During the presidential campaign Republican John McCain and Democrat Barak Obama both made reforming health care a cornerstone of their campaigns. Obama’s victory, however, was widely interpreted as a vote for change.
But in the year since his election, the health care debate has been stalled by sharp partisan politics and what can only be described as a failure to lead by the Obama administration. The president lost control of the debate early on and the reason has little to do with the proposals now being debated in Congress.
While his call for a bipartisan solution to health care is commendable, he failed to realize, or at least to react quickly enough, to the political implications of the debate, and to the ferocity of misinformation campaigns that ended up spooking the public and undermining support for reform.
Obama’s efforts to compromise and seek bi-partisanship has only made him look weak and vacillating, creating uncertainty and ultimately the very distrust of government that his political opponents have been fomenting. In short, he’s been played by ideological opponents who want to see him fail at any cost – health reform be damned – because it will bolster Republican chances of winning mid-term elections.
Wild claims on the far right about death panels and other distortions had their intended effect. They turned reform into a debate about Big Brother and distrust of government rather than health reform itself.
That leaves Democrats and the President with a choice, argues Len M. Nichols, a health economist. “They can follow the public’s fear and confusion down the path of perpetual inaction. Or they can lead,” he writes in the latest issue of the New England Journal of Medicine.
In the face of an entrenched $2.7 trillion health care industry, only the government can rewrite the rules of private insurance markets to ensure insurance companies stop basing profits on excluding the sick. Government is also the only buyer strong enough to lead locally dominant providers through payment reform.
“The objective truth is that we cannot begin to get our fiscal house in order until we control the growth of costs in Medicare, Medicaid, and the entire health care system. We cannot achieve this without government action. Not a government takeover, but government action,” writes Nichols, who is also director of the Health Policy Program at the New America Foundation, a non-profit, non-partisan public policy research institute based in Washington, D.C.
“Payment reform that rewards quality over volume is the key to using market forces to align incentives for patients, providers, and payers while reducing cost growth for taxpayers,” Nichols continues.
He also suggests that Democrats need to start focusing on what’s good about the House and Senate bills. They would, for example, cover the vast majority of the uninsured — more than 30 million people, “and would make it possible for all to buy decent private insurance regardless of income or health status.”
But more importantly, the measures would “signal to insurers that the days of profiting from denying coverage or care are over. It would also signal to hospitals and clinicians that the days of unaccountable fee for service and pay for volume are ending,” he argues.
Ironically, it was McCain who announced during the heat of his Republican bid for president, in October 2008, that he would pay for his health plan “with major reductions to Medicare and Medicaid.” Those cuts would have reduced Medicare and Medicaid spending by as much as 20 percent over 10 years and cut benefits, according to reports and independent analysis at the time.
In December, however, the Arizona senator made an abrupt about-face when he trashed $487 billion in Medicare reductions in the Senate bill, by moving to exclude them. The reason? The reductions, McCain argued, would “directly impact the health care of citizens in this country.”
The hypocrisy of McCain’s argument wasn’t lost on numerous political observers. “It’s a bit rich for McCain to make this argument, given that it was just a little more than a year ago McCain himself, as a presidential candidate, was calling for substantially larger Medicare cuts,” wrote Jonathan Cohn in the New Republic.
Efforts by Republicans to thwart any Democratic health care reform came to fruition with Republican Scott Brown’s stunning upset victory in the Massachusetts race for late Sen. Ted Kennedy’s Senate seat. The move ended the Democrats’ 60-seat majority and effectively killed the political momentum for passage of a health reform bill.
The upset victory was also a major reason for Obama’s call for a high-level summit on Feb. 25. The president, according to reports, hopes to break the impasse with a range of new “compromises.” According to a report in the Wall Street Journal, he has yet another back up plan with even more limited reforms, if his new plan doesn’t fly, although the administration has flatly denied the report.
The other overriding argument for reform is the high cost of doing nothing. Skyrocketing costs, shrinking coverage, and rising Medicaid and Medicare deficits will mean draconian health care price controls, massive benefit cuts in Medicare, Medicaid down the road.
Without any policy change, the uninsured population is forecast to increase by 15 million, from roughly 52 million in 2009 to 67 million in 2018, according to a study by the Urban Institute/Brookings Institution Tax Policy Center.
Given the stakes, it’s no surprise that such groups as the American Hospital Association, the American Medical Association, and PhRMA (Pharmaceutical Research and Manufacturers of America), have all embraced comprehensive reform.
A bi-partisan solution would be the best of all possible worlds, and hopefully the summit will lead to a more cooperative effort. But the president has already lost critical momentum, and can no longer afford to continue trying to bring on board lawmakers who have a vested interest in his failure, no matter what the cost. In short, it’s time to lead.