Can Electing Obama Get us Real Healthcare Reform?

In this election campaign, most progressives are pinning their hopes on an Obama victory as the best route to bring us meaningful health-care reform. His plan, of couse, is far more likely to lead to broad coverage and affordable care than the free-market nostrums of John McCain.

But pragmatists at the state level and in Washington are looking closely at the real-world political obstacles that have stymied health care reform in the past, and if progressives don't learn from past failures, we're doomed to repeat them again, especially in overcoming the resistance of conservative Democrats and Republicans in the Senate -- and greedy business interests.

Some of the smartest insights about these challenges come from the influential American Prospect journalist Ezra Klein and the grass-roots "Archimedes Movement " for health-care reform led by former Oregon Gov. John Kitzhaber. Today, Archimedes leader Liz Baxter and Ezra Klein talk about the real-world prospects for health-care reform on the "D'Antoni and Levine" show at 5:30 p.m. east coast time.

Recently, Klein has been focusing on the role of Sen. Max Baucus as the potential linchpin to any health care reform in a Democratic presidency. He's guardedly optimistic, but stresses that massive pressure for reform has to be focused on Baucus and members of the critical Senate Finance Committee. Klein points out:

This is where organizing matters. The argument of my article was that the Senate Finance Committee (and, for that matter, the Senate) is the key body for health reform. Absolutely enormous amounts of energy -- including by me -- have been expended pushing the presidential Democrats towards better positions in campaign proposals that won't be implemented. That was useful insofar as it effectively conveyed the importance of health reform to the Democratic base. But that message has been conveyed, and the organizing energy now needs to shift to the Senate. As I wrote in the piece, "By publicly asserting jurisdiction on health reform, the Finance Committee is also taking responsibility for it. If the effort fails, it will be on their heads. And none will receive more blame then Baucus." The question is whether he, and his colleagues on the Committee, will fear failure and the consequences of blame, or whether they'll figure a couple irritated editorials will be better for their careers then sticking their neck out on this issue.

At the end of the day, for better or worse, Baucus is the key figure here. Progressives can't have him as an enemy, or there simply won't be health reform. But nor should they assume him an ally. They need to watch, organize, and agitate. They need to make it easy and rewarding for him to do the right thing, and hard and dangerous to fold before industry. If comprehensive health reform ends up being the right political play for Baucus, he'll happily make it. He's not ideologically opposed to the issue. But nor is he likely to lead in the absence of such an environment.

That's where groups like the Archimedes Movement come in -- organizing a grass-roots, democratic movement for health-care reform. They're banking on creating a "shared vision" of reform that will lead to changes in the health care system to make it affordable, accessible and emphasizing prevention. Will that be enough to build change? Not by itself, but in alliance with groups such as the Campaign for America's Future and Families, USA, along with those organizations' grass-roots allies, they can start to make a difference and bring about change.

It's a realistic vision worth achieving:

The Political Environment

Navigating the Current Political Environment

It is important to acknowledge that our current health care system was not designed to prevent illness or manage chronic disease, two issues that are at the heart of our health care crisis. Our shared vision has to have elements that are focused on:

* improving population health;
* reducing per capita cost; and
* improving the patient's experience, measured in health outcomes, safety and satisfaction.

The political gridlock comes about becaue we're askign the wrong questions. The entry level questions aren't 1) how do we preserve Medicare; 2) how do we fix Medicaid; or 3) what do we do about employer based insurance?

What we should be asking is this -

What would the optimal system look like that could improve population health, reduce per capita cost and improve the patient's experience regardless of their category, how care is financed, a person's age, income, race or gender?

We have to acknowledge that:

* Millions of jobs depend on the current structure of the health system and no one wants to lose their job.
o 1 of every 11 jobs in the US are in the health care sector;
o 1 of every 7 dollars in the US economy is related to health care.
* While 16% of Americans don't have health insurance, 84% do and they're not going to give up what they have without having a chance to fully consider what they would get in return.
* There is a lot of 'trapped equity' in the current system - buildings, technology and reimbursement, that no one is going to walk away from without making sure that their economic interests are addressed.

