Health Care and the Past

by admin on July 27, 2009

As more time passes more people are rethinking a government run health plan. Health Care Reform seems to be not as easy as Americans thought or wish it could be.


WASHINGTON — Bill Kristol, a powerhouse policy guru for Republicans, often has a tin ear for politics. A week before the presidential election last year he predicted John McCain would “win huge.” In May, he said President Barack Obama had decided to nominate Governor Jennifer Granholm of Michigan to the Supreme Court, and he’s been a cheerleader for Sarah Palin.

Mr. Kristol was prescient, however, 16 years ago in advising Republicans that defeating President Bill Clinton’s health care overhaul would be devastating for the Democrats. He’s making the same case today, imploring Republicans to “go for the kill” on the Obama health care initiative.

He’s right again. A defeat would be a killer for Democrats. The trademark of Mr. Obama’s first year in office would be failure; the reputations of the president and his celebrated White House staff would be decimated.

Less evident, though equally true, it would almost certainly cost congressional Democrats seats in elections next year, striking especially hard at some of the same centrist Blue Dogs who are resisting a health care bill.

Now those nervous Democrats are looking at polls showing declining support for Mr. Obama on health care and data heralded by the health insurance industry showing that most Americans are pleased with their coverage.

Both are misleading. There is no Obamacare plan. The declining poll numbers arguably reflect the disarray in Congress and among Democrats; this is what happened in 1994. And most Americans are satisfied with their health insurance until they have to use it.

For 30 years my health insurance seemed just fine. Then one of our children was paralyzed and needed to learn to walk again. The insurance company said its “expert,” dismissing the opinion of Johns Hopkins physicians, had concluded he had no need for a physical therapist.

To contest this expert, we had to put this severely disabled teenage kid through the humiliation of videotaping him while he tried to take steps. Most people who have been deep into health care understand why moviegoers cheered Helen Hunt’s famous denunciation of health insurers in the movie “As Good as It Gets.”

A more relevant number for nervous congressional Democrats to consider is 54 — the number of seats they lost in 1994 despite a reasonably good economy and no wars; this was after the party disintegrated over health care.

The big news back then was the defeat of powerful leaders like Tom Foley of Washington, the House speaker. Over all, the losses disproportionately affected middle-of-the-road Democrats — the Blue Dogs of their day — from states like Indiana, North Carolina, Georgia and Ohio.

Some Blue Dogs calculate the best deal for them may be to go on the record as voting against a bill that will become law anyway. The other politically viable option is to help craft the legislation. It’s unlikely the Democrats will suffer in 2010 for voting to overhaul a failing health care system; it will be several years before the effectiveness of such action is apparent.

Mr. Obama and his chief of staff, Rahm Emanuel, need to persuade the Blue Dogs that many of their political futures are at stake, too, while pressuring liberals not to let their notion of the perfect be the enemy of the good.

That won’t be easy.

“A lot of members are choking,” Mr. Emanuel acknowledged. Everybody liked health care reform, he said, “until they got visited by their local self-interest.”

With fractious fights in both chambers, one important advocate says the prospects for success are no better than 50-50.

That seems a little too pessimistic. Amid the squabbles, there has been considerable progress. In the House, a deal was engineered on the politically sensitive question of regional disparities in Medicare reimbursements.

The House speaker, Nancy Pelosi, will decide in the next few days whether to bring a bill to the floor before the August recess.

Passage would add to a sense of momentum, yet there is a danger in appearing to rush through a measure that affects one-sixth of the U.S. economy, and she could lose up to three dozen of her Democrats in a floor vote. (The White House would prefer that the House stay in session a week beyond the July 31 summer recess date. The problem is that many members, with younger children, have family plans before school starts in mid- August.)

For all the difficulties, the contours of any ultimate measure are clear.

The so-called public option — some form of government-run plan to compete with private insurers — will only be a fallback in the event private insurers fail to meet the goals, and will probably be in the form of health cooperatives or another mechanism. Liberals simply will have to accept that they lack the votes for a full-fledged public option.

Raising revenue — in the neighborhood of $300 billion over the next decade — may be the toughest nut. The House Ways and Means Committee’s millionaire’s surcharge plan is dead; at most, only a much smaller tax on the rich will fly. More likely will be some amalgam, including a tax on the most generous health insurance plans or the insurers that offer them, that would be part of the $200 billion in tax measures on the Senate Finance Committee’s table. Fears of a budget-busting bill are misplaced. Neither the politics nor the procedures will permit that.

Cost controls, so great in theory, will bite and will require politicians to take on special interests. The Blue Dogs, for all their talk of bills being too expensive, start off demanding more expansive health care for rural areas.

It is fantasy to talk about a bipartisan bill; no more than a handful of congressional Republicans are likely to vote for a final bill. They’ve heard Mr. Kristol.

The bottom line: Democrats control their own fate. That’s the glory and the agony of governing.


Most Americans are pleased with their coverage but that does not mean they are pleased with the price. With Health Care costs on rise would you rather have cheaper rates for less coverage? A government run health care system will bring that. It will give the government control over your doctors, who can have needed medical treatments and when.


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