Politically, 2009 and 1993 will share some similarities. A new Democratic President takes over after years of a Republican White House. The new president will be able to work with a Congress firmly in Democratic control. Both soon-to-be President Barack Obama and then President Bill Clinton entered office during difficult economic times. And as candidates both made health care reform a top issue in their successful campaigns.
But 2009 is far different from 1993 in many ways. Concerning health care reform the political environment are strikingly different. In 1993 President Clinton asked First Lady Hillary Clinton to take the lead. As I’ve noted previously, her insular and heavy handed approach helped doom that effort. But she had lots of help. There was broad disagreement about the nature of the problem, let alone the solution. Interest groups fought the Clinton Administration reforms vigorously and effectively. Given the lack of consensus and clumsy politics, it’s eventual defeat, in retrospect, seems inevitable.
In 2009, the political environment will be far different. That there is a crisis in America’s health care system is broadly accepted. Out-of-control medical costs, and the ever increasing health insurance premiums they cause, are harming the financial security of families and the economic viability of companies. Tolerance for the large number of uninsured in the country is near an end.
There’s not only wide agreement that there is a problem, there’s a growing consensus on what the solution might be. The several proposals already circulating in Washington overlap with one another and the approach advocated by Candidate Obama. Interest groups and academics who waged pitched battles in 1983 are finding common ground as 2009 approaches.
This was strikingly clear in a recent broadcast of NPR’s To The Point. Host Warren Olney interviewed representatives from Families USA (generally considered a liberal health care reform advocacy group, America’s Health Insurance Plans (the carrier’s trade association), the United States Chamber of Commerce and an academic from UC Berkeley. Their perspectives differed, but what was striking was the amount of agreement they expressed. True, there were no representatives of medical care providers on the show, but the common ground expressed by these four may not have been possible in 1993. And, as is usual when Mr. Olney is conducting the interviews, the show was very informative. (I recommend making the time to listen to this episode, entitled “Barack Obama and ‘Universal’ Healthcare Reform“).
Consensus in December 2008 does not guarantee a smooth and easy process to enacting comprehensive health care reform in 2009. The debate will be vigorous and heated. There will be winners and losers — and the losers will not take their lumps quietly. But unlike in 1993, when the top priority of many stakeholders was to stop health care reform, in 2009 their approach will be to help develop the right reform. Now that is a big difference.