Once we acknowledge that we cannot politically or economically move from the current system to a new system overnight, then the dialogue shifts to what happens during a transition period.

It may sound too gradualist to some liberals, but they describe such a transition period as necessary to bring about sustainable reform:

Acknowledge The Need For A Transition Period

In order to successfully put together the politics of health care reform, we have to be able to separate the process of agreeing on the vision - on deciding what the purpose of the health care system should be; and on what we want it to do - from the process of realizing the vision through the political process.

In other words, we have to acknowledge and legitimize the politics and economics of reform and make them explicit.

And if we can do that we are then in a position to design a series of incremental steps which, over time, can gradually shift the trapped equity in the current system to one that is more effective, efficient, equitable, sustainable and more aligned with the long term interests of our nation without disrupting either the delivery system or the economy in the process.

Dr. Don Berwick, founder and CEO of the Institute for Healthcare Improvement, describes this challenge by comparing the Vision of a new system (the future state) and the current system (current state) with the economic burden on the various stakeholders involved. If we could move from the current state to the future state while reducing economic burden on the stakeholders, the politics would be simple and straightforward. Everyone would win.

The problem is that - because of the significant trapped equity in the way our current system is organized and financed, the economic burden is likely to go up for most stakeholders during the transition period. And, as described earlier, these stakeholders all have a significant influence over the political process and are able individually and/or collectively to block anything that will adversely effect their short term economic interests.

The challenge for us is to make the politics and the economics of this transition period explicit by starting with an agreement on the future state.

This will allow us to move beyond the political gridlock by shifting the focus of our discussion and our energy away from the narrow debate over how a particular reform strategy will effect a given economic stakeholder to a broader discussion:

* first, of what we want our health care system to do - what we want it to deliver us as individuals and as a society; and,
* second of how the economic impact of these changes on any given stakeholder can be mitigated during the transition state.

However, without first agreeing on where we want to end up, there is no political pathway for us to get there.

The Archimedes movement's assertion: Leadership Starts With Us

Without such a grass-roots movement, one that an Obama election could help promote and strengthen, there won't be any real change on health-care reform. But, in my view, unless grass-roots activists and organizations hungry for affordable, accessible coverage unite with those responsible business interests that want to curb skyrocketing health-care costs -- and then work together to overpower the health-care and insurance industries, not much will be done.

But as Klein points out in his latest article on "The Elusive Politics of Reform":

"It will be a tough road. But look at the numbers. One way or another, reform must come. We really don't have any choice."

Comments

[closetodemfection]

HC had the absolute best plan, it's a shame all the pundits were so bored with her talking about it.

Mandated health care is the only way to go. It is the only way to bring down the costs overall.

The simplest comparison is car insurance which is mandated - if you own a car you are required to have insurance.

Two insured drivers get in a wreck. Their insurance companies talk, the body shops already have clear prices set with the insurance companies, the drivers get their rentals paid for, everyone wins.

An uninsured driver gets in a wreck. Suddenly, the body shop is dealing with an individual rather than an insurance co. They can charge whatever they want. The person who's at fault says **sorry i have no money, YOU pay.** The other person has either a damaged car or has to pay out of their own pocket or get their current premiums raised. Lose lose situation.

We're already paying for the uninsured. The hospitals have to take them in - then they're charging it back to our premiums with no regulation. Not to mention uninsured people don't go to the doctor for preventative care which raises the costs per person when they do get sick.

With mandated coverage the gouging stops and the premiums are much lower. Without it (like O's plan) the gouging will continue but the government will be paying the high costs giving people tax rebates. It will throw this country into unimaginable debt.

[BillZBubb]

There is no reason to be optimistic. There is little reason to even be hopeful. Obama's "health plan" was by far the weakest in the Democratic field. His chief advisor, Goolsbee, is a Republican Lite.

Sure, he'll get some "reform" passed, but it will just be another blow out patch on the burning Hindenberg. But, then Obama can claim "Mission Accomplished"!

