President Barack Obama’s address to the nation was both a rallying cry and a call to arms. And, if there remained any doubt, President Obama made clear he wants health care reform and he wants it now.
In his speech, President Obama promised the budget he will propose soon “includes an historic commitment to comprehensive health care reform — a down-payment on the principle that we must have quality, affordable health care for every American.” He then pledged to begin meetings among stakeholders to begin working through the contentious issues surrounding the topic next week. Pledging reform at warp speed he proclaimed, “So let there be no doubt: health care reform cannot wait; it must not wait and it will not wait another year.”
Can meaningful and comprehensive reform really be developed, debated and enacted in less than 12 months? Some would argue that it has to, that the political will to pass meaningful change must be seized and seized quickly. There will be great pain for some in the reform, and like pulling off a band aid it’s helpful to pull it quickly. Others will say making massive changes to a system as complex as America’s health care system needs to be done thoughtfully and carefully or else the damage from unintended consequences will swamp the benefits of change.
My take on it is that various aspects of a reform package can be developed in a year, but some elements will take longer. The question will be whether the Administration determines it’s better to pass what it can quickly and continue the legislative process into 2010 or wait for an omnibus package.
In any event, the President has little choice but to call for fast reform. His political capital is high right now. It has a lot more room to fall than to grow. Further, there’s broad consensus that health care reform could greatly aid the nation’s economic recovery — and that is his top priority. The sooner the details of reform are clear, the sooner business can rely on help in managing this cost. Further, there’s no shortage of proposals being discussed in and around Congress. If he doesn’t act on health care reform, someone else will. And he has no intention of ceding leadership on the issue to anyone else. Besides, if he misses his target and only brings about reform in 2010, is anyone going to complain? The only real deadline he has is to pass something before the mid-term election in November of next year. In the meantime, why not call for fast action?
More important than his timetable for reform is his focus for reform. And President Obama has made clear the kind of reform he’s looking for. Although former Senator Tom Daschle will no longer be leading the effort, his book, Critical: What We Can Do About the Health-Care Crisis (co-written with Scott S. Greenberger and Jeanne M. Lambrew, now the Deputy Director of the White House Office of Health Reform) clearly sets forth the Administration’s goals.
As I’ve written before, what’s significant, and encouraging, about this approach to health care reform is its focus on controlling the underlying cost of medical care. And that’s where the focus needs to be. A report by the Department of Health and Human Services projects health care costs in 2009 will exceed $8,000 per person. And this doesn’t include additional costs likely to result from the recent expansion by Congress of coverage for children and the economic stimulus money targeting medical technology. In a story on the report, the Associated Press quotes White House spokesman Reid Cherlin as saying “Health care costs are crushing middle class families and the small business that fuel job growth in this country.”
This doesn’t mean the administration will ignore market reforms or back off from seeking to establish a national purchasing pool (they’ll call it an Exchange) for coverage. But the fixation on costs is both appropriate and needed. Especially if we’re going to take health care reform where no American system has gone before — and at warp speed at that.