No One Defends the Status Quo. Nonetheless …

Health care reform is not for the weak willed. Just ask President Barack Obama. As Congress continues to draft legislation the President is expending his political capital to mobilize supporters of his reform package while at the same time seeking to soften the opposition. As tough as the task lawmakers face, President Obama’s is in many ways the more challenging.

Consider President Obama’s appearance today before the American Medical Association. According to the Associated Press, when he sympathized with the doctors on the need to address malpractice reform he was cheered. When he told them he did not oppose capping malpractice judgements as the way of accomplishing this, some booed. That the President brought up malpractice at all was enough to mobilize trial lawyers. The president of their primary lobbying organization, the American Association for Justice, issued a statement denying that defensive medicine leads to higher health costs, according to the Associated Press.

Then of course there’s the opposition from the insurance industry and others concerning the creation of a government-run health plan to compete with private carriers. Yes, compromises are being put forward to find common ground on this issue. Meanwhile, however,  there’s former-Governor Mitt Romney’s claiming on ABC’s “This Week” Sunday declaring that public plans are “a Trojan horse … a way of getting government into the insurance business so they can take over health care.”

Or take the Republican attack on the Administration for creating a working group to study the effectiveness of various medical treatments. Representative Tom Price, a former surgeon, accused the President of “seeking a government takeover’ of health care.” The committee, he claimed would turn into rationing boards that would instruct doctors what services they could — and could not — provide their patients.

In a similar vein, Senate Minority Leader Mitch McConnell, Senate Minority Whip Jon Kyle and other GOP Senators introduced “The Preserving Access to Targeted, Individualized, and Effective New Treatments and Services (PATIENTS) Act. The legislation’s sponsors claim it is targeted at “comparative effectiveness research” which they claim is “commonly used in ‘socialized health care systems,” according to The Hill’s Blog. To its advocates, comparative effectiveness research holds the promise of eliminating much of the $700 billion in unnecessary medical spending incurred each year. It would also go a long way toward eliminating the disparity in spending profiled by Dr. Atul Gawande in his much discussed New Yorker article. Opponents do not address the difficulty in making politically free determination of what treatment is effective or not. Instead they attack it as empowering the government to determin who lives and who does not, even though current instances of comparative effectiveness programs in the United States are highly regarded by doctors, patients and others.

No one is defending the status quo. Not surprising since most people believe it is seriously broken. President Obama has rightfully framed the health care reform debate as an integral part of his economic recovery efforts. The reality is that American businesses are hamstrung by an often dysfunctional system. It’s equally true that hundreds of billions of dollars are wasted each year on defensive medicine, ineffective treatment and overpriced prescriptions.

The critical political puzzle facing President Obama is whether he can marshal the votes necessary to force through health care reform that causes pain to so many interests while improving on the status quo. He has some advantages other presidents have not shared. There is widespread agreement the status quo is unacceptable. He is extremely popular. His party holds significant majorities in both the House and Senate.

And did I mention the widespread agreement that the status quo is unacceptable? Because it is worth repeating. Opponents to reform have an advantage. They can zero in on one or two items they dislike knowing others will be attacking the package in other weak spots. To prevent the death of reform by a thousand cuts the Administration will need to fend off all of these attacks. Not an easy task. Among other tactics, it will require developing compromises that address opponents’ reasonable concerns without watering down the entire package so much it fails to improve on the current system.

That’s why health care reform is not for the weak willed.