[argeec]

The discussion is improperly framed.
The discussion should be health INSURANCE reform - not health CARE reform.
The easieat way to reform health insurance is to expand medicare to the whole population.

[ranchobob]

I think we need to be realistic about how much anyone can accomplish after taking office jan 2009.
The best we can expect is for Mr. Obama to begin a turnaround.
Like an oil supertanker - our violent corrupt oligarchy has a lot of dirty momentum to overcome.
Expecting and demanding unreasonable results will sabotage change and fuel the right wing propaganda machine - which feeds on the overwhelming STUPIDITY of half the country.

[SeriousBlack]

Yep, and that's exactly what they will proceed to do, from day one. Just like they did to Bill Clinton from day one of his presidency to day last. The Limbaughs and Hannitys and Ingrahams will be having multiple, continuous orgasms for 8 years spewing their B.S.

Sigh.

[blueken]

No canidate has anything more that half way measures, all doomed to failure. Dean himself (a doctor by the way) has called for single payer universal health care. We are the only modern western industrialzed nation in the world that doesn't have it.

[UnbiasView]

Are we changing our hope from universal health care to health care reform now? I guess reality is starting to sink in.

[unionave]

I can remember when a person got a aliment small or big they called their doctor or just went to his office . Some how insurance companies got in between us and our doctors . Now the doctor will see us only if the insurance companies allow it . The insurance companies have been seen handing out checks on the floors of congress in plain view of the c-span cameras . When the insurance companies started paying our elected representatives they became more important to the members of congress than the electorate and laws were devised by the law makers to impliment the wishes of the insurance companies against our wishes . I guess this is a measure of the astuteness of the electorate .

[GnitenGoodLk]

"While 16% of Americans don't have health insurance, 84% do and they're not going to give up what they have without having a chance to fully consider what they would get in return."

Really. That many people have insurance huh? Wow. How arrogant for us to continue this "spoiled socialist" agenda of getting a single-payer insurance system.

16% are crybabies. Why aren't we just ignoring them? That low a percentage shouldn't have any say at all. Hardly a majority. Why oh why do you even waste a whole post on such a dismally small group who obviously are a bunch of commies looking to take away the wonderful healthcare of the vast majority?

All those folks on the campaign trail screaming about lack of insurance, or being hosed by insurance companies just turned out to be a small group of pissants after all.

Europe, Ireland, UK, heck, even Israel has a national health plan administered by the state. But the U.S.? No need. "We're better than that"

Besides, according to your numbers (would love to see Kleins' source for such a low percentage) it's just a small group of whiners anyhow.

Oh it's going to get done. Many eyes are watching now. Obstructors won't go unnoticed. The bullshit express stops this election year.

[UnbiasView]

You just proved you are one of the 16% in the crybaby category.

[GnitenGoodLk]

On the contrary, I'm smiling up a storm. The rats are scurrying in the face of major change. I'm loving it.

[Aaror]

You know, there may be a way...
The primary purpose of health insurance is to pay for catastrophic health care costs. It is not intended to pay for going to the doctor about that weird twinge in you knee, it is intended to pay for an operation and Kemo if that twinge turns out to be cancer.
At the same time, study after study proves that early detection and prevention are the best ways to reduce healthcare costs, and therefore the costs to the healthcare insurance system.
What if...
Instead of a national singer payer system for all health care, we had govenment paid annual checkups and, say, 8 government paid visits a year to check on a cold or unexpected pain. This would allow folks to get preventative medicine and early detection, cutting costs for both patients and the health care insurance folks. Gov't doctors could certify any significant conditions for the health insurance folks, so there would be no need for the back and forth of "does the patient need this care." and the government could mandate a standard form for communication between it's doctors and the health insurance industry, which would reduce paperwork costs and the number of clerks required (and the time to train those clerks).
Oh, and those 8 visits a year would allow folks with no health insurance to at least get diagnosed, which would cut the huge costs hospitals currently have from emergency room visits...
I think everyone wins with this one...

