Confused about what’s happening with health care reform? Join the club. After months of buildup and debate, endless meetings and daily pronouncements, we’re still waiting some clear outline of a reform plan to emerge. Instead, the picture seems to get fuzzier with every passing day.
At the American Medical Association convention in Chicago this afternoon, the President called health care expenditures a “ticking time bomb” for the nation, and told eloquent stories of families, small businesses, and even doctors who are being crushed by these spiraling costs. The rest of his speech catalogued the most uncontroversial elements of any proposed reform–encouraging more preventative care, promoting “best practices,” eliminating waste, reducing junk food consumption, instituting electronic medical records. Who could possibly object to such things, other than perhaps the manufacturers of potato chips and Wite-out?
Meanwhile, the speech offered only the vaguest clues as to how Obama proposes to resolve the most contentious—and important—issues in any possible reform plan. The best insight into this ongoing state of irresolution came after a meeting last Wednesday at the White House, where the President called together a group of senators from both parties to hash out their differences. The Associated Press reported:
A senior Republican who recently criticized Obama also sounded positive. “The president, I thought, was very flexible except on one thing, and that was getting it done,” said Sen. Chuck Grassley, R-Iowa. “When the president is flexible on controversial things … I think that that’s good news.”
Given all this “flexibility,” the senators at the meeting—Grassley and Max Baucus (D-Mont.), ranking members of the all-important Senate Finance Committee, plus HELP Committee leaders Mike Enzi (R-Wy.) and Chris Dodd (D-CT), who has stepped up in Ted Kennedy’s absence—agreed they could bring a bill to the Senate floor in July.
In other words, expediency has replaced essence when it comes to the Obama administration’s position on health care reform, and strategy has replaced substance. What matters is not so much what kind of health care system we end up with, as long as we end up with something that looks like reform—preferably, before the end of Obama’s first year in office. What this is, of course, is the perfect formula for a health care reform that is uncontroversial, weak, and expensive.
What is shaping up here is a replay of the credit card legislation: Under a propaganda blitz heralding sweeping reform, we get legislation that reins in some of the very worst abuses, while making no significant change at all to the underlying flawed system. So, for example, we may see insurance companies required to provide coverage in spite of pre-existing conditions–something Obama referred to in his AMA speech, with moving references to his mother’s own battle with cancer. We might see what the President today called “more efficient purchasing of prescription drugs,” which presumably means more power to haggle with Big Pharma over drug costs, as well as speeding up approval of generics. We will see health care providers given incentives for more cost-effectiv–and, we can hope, better–treatment. These things are not meaningless, and they will provide a modicum of help to some struggling Americans. But they do virtually nothing to strike at the basic American system of health care for profit. And at the same time, they offer only a fraction of the savings a single-payer system could offer.
With no clear vision emanating from the White House and no bottom line, everything is up for grabs when it comes to the details of this tepid reform. It’s no wonder, then, that new balls keep coming out of left field every day. As Obama prepared for his AMA speech, the Washington scuttlebutt was that he would seek to reduce costs by accepting limitations on malpractice suits. In the speech, the President said he was “not advocating caps on malpractice awards,” but wanted to “explore a range of ideas” to reduce the malpractice threat. The New York Times reported this morning:
In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits—a goal of many doctors and Republicans—can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials.
It is a position that could hurt Mr. Obama with the left wing of his party and with trial lawyers who are major donors to Democratic campaigns. But one Democrat close to the president said Mr. Obama, who wants health legislation to have broad support, views addressing medical liability issues as a “credibility builder”—in effect, a bargaining chip that might keep doctors and, more important, Republicans, at the negotiating table.
It’s in this same spirit of seeking “broad support” that the so-called public option–a government-run alternative to private insurance, which could at least have begun to show up the insurance companies for the bloodsucking middlemen they really are–seems to be dying a slow and painful death. In fact, it looks more and more like the public plan may have all along been a straw man, set up only to be knocked down. On the one hand, it has served as a temporary panacea to single-payer advocates and other critics of medicine-for-profit, including important Democratic constituencies like labor unions. On the other hand, it is now a major bargaining chip, or “credibility builder”–something that the administration can give up, in what looks like a generous concession to its opponents.
TOMORROW ON UNSILENT GENERATION: What the not-so-public “public option” could look like.