History Will Ignore Much of Today’s Health Care Reform Headlines

Living through historical moments can seem far less grandiose than reading about it. In the day-to-day grind of making history the big picture can get lost. Little issues take on huge proportions while overarching themes are hidden in the maelstrom. Historians get to step back, find the threads that build tension, create a narrative, and set-up the pay-off.

So it is – and will be – with health care reform. There have been a lot of distractions. For instance, critics of the Obama Administration have been pounding away at HR 3200, the House version of health care reform legislation. That legislation makes great fodder for 24-hour news channels and partisans across the spectrum. The bill offers something for everyone to demagogue. The fact that, in the end, HR 3200 – America’s Affordable Health Choices Act of 2009 – won’t have served as anything more than a lightening rod hardly matters.

The same can be said of the Senate Health, Education, Labor and Pensions Committee’s proposal. The Senate HELP Committee’s and the House health care plans gave liberals something to cheer about and conservatives something to attack. My guess is history will show that was its greatest contribution to the debate. Yes, elements of these bills will be included in the legislation that will be signed into law by President Barack Obama later this year. But that’s because there’s always been a broad consensus concerning health care reform. It’s the 25 percent or so of the issue on which there is disagreement that is causing all the ruckus. And at the end of the day, I’ve longed believed it will be moderates who resolve the contentious health care reform issues.

And those moderates are almost ready to make their positions known. Senate Finance Committee Chair Max Baucus has promised to unveil a formal proposal Tuesday or Wednesday. While it’s not certain that any Republican Senators will sign-on to the proposal, what Senator Baucus will propose will be far more moderate than the current alternatives. According to the Associated Press, Senator Baucus and the other five Senators negotiating a bi-partisan bill have made progress on several controversial items, “including health insurance for the poor, restrictions on federal funding for abortions, a verification system to prevent illegal immigrants from getting benefits, and ways to encourage alternatives to malpractice law suits.”

If compromises have been reached on these issues, HR 3200 and the Senate HELP Committee’s proposal will have played an important role. By being the most extreme bill available to critics during August it flushed out their attacks. This, in turn, made it easier for moderates to indentify the hot buttons they needed to address. A Washington Post story describing some of the solutions being developed by the Senate Finance Committee’s so-called “Gang of Six” underscores this. (The Gang of Six are Democratic Senators Baucus, Jeff Bingaman, and Kent Conrad along with Republicans Mike Enzi, Charles Grassley and Olympia Snowe). For example, illegal immigrants will be specifically prevented from obtaining any benefits from the insurance exchanges being contemplated. A government-run health plan – the means leading to a government takeover of health care according to critics – will not be missing from the proposal.

For the past few weeks, Republicans have associated President Obama with HR 3200 and the liberal Senate HELP Committee proposal. Yet he has embraced neither. Instead, he is has set the stage for circling the wagons around whatever moderate proposal emerges from the Senate Finance Committee. And Senator Baucus and the others are working hard to make that possible. For example, President Obama embraced a Bush Administration proposal to permit states to test approaches to medical malpractice reform. According to the Washington Post article, such a provision will be in the Senate Finance Committee’s bill.

Liberal critics of President Obama will accuse him of capitulating to conservatives on many of these issues, especially abandonment of a public option. Conservatives will say he’s proven himself to be a liberal tax-and-spender and government-expander (the proposal is expected to cost around $880 billion over 10 years). In the short term there will be much sound and fury over such issues by both sides. If the compromise health care reform solution put forward by Senator Baucus and his colleagues becomes law, however, history will little note nor long remember such histrionics. (Which, for those paying attention to the clichés in this paragraph would tend to prove that Abraham Lincoln trumps William Shakespeare).

So long as the outcome meets President Obama’s general principles for the health care reform the White House will declare victory. History will relegate talk of death panels, cries of socialism, and demands that government get out of Medicare (along with other government-sponsored programs) to footnotes, if that.

As with any major reforms, history will also likely show that the historic health care bill to come will accomplish less than its critics fear or than its advocates claim while at the same time bringing forward unintended consequences of significant proportion. But those problems will be a challenge for a future Congress and Administration. History, after all, is made one step at a time.

Obama Speech Accomplishes Much, But It’s Only a Start

Agree with him or not, President Barack Obama knows how to deliver a speech. Anyone free of Pavlovian conditioning against the man would admit his address to Congress Wednesday night was powerful and at times moving. The question is, of course, what does it mean? (For those interested in reading along, here is the prepared text of President Obama’s health care reform speech).

