You have to congratulate him for trying. Some of us were there the last time around, and it wasn’t pretty. So it’s hard to see him making some of the same mistakes the Clinton people (I was one of them) made, despite his efforts to avoid them. And, since 1993-94, there are new potholes that have opened up.
The first pothole is the overarching push to provide universal coverage, something next to impossible without a single-payer system. The second is the failure to properly address issues of cost and cost savings. Cost, value and rationing were the issues least discussed in ’93-94, and they are only now getting to the table. The third pothole is leadership, which the Clintons didn’t provide, and from which Mr. Obama has so far demurred.
He blew a big chance last night by failing to step up and tell the public: a) that this was his health care reform effort, not Congress’s to play games with; b) that he would not accept anything less than full cost accountability on the principles of reform he has outlined; c) that his party has failed him by providing a messy, superfluous bill full of window dressing that fails to address the real issues.
Mr. Barack is ever the cool customer, Mr. RationalCool, the one who looks askance at the mud wrestlers. Some of us want to see him taking sides for a change, kicking some Republican ass and laying out the steps needed to get the health care system to change. Stop tinkering with the plumbing. Some of us also want to see him stop handing the substantive decisions over to the Speaker of the House.
What’s Wrong with HR3200?
Everything. Congress needs to start over. The Health Care Blog has been running some commentaries on it lately. Here’s Jeff Goldsmith:
Just as she did with her “stimulus” pork fest back in February, Pelosi has created a huge problem not only for Obama, but moderate Democrats in her own chamber. Not only does the bill, under the best of circumstances, still leave nearly 17 million people without coverage. It will greatly handicap any chance for recovery in our country’s ailing economy.
The worst thing about HR3200 is its cost shifting of financing onto the backs of business, tying health care even further into the employer mandate. Politically, this could be a replay of 1993-94 when the National Federation of Independent Business and the Chamber of Commerce drew their long knives to finally kill reform.
After the CBO came out with its assessment that this bill contained no real long-term cost saving, Dr. Albert Waxman wrote that there are better, viable solutions on the table:
2. Proposals that remedy the inefficient and poor quality associated with the treatment of the chronically ill and excessive re-hospitalizations.
3. Promising approaches in designing Value-Based Benefits that effectively lessen chronicity, improve quality and stimulate compliance and adherence to an individual’s care plan.
Why are we not hearing about and considering these concrete approaches? Why are our elected officials so intent on a “quick-fix”? We know that a quick fix is just that. We must have a systemic overhaul. Systemic overhauls require expertise and thought, not haste.
And why has single-payer not even been considered? If Obama had come out strongly for it (he admitted it was the best solution but not “achievable” politically), he would be no further behind the eight-ball than he is now with an indefensible bill on the table. If you really believe, as some Republicans have suggested, that the “public option” is just a stalking horse for single payer, you haven’t understood how intimately reform is tied into the whole economy, not just service delivery.
Last night the president spoke about how important reform was to this economy, one-sixth of which is health care. What he didn’t discuss is how the climate for reform is getting worse—because of the political debate and the severe compromises this bill represents.
Here’s Goldsmith again:
If I were Tom Daschle and Peter Orszag, I’d barge my way into those political meetings, and help their President salvage this thing. Way more savings need to come from the health system itself (50% isn’t enough), particularly from the rich matrix of subsidies and inappropriate incentives which sustain the industry’s inflationary cost curve, and the tax burden needs to be spread across consumption, particularly unhealthy consumption, and removed from the wage base. Health insurance also needs to be much more affordable for ten million uninsured young people, or they’ll simply blow off the individual mandate and remain uninsured.
Mr. Obama says he disdains the way politics impinges on reform, but he in fact is playing politics by taking the laissez-faire, hands-off approach. If he doesn’t commit to real reform and real leadership, we can write yet one more chapter in the history of failure. He’s given himself another five months . . . maybe.
John, This is good, really good. I believe you should forward this directly to the President.
Ann Hubbard
Posted by: Ann Hubbard` | July 25, 2009 at 02:34 PM