[SeriousBlack]

Good idea - there definitely needs to be this kind of thought-out component of a comprehensive health care system.

[wayoutleft]

the healthcare gongshow rolls on. so now i have to make a hobby out of moving some snoozing old codger from montana off his duff to maybe out bid the medical insurance industry for his estimable services? is that it? democracy as we know it? i not only have to work to pay his gargantuan salary and percs; after work i have to devise some kind of pressure campaign to get him to work? have i got that right? when all he cares about is the cattle and coal industries?
on the other hand, we can junk the whole concept to make absolutely sure RightAway doesn't lose a partially subsidized health club membership, an alternative with the sinister rational appeal of a conversation among the donner party. or we can return to the gold standard and all pay in doubloons.
i'm just here for the kicks. i've known my whole life that americans are too selfish to share resources to the end of the physical health and well-being of all citizens. and too shallow to entertain socially progressive ideas from a short guy with a bad haircut. i understand that about healthcare in america. in other words- i get it. i, me, mine- no healthcare but MY healthcare. and i get that no snoozing old senator has to do a god damned thing for anybody. i get that too. i'm just glad there are societies that completely different. i take great comfort in that.

[iswideopen]

Yes; never underestimate Senator Obama. That is why Hillary will make sure he is elected. She has seen the pitfalls of handling a task of this magnitude in secret and without the opinion of others This time, she will take the proper steps to assure its success. Obama is more than man enough to give her that respect, (which he has always done) and task, with fine tuning, of course. We don't want to be waiting 6 months for an appointment or feel like we're having our dignity taken away while waiting in mass lines, so Obama will make sure Americans are not "degraded" in the process.

[Herrington]

The time to nationalize healthcare is when the problem is at its worst. Whether that is now or in the future remains to be seen. Given the self destructive path on which the oil industry, the mortgage industry and capitalism in general has set its feet, the prospect of private for profit healthcare's survival for another decade is in serious doubt.

If we can expect the same restraint from medicine that we have seen in the oil business, then it is a done deal. If by some miracle of prudence, medicine decides that they no longer need to increase profits, then maybe not. It does not seem likely though. Greed is the least sensible of weaknesses, and greed has sunk industries time and again. It has even sunk countries, one greedy bastard at a time.

No, don't delay, don't be reasonable. It is political will that will do the job and not careful negotiations. The spectre of nationalization should be sufficient to get significant concessions in congress. if not, wait it out. Let the nation see just how dedicated the medical profession is to the health of Americans.

Unfortunately we are calculating with people's lives here. People are dying because of lack of a primary care physician. The math is this, a true national healthcare system will save more lives in the future at the cost of lives if nothing is done now. We, are after all, in a war with capitalism, and we always will be, even as capitalists.

[acudoc]

It's not the purpose of government to fund health care. If we had a stable currency and an honest banking system that was not inflationary and that was not dedicated to the transfer of wealth from producers to a financial elite (a transfer empowered by law since 1913 in order to create money out of nothing but our indentured servitude), we might actually be in possession of a monetary unit that had the purchasing power needed to fund health care. This is certainly not the case with our present system which systematically destroys the currency at a rate of 5-10% per year, aided and abetted by politicians who can't balance a budget and who run to the private centralized banking cartel to fund their cockamie programs and assinine wars when they realize they can't fund their illusions by direct taxation. Jeez, wake up brain-dead America.

[SeriousBlack]

GOVERNMENT does NOT "fund health care". Do you even know what "government" is? Can't make the freakin' connection?

"Government" is who the PEOPLE elect to represent the PEOPLE. And "government money", or in your myopic view, "government FUNDS", is OUR money, paid in taxes.

And it is we the people who should be able to decide, and direct our elected representatives, to PROVIDE A CRITICAL AND NEEDED service such as other services that we as a people and as a country have decided in the past SHOULD be administered by local and national government. Such as fire and police protection at the local level and a national military at the national government level.

