The Health Care Troubles

Having been in the Clinton Health Care War Room, I knew that moments like this would come, times I would describe as "the troubles." Health care is such a massive issue, with so many land mines and pit falls, that the monumental effort to reform it will always run into panic inducing barriers. You just cannot transform 17% of the American economy without goring a lot of people's oxes, and generally ticking off lots of powerful people.

We are officially in that phase. Hospitals, doctors, insurers, powerful Congresspeople and Senators, and all manner of other special interests are screaming bloody murder at one thing or another. Nobody wants to change what matters the most to them, or pay anything more to get health care reform, or have their sacred dollars in the federal budget cut. And the media treats every complaint as an apocalypse, another sure sign that health care reform is doomed.

Well, to steal my favorite line from Desperately Seeking Susan, everyone "should take a Valium like a normal person." What, you thought this would be easy? Based on Clinton experience, this has all been highly predictable kabuki theater:

Step 1: Everyone comes together and professes support of common goals and a commitment to working together and staying at the table. (In the Clinton fight, we launched our health care issue campaign with a media event where about 1500 groups endorsed our goals and outline of our plan. After President Clinton congratulated me on the success of the event, I told him how few of those groups would actually help us when the tough times came.)

Step 2: Proposals and compromises get floated, some push back happens, but the special interests mostly hold their fire because they want to stay at the table.

Step 3: CBO announces that health care reform is going to cost money. Everybody panics, because this had apparently not occurred to them before.

Step 4: The policy teams start firming up decisions, and the cries of anguish and outrage begin.

All of this happened in the Clinton health care fight, and all of it was completely predictable. But there are a lot of differences between this time and that time, including the fact that we are doing this in the 17 months from the next election rather than in the summer and fall of an election year; the fact that Obama has a 67% approval rating instead of Clinton's 40ish% at the time of the 1994 fight; the fact that the head of the Senate Finance Committee is totally engaged and determined to get something passed as opposed to irritated and disinterested as Moynihan was; and most importantly of all, the fact that we only need 50 votes in the Senate this time rather than 60.

I think it's really important in all this to keep some perspective. There are five committee fights and two floor fights before this is all said and done. With President Obama making this his top priority, they are going to be able to negotiate a lot of things out and roll over the road blocks that remain. No single issue complaint, no single special interest has the power to single-handedly stop this thing. The interest groups today who are screaming NIMBY ("health care reform is great, but not in my backyard") will have their 15 minutes of fame in the process, but they can't stop health care reform unless the Democrats themselves lose their nerve. So to my friends on Capitol Hill and in the media: just chill baby, we're in the period of "The Troubles," but we will come through it if everyone keeps their head together and hangs tough.

Comments

[hsr0601]

I suppose some common sense and cool head can solve this cost problem.
As we know, the public option currently being discussed is modeled after Massachusetts Plan, under which about 97% of all Massachusetts residents are now covered.
According to the approach of CBO, its rate of the uninsured in Massachusetts should be far greater than the present one at the moment.
Moreover, in case the strong public option, medical IT, increased efforts in prevention, and a broader array of cost-saving plans and beyond add to the Massachusetts Plan, the cost containment does not matter at all. And most importantly, the promising stem cell research is making its way.
To date, private insurers have coexisted profitably with Medicare and Medicaid for many years.
Basically, healthy society leads to better productivity and better performance.

[Tim303]

I appreciate this mellowness. I'm doing my best to lobby as a private citizen for the public option.

[OkieMon]

the only way to stop runaway health care costs are to eliminate the insurance companies and put people who can pay on medicare and people who can't pay on medicaid..­..employer­s and employees will still have to contribute like they are contributing now but this is the only way to slow costs at a time of apparent tripling of our national debt since the year 2000.....

[Awake-and-Sing]

This is what wimpy new politics brings you -- a watered down ineffective bill that conservatives still won't vote for.

The Democrats in Congress intentionally chose weak leaders so that they wouldn't be pressured to vote for bills their corporate campaign contributors didn't like.

The one in a lifetime opportunity to pass health care reform is being squandered under the farce of "new politics" and hollow "bi-partisanship".

It's almost too late.

Ram a public not-for-profit health plan down unwilling conservative throats. That's the only way we got Social Security and Medicare. They did NOT come from negotiation.

How I wish we had leaders like FDR who said about the conservative obstructionists during his day: "I welcome their hatred".

"New politics" never really had any effectiveness in terms of policy, on in short-term politics.

