President Obama and Health Care Reform Expectations

Senator Barack Obama remains a Senator for another 77 days. Then he becomes President of the United States. His is a remarkable story heightened by his ability to both symoblize and articulate hope. The challenges he will face upon assuming office are daunting, to say the least. Then there’s the expectations.

Every political campaign is about expectations. Candidates make promises because voters want to know what to expect. Democrats and Republicans, Mavericks and Insiders, they all make promises, which means they all create expectations. In this election, both candidates raised expectations that the nation’s “broken health care system” would, at least, be fixed.

I believe there will be comprehensive national health care reform in the next four years. There’s clearly pent-up demand in Congress for change. A bi-partisan group of Senators led by Democratic Senator Ron Wyden and Republican Senator Bob Bennett already have introduced a comprehensive health care reform package, the “Healthy Americans Act.” Senator Edward Kennedy is looking to cap his historic tenure in Congress with health care reform. While battling brain cancer he and his aides have been meeting (both personally and by video conference) lawmakers and advocacy groups to create a framework for health care reform. Many in Washington believe that the Clinton Administration squandered a unique opportunity for reforms that would have greatly benefited the nation over the past 14 years. They do not intend to let another chance go by.

Health Access outlined several reasons for progressives to be optimistic that meaningful reform is coming from Washington, D.C. They note the starring role health care reform played in Senator Obama’s campaign and the Obama/Biden ticket’s endorsement of Health Care for America Now!’s principles. They point out Senator Obama’s resounding victory will give him the political muscle, and his campaign theme and image gives him the credibility, to push through meaningful reforms.

I believe Health Access’ analysis is correct. There’s another reason health care reform is likely: the Obama Administration will take a far different approach than that taken by the Clinton Administration in 1993. They’ll learn from President Clinton’s mistakes. They’ll be far more inclusive and more accepting of input from Congress. They’ll be more willing to compromise on specifics to achieve their principles.  President Obama will bring to health care reform the same superb organization and discipline he brought to his campaign. All of this bodes well for some kind of significant reform coming out of Washington in the next four years.

The Obama Administration will face two challenges in fulfilling the health care reform expectations. First is the complex nature of the problem. A great deal of the upcoming debate will be spent on market reforms (should insurers be required to sell coverage to all applicants?) and access (should all Americans be required to have health care coverage?). These questions alone have brought down many a reform proposal. Yet they’re the relatively easy challenges. Too little attention will be spent on the most vexing problem facing every health care system in the world: the skyrocketing cost of medical care.

Someone has to pay for health care and there are only three sources: taxes, premiums or charity (some people pick up the tab for other people). Medical care inflation historically outpaces general inflation and there’s no reason to believe that will change. Which means it’s only a matter of time before the burden of paying for care crushes every and all of those sources.

This isn’t news. Last year the Henrey J. Kaiser Family Foundation released a study, Health Care Costs: A Primer, that put the discrepancy between inflation rates in perspective. There have been sporadic attempts in Washington to draw attention to the cost issue. In November 2007 the Congressional Budget Office identified the need for policy makers to focus on restraining health care costs. There are a lot of suggestions for controlling medical cost problem floating around. Few of them are easy to implement, especially since numerous interest groups will work hard to defend their current share of the health care dollar. And in the end, for better or worse, health care reform comes down to dollars.

Which leads to the second problem facing President Obama’s health care reform efforts. The nation’s economic house is in disorder. Can the nation afford expensive health care reform during a time of financial crisis?

Well, it depends. If health care reform is viewed as a line item expense on the government’s ledger, the answer is no. Even a liberal Congress is going to be hesitant to run up ever greater deficits by increasing government spending. And it’s not yet clear this Congress will be more liberal than the last. After all, a lot of its newer members came from relatively conservative districts or states. Especially when it comes to budget matters like deficits and taxes, the new Congress may have swing toward the middle.

But spending money on the health care system need not be viewed as a simple expense. By repositioning health care reform as part of a public works-like stimulus package the huge costs involved may be more palatable to the public and fiscal hawks in Washington. President-elect Obama has already declared his desire to increase spending on the nation’s infrastructure in order to create jobs and bolster the economy. Infrastructure is usually defined as roads, bridges and buildings. That doesn’t mean the definition can’t be expanded to encompass the health of its work force. In this context, health care reform is not a cost, it’s an investment.

President-elect Obama has promised voters health care reform during his first term. Upon taking office, however, he’ll face wars abroad and economic crisis at home. Dealing with the latter does not require him to ignore the former issue. By positioning health care reform as part of his plan to rebuild America, he might actually be able to fulfill the great expectations he’s created.

6 thoughts on “President Obama and Health Care Reform Expectations

  1. today march 5th barack obama’s health reform speech made me cry so many americans are struggling and the letters he mentioned just brought me to tears. too proud to ask for help and yes i want to be a proud american whom when i awake in the morning i know america’s health reform call it universal or whatever is real care. this is soo vital to our future so vital!

  2. Mark, you have a very good point and I agree with you that personal responsibility plays a big part in it. Ultimately, people have to choose to do the right thing when it comes to diet and exercise. However, there are ways to persuade people to make that choice by either making the right choice less costly or making the poor choices more costly or both. The state of Alabama, one of the highest when it comes to the rising rate in obesity, is lowering health premiums for employees who undergo a health risk assessment. Once the high risk individuals are identified, step can be taken to encourage them to meet certain goals with the appropriate incentives. A number of employers cover smoking cessation programs. Some employers charge 3X for French fries at the cafeteria but the salad bar is free. The cooperation between employer and health insurance companies is essential in influencing individual’s choices. Otherwise, the rest of us have to pay for increased cost in healthcare down the road.

  3. Nazim makes a good point. But how does a doctor write an Rx for no french fries? We are the kings of fast food and I don’t see education making much of an impact.

  4. Studies such as the Milken report shows that most of the money is being spent on chronic disease issues. A lot of these which are preventable are related to exercise, diet and personal habits. Two-thirds of the country is either obese or overweight. These issues are related to diabetes, heart ailments, hypertension, cancer and lots of other conditions. This issue is by far costing us the most because of ballooning the cost of treatment in the late stages. Aggressive prevention has to be central to any healthcare reform by a President Obama’s administration.

  5. The Obama Administration will face two challenges in fulfilling the health care reform expectations. First is the complex nature of the problem. A great deal of the upcoming debate will be spent on market reforms (should insurers be required to sell coverage to all applicants?) and access (should all Americans be required to have health care coverage?). These questions alone have brought down many a reform proposal. Yet they’re the relatively easy challenges. Too little attention will be spent on the most vexing problem facing every health care system in the world: the skyrocketing cost of medical care.

    The above paragraph is the whole issue. You can’t have a without b and even with mandated coverage the cost of care is rising at an unsustainable rate. Electronic records, group purchasing ET AL doesn’t really do much to lower the cost of care. Evidence based medicine is fine until it doesn’t work. How will Americans who have had good coverage (the majority) take to lower expectations?

  6. Just curious as to your opinion on the issue of chronic diseases. I know President-elect Obama often talked about prevention, especially during the 3rd debate and also mentioned it during his stump speeches, but do you see it becoming part of any real health reform? I know with the economic crisis, funding is a big issue. Preventive care takes a significant investment up front, with the benefits not showing up for several years. The thing is that, Obama’s plan is not a government administered health plan. The market driven insurance companies will play the dominant role in the industry, so any reform will only be changes in the ground rules of who pays and who gets covered. Will these ground rules include some mandatory chronic disease screening and prevention?

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