YOU can choose to believe that "It's not the purpose of government to fund health care." That's YOUR right. It is also MY right to believe that, just like in almost every other modern western democracy, that the health and yes, LIVES of our country's citizens are worth more than a sick health care system that is becoming almost completely dysfunctional because of a basic, fundamental, fatal flaw - being ruled by private health INSURANCE companies whose goal is NOT to FUND ***OR*** PROVIDE effective health care for all americans, but to sit in between patients and medical professionals with their hands out, taking as much money as possible with the only goal of making as much profit as possible, and MAXIMIZING their profit by DENYING people insurance and refusing their claims once they get sick.

[SeriousBlack]

And, don't just believe me (or the many other posters calling for the elimination of the private health insurance industry). Here is some more supporting info, profiling someone with a lot more credentials about the topic than some anonymous poster like me (if you're open-minded enough to even read it):

http://www.huffingtonpost.com/norman-solomon/death-under-the-guise-of_b_108315.html

And sorry for the angry tone of many of my posts on health care but I can't even get health insurance because I have a pre-existing condition, so I live in constant fear of finding out I have something serious like cancer and not even being able to get treatment for it - even though that treatment might have excellent odds of saving my life. Just a LITTLE hard not to be angry and bitter whilst in a situation like that, doncha think?

[RightAway]

Every time someone has proposed health care reform, I have asked them the following question:

Many health insurance plans that are already provided by major American corporations to their employees, are quite generous. Mine included such things as dental care, mental health counseling, acupuncture services, and even a subsidized membership in a local health club. I see no way that such a generous level of health care coverage can be provided to everyone in America (including the tens of millions who are currently uninsured) without bankrupting the country.

Therefore: Does your health care plan require folks like to me to give up some benefits we are already enjoying through our employer-provided health plans, and accept a lower level of coverage with fewer benefits? Or will we end up with a two-tier or multi-tier level of service, in which newly covered citizens will get fewer benefits, but existing policyholders can keep the benefits they currently have?

A spokesman for the single-payer plan admitted that Americans who already have generous private plans may have to accept less coverage and fewer benefits under his single-payer plan.

And that's why all these health care proposals have failed. They are perceived as threatening those who are already quite satisfied with their existing coverage and don't want to switch to anything less comprehensive.

I believe that no health care reform can get passed if it is perceived as reducing anyone's existing health care benefits.

[SeriousBlack]

"I see no way that such a generous level of health care coverage can be provided to everyone in America (including the tens of millions who are currently uninsured) without bankrupting the country."

The CURRENT health care system in this country IS ALREADY bankrupting the country.

Next argument.

[Geekboy]

I was pondering this while Mr. O and HRC were duking it out on their respective health plans. To me, it seemed a rhetorical exercise. Neither had any chance of becoming reality but they had to go through the motions to appear serious on "the healthcare issue".
One thing that makes "reform" more difficult is the seemingly infinite capacity of our medical experts to develop new treatments and medications. Problem is, if these were applied to everybody that could benefit, nobody could afford to pay the bill!
We very commonly hear about patients being turned down for coverage of some procedures by Medicare or their insurance company. And we think how awful those people must be for turning down an obvious life-saving treatment. But they're just trying to stay solvent.
We simply can't afford to pay for all medical procedures that would be beneficial to people. Consider the doctors in France with the face transplant. They (with straight faces) went on to say this procedure could help MILLIONS of people. No it can't. No government could afford what it would cost for all those doctors to do that millions of times. It's not going to happen.
It's a big ethical issue, and one which has mostly been ignored so far... who gets what treatment? Especially if others (possibly taxpayers) are being asked to pay for it.

[Deaninphilly]

The one thing that makes your argument flawed is the fact that our "medical experts" don't receive money for new treatments through medicare or the any other health care system. It receives grants and money directly without affecting medicare now.

These "medical experts" receive Government funds (taxpayer money) to investigate and find new drugs and cures already. Once they find something they then charge us a high price for these "cures" stating that they need to make up the money they spent finding them. Funny we already gave you money to find the "cure" now you are charging us twice.