I love Daniel Schorr. I’ve never met him in person, but I love his voice and his insights about politics on NPR’s Weekend Edition. But this morning I was disappointed. After listening to his comments on the Olympics and Iran, I looked forward with anticipation to his thoughts about the Senate Finance Committee’s accomplishments earlier this week on health reform legislation. When asked whether a “real health care bill” is likely to pass later this year, he said, “Well, it begins to look more [likely] . . . that there will be a bill. The question is not whether there will be a bill . . . but what will be left in the bill, because so many things have been taken out.” I could almost hear him sigh. He went on to talk about the fact that the public option is not a part of the Senate Finance bill, although it might be restored in full or part (through a trigger mechanism or health cooperatives) as the bill moves through Congress. Let’s step back for a minute. (This is what I usually rely on Schorr to do for us.) Where were we a year ago? Although advocates of health reform were encouraged that the health care crisis was getting a lot of attention in the Presidential election campaign, the outlook was not rosy. Obama and McCain were neck and neck, and McCain’s reform proposal was so weak as to be laughable. The pundits and pollsters were predicting that the Democrats would get about 56 seats in the Senate – not enough to overcome a filibuster. And there was serious concern that even if Obama were elected, health reform would be crowded out by other major crises – the threat of a serious economic depression, the banking collapse, Iraq/Afghanistan/Iran, energy and global climate change, and who knows what else. In October 2008, the likelihood of serious comprehensive health reform was probably about 25%.
What has happened during the last 12 months? Well, Obama was elected with a clear mandate to do something about health reform, and his proposal was pretty solid. The Democrats surprisingly won 60 seats in the Senate, although it took months for the Minnesota recount to be completed. The President and the Democratic leaders in Congress have made health reform a top priority and haven’t let other critical issues get in the way. Obama selected a top-flight team of policy experts and – more importantly – politically savvy professionals to push health reform. (Sen. Baucus and others on the Hill had started doing this a year earlier.) Using the lessons from the defeat of the Clinton plan in the 1990s, Obama set the overall goals and framework for reform but let Congress take the lead in creating the specific legislation. The administration worked closely with health care industry groups to get their support for reform, or at least reduce the likelihood they would torpedo it. A strong consensus emerged about the basic shape of the reform package, and five Congressional Committees have passed very similar bills. We’re on the verge of actually getting something done. What’s in the bills? Is it real reform or something watered down? As the President reminded us in his September 9 address, we need to stay focused on the goals and not get tangled up in arguments about the ways we achieve those goals. Reform advocates have been working for decades to improve access to health care for all Americans, improve the quality of health care, and reform the system in a financially responsible and sustainable way. The bills in Congress would make major progress on all three of these goals, and we shouldn’t lose sight of that. The bills can be improved, of course, but we must not let the perfect be the enemy of the good. The inclusion of a public plan option should not be the litmus test of a good bill, despite what Howard Dean says; it’s only a means to an end, and there are other ways to get there. We should focus instead on whether the final reform plan would make real progress on the three critical goals of access, quality and affordability. In the end, it seems increasingly likely that we will pass the most important and far-reaching domestic legislation in many years – one that will help millions of people who cannot afford decent health care – and we should not lose sight of that. But I still love you, Daniel Schorr. We all need a healthy perspective on the major issues of our day, and I’ll listen in again next weekend. Bill Kramer is an independent health care consultant, focusing on health care management, finance and public policy. Bill served as a senior executive with Kaiser Permanente for over 20 years, most recently as Chief Financial Officer for Kaiser Permanente’s Northwest Region. More information about Bill may be found at his website. You can read more of his commentaries on health care management and policy at his blog, Now’s the Time, where this post first appeared.