Bring back some of LBJ's ugly, but effective "old politics".

[breakingpoint]

Democrats Hate Health Care
http://jischinger.wordpress.com/2009/04/30/democrats-hate-health-care

If they want to lose Congressional seats in 2010 then they can go right on listening to guys like Daschle.

Perhaps, democrats don't want to win. Not having a majority or even the current small majority allows them to keep the American People caged and their pockets full of lobbyist insurance money.

There has been no better chance in the history of the US to pass sweeping Health Care Bill (HR 676) so that ALL Americans are covered. If Obama drops the ball on Health Care he can forget 2012. There's nothing that effects MORE Americans right now than Health Care. Not the war, privacy, education, housing and even jobs.

No matter what plan they comes up with Democrats will still lose in 2010, unless they do the right thing on this one issue.

Progressives see the power the Insurance Lobby is putting on the Democrats. Even former Democrat Tom Daschle who has no political seat to lose is on the side of the Health care Industry. Progressives see the game both sides play to maintain power.

Bill Maher is correct, it's time for a real Liberal Party in the US, not these two Corporate shills.

As more and more conservatives move to the Libertarian Party and GOPChristian move to the Constitution Party, The Democrats Party will start to lose support to more Progressive Candidates or worse, just stay home.

[plumnelly]

76% percent of the American people are tired of the rigged for profit healthcare system and want change ,NOW, not at the convenience of the insurance companies and their best friends ,our Congress and wall street. It's really inconceivable, that we as Americans have allowed Congress to enjoy access to 5 different health plans while denying the taxpayer who paid for their wonderful socialized healthcare. It's nuts. The Congress has nothing to say to us except a public policy choice.

[Viola]

"but they can't stop health care reform unless the Democrats themselves lose their nerve... but we will come through it if everyone keeps their head together and hangs tough."

I think the reason for panic lies in your final lines. First, Democrats seem to be losing their nerve right and left. Democrats have shown very little nerve for a long time and a reflexive tendency to screw citizens and reward large companies. Secondly, the notion that Democratic members of Congress will hang tough on anything really difficult is hard to imagine. Enough of them? I want to believe, I want to believe, but spines are in short supply in Washington, (except in the backs of lobbyists). Daschle (who was a complete marshmallow in the face of the Bush administration) is now calling for Obama to drop the public option. And Obama thought this was the guy who was going to lead us through these difficult waters? Daschle's true colors have emerged - he's just another weenie, as anyone who simply pays attention to what these people actually DO, vs. what they talk about - would already have known.

Maybe Obama will triumphf by showing true leadership in the face of greedy entrenched interests and contemptible Democratic enablers - but if it's up to Congress I shudder to think what they'll eventually do. (Please note, I'm a very unhappy Democrat. The Republicans aren't even worth discussing here.)

[plumnelly]

Everything you said and more.

[Lochmon]

With so many horror stories out there, let me tell you a story of how private insurance provided by an employer can get things right:

When I broke my arm, I saw a GP, who realized I would need surgery. He referred me to a specialist, who got me into the hospital the same day, with my operation scheduled for the next morning. At the hospital, the only shared room available was with a man who had broken his back, was in constant pain, and was apparently being loud about it. My doctor recommended a private room for me, and that's what I was given. The operation was completely successful, and all followup care went smoothly.

The insurance company paid the bills promptly. I do not have the figures on what all that cost and what my deductible was. You see, this was 1973, and I was only 12 years old at the time. My parents didn't have insurance, and my brothers didn't have insurance. I was the only member of the family with employer-provided insurance... because I had a small-town paper route, and the newspaper provided insurance to all employees, even us kids. My parents were relatively poor at the time, but I do not recall us doing any unusual belt-tightening.

That is how private insurance is supposed to work, and obviously has not done so in a very long time.

[nohobear]

Not sure how valuable any advice from a member of the failed Clinton Health Care Reform Team is. That debacle pushed health care reform off the table for over a decade.

No compromises. We need to hold the administration's feet to the fire. The people want single payer health care. The hell with placating the business interests and Republicans. They gave us the blood sucking system we have now that is bankrupting and killing all of us.

[mountclemens]

Sorry. If we "just chill," we're going to see the electeds squeeze out a sausage. Many of us don't want a sausage.

We can't stop. We must push and never let up for the fairest, best, least expensive reform: s.in.g.le p.ay.er. (I'm trying not to get deleted again.)