Then and Now: The Saga of Health Care Reform

The nation or more precisely the Obama Administration is consumed with the debate about health care reform. The debate is far from academic it is commingled with rhetoric, uncivil discourse, charges and countercharges. For those who are not directly involved, who are on the sideline so to speak, the foray is a bit out of place.
Health care reform was at the top of the presidential candidates’ agenda. One and all: democrat, republican, or independent heard the presidential candidates speak about the need to reform the nation’s health care system. Many articles were written comparing the candidates’ plans. Economists and journalists took aim at the specifics of the two major proposals: the Obama plan and the Clinton plan. Nothing was left to the imagination. Judging from the coverage, no one doubted that if either Clinton or Obama won the presidency, health care reform would be at the top of the new president’s agenda.
Given that this expectation has been realized one needs to ask: what soured the population (public opinion seems to be oscillating between for and against) on reform?
There are several reasons that may account for this: The first and foremost is a doze of reality. The president took office in the midst of a financial crisis that brought the country to the brink of economic disaster. Although the recession was already in place prior to the inauguration of the new president, the euphoria surrounding the election did mask the severity of the financial and economic collapse. Americans are optimistic by nature; hence the expectation was that with a new democratic president, a congress with democratic majority in both houses, things could only get better.
Then came the realization that this assessment was too optimistic, that the financial crisis is more severe, and that many people’s livelihood was on the line. When one’s livelihood is on the line, the first priority is “jobs”: putting food on the table. The second or the third, is to make sure that medical care is there when needed.
I believe the administration missed the opportunity to inform the people—those unemployed, those who lost their houses, those who had to file for bankruptcy, those who lost faith in the American dream—that the Administration’s first priority is “insuring” their livelihood. Bailing the financial market first, a sound action to be sure, did not tell the ordinary citizen (Mr. Joe the plumber of the campaign) that his welfare is the focal point of the rescue plan of the economic system. Although actions speak louder than words, in personal crisis words matter as much as concrete actions. People’s interests were not at the forefront, not in the words or deeds until later on in the administration rescue game plan (The cash for clunkers!).
Once the faith of the people in the administration’s ability to address their needs has weaned, critics found an entrée to challenge the administration in all fronts. The most critical and perhaps the most effective challenge is directed towards the Obama’s plan for health care reform. And the public seems to be listening so let me take a minute and raise a couple of questions:
First, do we need health care reform? If not, we can quit now and go our merry way. If the answer is yes, then the “battle” is worth fighting.
Second, how much support “Health care reform” garners? In a democracy the plurality rule of 51% must be satisfied. Public opinion seems to put the support at over 50%. According to CNN, “going into the speech (Obama’s speech on September 8th); a bare majority of his audience—53%--favored his proposals. Immediately after the speech, that figure rose to 67%.”
Third, if the reform is a “mandate”, all must have health insurance by a certain date, then the question of affordability arises. To figure this out one needs to focus on the 15 percent of the population who are without insurance. A bit of information from the presidential debate about health care reform may be helpful at this point.
On March 25, 2008 The Ott Blog discussed the health care reform issue under the title: The Biggest Dilemma: How to reduce America Health Care Costs and “Ensure” an Affordable Quality Health Care for All? The article briefly compared candidate Obama’s plan with candidate Clinton’s plan. Although these two plans differed, they had two themes in common: Expand coverage to the uninsured and “cap” spending on health care.
Having set these two straightforward goals, implementation as everyone is finding out is not so straightforward. As it is turning out, the “DEVIL” is in the detail.
What was candidate Obama’s blueprint for reform (Barack Obama’s Plan for a Healthy America)?
· Coverage: Expand insurance coverage to the uninsured. No need for mandate, except for coverage for children.
· Choice: Offer all Americans an enhanced choice in the selection of insurance coverage through a mix of private and public plans. A new public insurance program would be offered to those who neither qualify for Medicaid or SCHI, nor covered by employers’ plans. He also called for a “National Health Insurance Exchange.”
· Quality and costs: Improve quality and cut costs through monitoring of services and modernizing the system.
True to his platform, the president put into motion his legislative agenda: To reform the US Health Care System. His reform proposal in its broad outline departed very little from the blueprint of reform outlined in the “Barack Obama’s plan for a Healthy America.”
Why then has it taken so long to enact a plan? And why all those cheap shots and not so cheap shots are lunched against the reform?
To answer these questions one needs to look at the realities of reform—the players; the legislators; our representatives in congress who write the laws, The Providers: Insurance companies, hospitals, physicians and nurse practitioners.
The payers: Those with employer provided insurance; those with own private insurance and those on Medicare.
The uninsured: Those who must now buy coverage.
I shall discuss how each of these groups is likely to fare or believe they fare under the reform plan (once the bill sets out of the Finance Committee) in my next blog.