Elections are about making promises and making friends; governing is about making choices and making enemies. If President Obama wants health care reform then, both for political and policy reasons, he needs to start making some real enemies on his left because the strategy of conditioning passage on an all-liberal-with-a-few-moderates strategy will not work.
The President should begin the upcoming February 25 symposium on health care reform by reaffirming his unwavering commitment to universal access, higher quality care and controlling costs. Next and as importantly he needs to acknowledge the real lesson of both his health care reform efforts to date and the failure of Hillarycare which is that neither our political system nor the majority of American think it is a good idea to have Washington redesign our entire health care system in one fell swoop...and for good reason. It requires a special combination of ignorance and arrogance to believe that a bunch of politicians and their staffs can redesign a large chunk of the economy without massive unintended consequences and thus incur the potential risk that the outcome could be a worse system than we have now, not a better one.
We should be ambitious about our goals and modest about our confidence that they can all be achieved immediately. Incremental reform is not a great political slogan, but it can be the basis of thoughtful change.
Three areas of incremental reform should be included as part of the upcoming symposium debate: 1) Most favored nation pricing for drugs which would require US pharmaceutical companies to offer US citizens the same pricing that they negotiate with other governments such as Canada. We don't need to re-import drugs from Canada; we just need them priced at the same levels as in Canada; 2) tort reform which would focus on faster and more predictable resolutions of medical malpractice allegations (using a combination of specialty health care courts and arbitration proceedings). This kind of reform would also require complete transparency in these proceedings so that we can create a constant information feedback loop to the medical industry. Only this kind of quick and comprehensive information flow about mistakes will provide the basis for a system of continuous quality improvement; and 3) a national reinsurance pool that would provide subsidies which would extend the reach and affordability of health care insurance to citizens who either can't afford it or have preexisting conditions which preclude them from obtaining it.
If the President is calculating that his symposium will allow him to bludgeon Republicans and moderate Democrats into supporting the existing health care legislation, he will be sorely disappointed. On the other hand, if he uses the forum to seriously consider incremental changes that use a combination of market mechanisms and government regulation to begin transforming our health care system into one that provides more coverage at lower costs with higher quality, then he will go down in history as the President who led the way on providing the American people with the health care system they deserve.
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