Who do you think wrote the following paragraph?
"The health care system in America is broken. Costs are rising at an unacceptable rate -- more than doubling over the last 10 years, which is nearly four times the rate of wage growth. Too many patients feel trapped by health care decisions dictated by HMOs. Too many doctors are torn between practicing medicine and practicing insurance. And 47 million Americans worry what will happen to them or their children if they get sick."
That paragraph was written by Jim Coburn, Republican Senator from Oklahoma. It's the opening sentences from his Patients' Choice Act. It should sound pretty familiar. That paragraph could have easily been written by most Democrats, and it echoes the problems that President Obama has outlined himself.
It's easy to blame partisan politics for driving health care reform off of the rails, but I don't think hyper partisanship has been the central problem. The reason health care reform has stumbled over the last year is because there was never a clear consensus on what we were trying to achieve and what specifically constituted a health care victory. This absence of well defined goals, benchmarks and consensus on specific objectives left legislators wrangling over how seeming disparate policy proposals impacted their constituencies (and big donors), rather than asking whether or not the total package of policies being proposed would, on the whole, help the voters they represent.
Oddly, rather than being shocked by the hyper-partisanship, I've been surprised by the degree of unanimity that there has been with respect to health care reform, particularly outside of the beltway.
In most cases, health care experts, regardless of their political affiliation, have been in lockstep about what needs to be done and have had no problem proposing seemingly apolitical solutions. Atul Gawande, Donald Berwick, Elliott Fisher and Mark McClellan -- four physicians -- have written persuasively about health care reform and they haven't used the words Democrat or Republic once. I recently participated in a roundtable forum with a member of President Bush's Cabinet, a representative from Newt Gingrich's health care think tank, and participants from the political left. I was shocked at the extent to which they all agreed! And then there's the trio of Bob Dole, Howard Baker, and Tom Daschle -- once they were out of office and were able to put aside politics, band together on common goals and collectively proposed a sensible pathway to reform.
Then think about the kind of patient safety proposals that Peter Pronovost, a doctor at Johns Hopkins has developed. His checklists save lives, improve care and can reduce how much we spend on health care. Surely, we're all in agreement about what he's proposing.
Partisanship isn't going anywhere and it doesn't have to cease in order to pass comprehensive health care reform. In fact, healthy partisanship may even make the policies stronger.
There are a host of other countries that have achieved comprehensive health care reform, and it's not because politics in those countries are devoid of left versus right ideological battles. Instead, the reason why Switzerland, England and the growing list of other major countries like the Netherlands have passed major health care legislation is because there's bipartisan consensus on the need to have high quality health care. Once there are agreements on those macro principals, legislators are left free to argue about how to improve the specifics without the risk of throwing the baby out with the bath water if the talks collapse. If they fail, there is agreement that it is a plague on all their houses.
The challenge is getting legislators in America to mirror this sort of thinking in a political environment where unfortunately, cooperating across party lines is a sign of weakness for both parties, and ideological entrenchment is becoming a key ingredient for reelection.
With that in mind, the test President Obama is facing tomorrow is not how to achieve compromise on the public option or agreement on the Cadillac taxes. Instead, his challenge is to draw out the shared goals from Democrats and Republicans and then get both sides to be very explicit what they expect from health care reform. There won't be agreement on everything, but I suspect everyone will find that that they are far closer than they expect and that laying out specific goals will help dictate which specific policies are imperative, and how they fit within a broader push for health care reform.
If it were up to me, I would aim to get the participants to give specific answers to the following 4 questions:
- What is the minimum level of health care that every American should be guaranteed?;
- On what day of what year will we provide every American with health care at that minimum level which we have agreed upon?;
- How do we specifically define 'affordable health care'?; and
- How much money are we prepared to spend now, in order to meet these objectives?