First, it signals President Obama’s intent to shape not just the Congressional and public debate, but health care reform legislation itself. He repeatedly sprinkled variations of “under my plan” when discussing proposals. Whereas in the past he was content to lay out general principles to guide the reform process, this phrasing signals he is now taking ownership of the legislation. That alone will change the course of the legislative process.

Second, he gave Senator Max Baucus and the Gang of Six the cover they need to negotiate bi-partisan health care reform. As discussed in earlier posts, the Senate Finance Committee Senator Baucus chairs will take up legislation next week. The path they are headed down, as outlined in the Framework for Comprehensive Health Reform, disappoints many liberals. President Obama could have left them out on a political limb. Instead he embraced several of their proposals and, by refraining from declaring a government-run health plan a necessary component of reform, gave the negotiators the space they need to deliver a moderate package. Based on the President’s speech, there is little if anything in the Framework he would not accept. What this means is that the legislation produced by the Senate Finance Committee could serve as the foundation upon which the President can build his own, detailed proposal.

Third, the President, after the requisite insurance industry bashing, focused on constraining health care costs. Whether his proposals go far enough to “bend the cost curve” as the Administration is fond of saying, is open to legitimate challenge. But by elevating the need for controlling medical costs to the top of the health care reform discussion, the President makes it more likely cost containment will be part of the final package.

Fourth, President Obama made clear he would no longer tolerate lies and half-truths about his health care reform package. He called those who claim he would establish death panels liars. He rebuked those who claim illegal aliens would be eligible for federal premium subsidies. He rejected charges that he would be cutting back on Medicare benefits. There are those who will continue to make these charges, but the President made clear their claims would be repudiated quickly, loudly and sharply.

Fifth, President Obama called for a more robust Health Insurance Exchange than some moderates have been considering. He noted an exchange available to individuals and small businesses would mean “these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. the same clout large employers enjoy when negotiating rates.” This implies the exchange would do more than simply present information to consumers, but would define benefits and seek bids from carriers wishing access to these markets. Whether or not such an exchange would be successful is open to debate. A similar approach was taken in California as part of its small group reform in the 1990’s. That legislation, AB 1672 is generally considered to have been very successful. The purchasing pool it created, however, has long been out-of-business, unable to compete with the private market.

Sixth, the President put forward his pragmatic side. He wants a government-run health plan to compete with private carriers, but he didn’t declare such a public plan was critical. Instead he said, the impact of a public option “shouldn’t be exaggerated – by the left or the right or the media. It is only one part of my plan ….” In other words, it’s a part of his plan he’d like to see in whatever legislation passes Congress, but it’s not an absolute requirement. Another example of his pragmatism trumping partisan ideology: the President reached out to Republicans by adopting some of their proposals, including those concerning malpractice reform. Yes, there was red meat for liberals, but there was plenty for moderates and even some conservatives to cheer about in his speech.

Seventh, President Obama’s speech was, well, presidential. Republican behavior was a bit childish. When President Obama stated that “the reforms I’m proposing would not apply to those who are here illegally” Representative Joe Wilson achieved a new low in politics by shouting out “You lie!” Even when President Bush was arguably shredding the Constitution and, intentionally or not, misstating the facts, Democrats still treated him with respect when he appeared before Congress. Many Americans will see Representative Wilson’s outburst as a sign of partisan passions coming to rule the GOP. (Representative Wilson later apologized for his “lack of civility,” but the damage was done). Meanwhile, Republican House members were shown on television waiving paper at the President. Apparently these were copies of the GOP health care reform plan and their presence at the speech was meant to demonstrate that the Republicans were more than just the party of “no.” Unfortunately, the television audience wasn’t in on the symbolism. It just looked strange and undignified. Again, like Representative Wilson’s behavior, these antics may play well to the base, but it does nothing to expand that base.

Eighth, the President made clear the status quo is untenable. However, this message was simply part of a 45 minute presentation, dampening the impact. Change scares people. President Obama needs to prove his message that change is needed. If the Administration wants to reposition the debate to require opponents of health care reform to defend the status quo, he will need to devote at least one political event to this topic.

President Obama accomplished a great deal in his address to Congress, but at the end of the day, it was just one speech. Now comes the tough part, tying together the elements of a package that can make it’s way through Congress, while at the same time justifying the reform effort. Given the passions surrounding the health care reform issue, this will be no easy task.