California Health Care Reform: Not Enough Corners to Go Around

Is it just me or, when it comes to health care reform in California, is everyone staking out uncomfortable positions? Because it looks to me we may be running out of corners for people to back themselves into.

For example, some labor unions and consumer groups are attacking Governor Arnold Schwarzenegger for proposing a health care reform package which requires individuals to purchase coverage from, among other sources, private insurers. Yet most of the leading Democratic presidential candidates are calling for the same thing. How will this approach suddenly become acceptable when it’s advocated by Hillary Clinton?

Several business organizations, medical associations, and carriers endorsed the Governor’s plan in principle back in September. To them, the key phrase is “in principle.” The reality is, however, once you’ve posed alongside the Governor for the cameras the details need to be pretty onerous to withdraw your support. Yet, there’s a decent possibility (although certainly not a certainty, to overuse a certain phrase) that, with the plan under attack from the left, the Governor will compromise in ways that could be pretty darn onerous to some of these folks. Onerous enough to walk away from the post powerful public official in the state? And what will they do with those pictures hanging on their wall if it comes down to this?

Meanwhile, Assembly Speaker Fabian Nunez and Senate President Pro Temp Don Perata have committed to both pushing the agenda of their supporters (most notably their union allies) and to producing a comprehensive reform package that can be signed into law — preferably before the February vote on the term limits initiative. If they move too far toward the Governor’s position they’ll fail to satisfy their supporters. Yet  if they don’t move a fair distance toward the Governor’s position nothing will pass. There are Auntie Anne’s pretzel’s twisted into more comfortable positions than these guys.

The Republican Leadership isn’t exempt from the rush to the corners. Their principles prevent them from supporting new spending. Bringing any significant number of the uninsured into the health care coverage system — which most people consider to be one of the main goals of health care reform — will require new spending. This means Republican lawmakers have boxed themselves out of negotiations altogether.

Even Governor Schwarzenegger has managed to find a corner of his own. He declared 2007 the year of health care reform way back in 2006. He has consistently declared California’s health care system as broken. Consistently as in weekly for nearly a year. Consistently as in changing the title of his health care reform site from “Stay Healthy California” to “Fixing Our Broken Health Care System.” Now that he’s convinced Californians the system is broken, he needs to show he can fix it. He’s said the key to this is personal responsibility (requiring individuals to buy coverage) and shared pain (meaning everyone pays for reforms, not just business). Considering these keys are the primary points of contention with Democrats it’s going to be interesting to see how he fixes health care without walking away from his principles.

Of course there’s ways out of all these corners. The simpliest method is to declare failure the “other guys” fault and then sponsor a ballot initiative to achieve your vision of reform. This is basic stuff, taught by both parties in Politics 101. By the time you reach this level of politics, spinning out of tight political spots is just another day at the office.

So I’m not predicting folks will stay backed into their corners. I just find it fascinating that virtually every actor in the health care reform drama seems to be occupying one.

The New Health Care Reform Dance: Noisy Action. Quiet Talks.

A lot of folks are saying the chances of health care reform in 2007 are gone. The unions and several consumer groups have declared war on Governor Arnold Schwarzenegger’s plan. They’re holding demonstrations and prayer vigils claiming the Administration’s proposal is too hard on the middle class and too easy on corporate California. The rhetoric is getting nasty. The demands more strident. It’s over.

Or is it? It seems to me that this could also be taken as a tactic to clarify — and strengthen — their bargaining position. At the same time it sends a message to their constituents (most of whom support a single-payer system) that they’re holding out for “real” reforms.

Anchoring an extreme position so others can appear more reasonable while extracting more from the other side is the negotiating equivalent of the “good copy, bad cop” interrogation routine. So one interpretation of what the unions and their consumer group allies is doing is giving their negotiators, Assembly Speaker Fabian Nunez and Senate President Pro Temp Don Perata, some help in the smoke filled tent. (Incidentally, this isn’t much different than what the Governor did back in August when he promised to veto the Democrat’s health care reform plan, Assembly Bill 8. Of course, in that case Governor Schwarzenegger was playing both the good cop and the bad cop).

The other reason the chances of health care reform remain alive is that on the two key issues which have emerged, the two sides aren’t all that far apart.

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Payroll Tax: The Governor wants businesses to pay four percent of their Social Security payroll to support the health care reform package; the union-led coalition wants a 7.5 percent tax. Would either side kill health care reform over a 5.5 percent tax? I doubt it. The Governor would still be delivering a ‘discount” to the business community and the Democrats can always seek an increase later.

There’s other issues to be worked out, but these two items are currently the center of attention. When it comes to reaching a compromise, my take is that the Governor has the stronger hand so he’ll have to give less. The Democrats have a greater need for a win on health care reform this year. Speaker Nunez and Senator Perata are pushing an initiative on the February ballot to modify term limits in a way that would enable them to remain in their leadership positions longer. With the budget debacle fresh in their minds they need something to convince voters keeping the current crop of lawmakers around longer is a good idea. Health care reform might be just the message they need.

None of this is to disparage the sincerity of the Democrats, the unions and their allies. I have no doubt they firmly believe the changes they’re calling for are good and necessary. Yet sincerity and good politics are not mutually exclusive. And noisy activity does not mean quiet talks can’t, and aren’t, continuing.

I should note, by the way, that others have a similar take on what may be happening. For example, Bill Ainsworth of the San Diego Union-Tribune made many of these same points in his blog yesterday. Today, Anthnoy York of the Capitol Weekly blog notes that “A day after blasting Gov. Arnold Schwarzenegger as the greatest obstacle to health-care reform, the head of the California Labor Federation appeared to back away from what many interpreted as the informal end of health care negotiations.”

Follow-up on Health Care Reform Chances

 As I wrote yesterday, the chances of California passing health care reform this year is dimming. Yet the consumer groups and unions joining together to attack Governor Schwarzenegger’s plan are creating an awkward situation for themselves: the front runners for the Democratic presidential nomination have proposals remarkably similar to that proposed by California’s Governor.

My thanks to reader David who, in his comment on that past, cited a San Francisco Chronicle article which reached the same conclusion. It’s worth reading this article and I mention it here to make it easier to find.

The article draws comparisons between Senator Hillary Clinton’s and Governor Schwarzenegger’s health care reform proposal, then quotes Barbara O’Connor, professor of political communication at California State University at Sacramento, as saying, “‘I think they are more similar than they are not – and I’m disappointed it’s been cast as a partisan debate. That means we won’t get a solution. I think it’s becoming not a conflict resolution but a conflict-creating strategy.’ She said it appears that ‘clearly the goal is to define the governor as soft on industry, and it’s not going to resolve the conflict – and so health care will not get out.'”

If that’s the result it would be unfortunate. Health care reform is a tough issue. It requires thoughtful debate and the less partisan passion at the table, the better. Unfortunately, that doesn’t seem to be the direction we’re heading in.