This means welfare, workers comps, auto accident insurance and HMO’s. If patients want my services they have to pay me following each office… Read more »

iBlogWestHartford
Guest

The most important part of health care reform is winning – without giving away the store, the farm, the house, and three of the four kids. We just did it in Connecticut. With tremendous grass-roots support, we took on the insurance insurance and the Republican Party and our own governor and we won. So it can be done. On July 20th, our state House and Senate successfully overrode Republican Governor Rell’s veto of the SustiNet health care reform plan – one of the most ambitious plans for universal health care anywhere. The SustiNet law mandates the creation of a nine… Read more »

propensity
Guest
propensity

Rick,
Expensive, budget busting, care disrupting computers are not needed to yield CER results proving that not every patient undergoing colonoscopy needs a biopsy, nor does every patient with chest pain need a nuceeler stress test or 64 slice CT.
Perversions promulgated by government and insurers instigate the gaming of the system.
Health care reform will not be sustainable unless the doctors gain something from putting up with the heaps of bulldung.

Dr.Rick Lippin
Guest

Up to 1/3rd of current US medical interventions are useless or dangerous.
That, my colleagues, is the issue and wherein lie the solutions.
-Honest and objective comparative effectiveness research (CER)
-Convincing the duped and swindled US public that “more in medicine” is not always better
Dr. Rick Lippin
Southampton,Pa

Biotech Analyst
Guest
Biotech Analyst

“A public option will allow competitive and impartial introduction of the tools required to drive these costs down. The public option is the pathway to reversing the perverse incentives of the status quo which push costs of care and its coverage ever upward.” Great, then let’s see Obama institute these reforms on the public option we have right now (Medicare), rather than embarking on a risky and expensive remake of the rest of the healthcare system that the government doesn’t already control. I’m sure that once the Big O and the Dems have demonstrated their success at this, the public… Read more »

MG
Guest
MG

Actuary – Yeah I fail to see how any of the largely terrible legislation that is coming out of the 3 version of the House bills (even with the public plan) are really going to control costs in any meaningful way including the public option as currently being advocated in the legislation passed by Rengel’s subcomittee. It just adds more fat to the fire largely.
There a few decent cost-control ideas here and there (e.g., Kerry and others in the Senate on taxing high-end plans) might act as more of a natural break in the interim but nothing comprehensive.

Actuary
Guest
Actuary

“The best informed experts agree that a public option will drive down health care and insurance costs,” The statement is patently false, unless one counts Nancy Pelosi and the like as “experts”. A government-run insurance plan has nothing to do with driving down health care and insurance costs. “A public option will allow competitive and impartial introduction of the tools required to drive these costs down. The public option is the pathway to reversing the perverse incentives of the status quo which push costs of care and its coverage ever upward.” Nothing could be further form the truth. If anything,… Read more »