THE BLOG

Relying on the Sausage Factory: The Best Way to Enact Health Care?

09/03/2009 05:12 am ET | Updated May 25, 2011
  • Lanny Davis Principal, Lanny J. Davis and Associates LLC

I am guessing that in the early days of the Obama administration, probably shortly after the arrival of Chief of Staff Rahm Emanuel, the "strategic decision" on health care was made, one that we are now watching unfold in recent days in Washington.

I am guessing it was essentially a negative decision -- don't make the basic mistake that the Clinton administration is widely seen as having made in 1994. The conventional wisdom says that the basic cause of its failure on health care was the choice to write in secret a complicated 1,000-page bill and then, send it up to the Congress, where no one could understand it and where it was ripped to shreds by all the special interests, especially by the nasty "Harry and Louise" ads.

So the "strategic decision" I am guessing the White House made was to announce basic principles and then let Congress write up the details. I never quite heard a simple listing of those basic principles. In fact, it took me a while to boil them down to five, and I am not sure I am right:

(1) Let everyone keep the insurance they currently have; (2) universal right to health insurance, regardless of risk or pre-existing conditions; (3) mandated insurance to be purchased by everyone or else pay a penalty ("pay or play"); (4) tax subsidies to cover the 50 million uninsured; and (5) a "public insurance" option to create competition for private insurance companies, as well as other ways to reduce health care costs, using savings generated by everyone's favorite budget item -- "eliminating fraud, waste and abuse."

I figured out these basic principles, and I think I agree with them, though I am still not sure about the effects of the public option on employers who are already paying generous health benefits to their employees. Then I tried to follow what the Senate and House Democratic majorities would do in enacting these simple principles. But they are not so simple when the legislative sausage factory process takes over. So what has happened so far?

Let me do full disclosure first: I read two or three newspapers a day (that means real paper newspapers, the ones you touch and feel and turn to the jump" page from the front page. I occasionally check the Internet. I read columns and the New Yorker and other wonkish publications. And at night, unlike normal, well-grounded people, I turn on the TV over dinner, and I watch the political cable-TV programs on CNN, MSNBC and Fox.

So I am not normal. I am a news and politics junkie. My point, and I don't mean to seem vain or patronizing, is that I am likely to be better informed than the average American just because I am such a junkie.

And yet -- I need help!!!

I know very little, and understand less, about what all these health care bills being debated in Congress, what they will or will not do, how much they will cost, who benefits and who pays, and most important, how they will affect me and my family and the nation's health care system.

In recent days, it seems that some progress has been made. I guess.

Some weeks ago a major health care proposal was approved by the Senate Health, Education, Labor and Pensions Committee, headed by Sen. Edward M. Kennedy and with most of the heavy lifting done by Sen. Christopher J. Dodd as he explained it, spending 60 hours, considering 300 amendments, 23 sessions. But, honestly, I do not have the foggiest idea what is, or is not, contained in his bill.

I am not blaming Mr. Dodd: I am sure he tried to explain it. Maybe it was on a day when the media were focusing on Michael Jackson or some other, far more important topic affecting our lives. Whatever. I don't know why I don't know. I just know that I don't know.

Meanwhile, there is another Senate committee -- the Senate Finance Committee -- writing another health care bill. Don't ask me why Mr. Kennedy and Mr. Dodd's bill is not enough and we need a second committee working on a second proposal. They haven't explained that either.

In any event, the Senate Finance Committee, led by Democratic Sen. Max Baucus of Montana and Republican Sen. Charles E. Grassley of Iowa, are apparently trying to write a bill that will be more bipartisan. So far though, only three Republicans have been participating in the talks, which doesn't sound very bipartisan to me.

And so far, all I have been able to figure out is that the Senate Finance Committee negotiators are talking about creating "health care co-ops" as an alternative to the "public option," a government-run health care system, like the one available to federal employees.

What's a "health care co-op"? I know what an apartment house co-op is. I know that there are rural electricity or farmers co-ops, so I suppose I can guess that's what a health care co-op will be like. But why is it better than a public option? Is it less expensive? Will it provide better care? I don't know. Don't know much else about the Senate Finance Committee bill either, except they say they won't have agreement until after the August recess.

There also seemed to be more progress this past Friday, when the House Energy and Commerce Committee, led by Democratic Rep. Henry A. Waxman of California, passed a version of H.R. 3200 by a narrow margin of 31-28, with five Democrats joining with 23 Republicans in opposition, not exactly an overwhelming mandate.

And what did they approve by such a narrow margin? I really don't know for sure.

I read all the newspapers all week trying to follow the negotiations between the Democratic Blue Dogs and Mr. Waxman and his fellow liberals; and I spent much of Saturday trying to read everything I could about the Energy and Commerce Committee bill, which news commentators seemed to say represented great progress.

The only two key elements of the compromise that I could make out that led to the narrow approval was, first, reportedly allowing the health and human services secretary to negotiate with health care providers rather than tying the program's payouts to the Medicare reimbursement rates; and, second, cutting subsidies to lower-income families for insurance premiums and getting savings from Medicare and Medicaid, which serve the poor.

Huh?

I thought one of the basic principles here was to ensure the 50 million people who are uninsured, most of whom are lower-income families and the lower-income elderly, would be covered by health insurance. Is the compromise intending to find savings by increasing costs to poor people and senior citizens -- those who are most vulnerable and need medical care the most?

Now I am really, really confused.

One other thing: the House Energy bill is more than 1,000 pages. Sound familiar?

I'd like to help the president support and enact national health care. But I know that to be effective, I need simple core messages to communicate, backed up by detailed facts and knowledge of what is, and is not, in the actual legislation.

It's that simple; and (it seems) it's that difficult.

I know to be effective helping the president pass national health care at long last -- which I strongly support -- it would help a little if I understood a little more. And a more effective message strategy will obviously be needed in the future if anything close to a comprehensive health care bill will become law.