A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

The Optimist

The Optimist

December 21, 2007

Ezra Klein, writing in the American Prospect (subscription required), is optimistic we'll get national health reform in 2009. Just read his title -- Why 2009 Is the Year for Universal Health Care: It's not 1994 all over again. The next president can get the reforms that Harry Truman and Bill Clinton couldn't.

Go Ezra!

Since the (1994) drubbing, Democrats have been afraid, as former Sen. Bill Bradley put it, "to go back into that room where that bad thing happened." But Democrats need to return to that room -- and bipartisan universal health-care campaigns in Massachusetts, California, Wisconsin, and many other states have opened the door. In the Congress, Sen. Ron Wyden's Healthy Americans Act has attracted 10 co-sponsors, six of them Republican. In the presidential campaign, all of the major Democrats proposed comprehensive plans. Talk of reform once again floats through Washington. ...

...all the major Democrats currently campaigning for president have proposed essentially similar health-care plans based on three planks: Universal access, an expansion of something like the Federal Employees Health Benefits Program that includes a public insurance option, and the preservation of current insurance choices. This is not, from a purely policy standpoint, the best way forward. These plans do not fully integrate the system, and initially, they will not do enough to control costs. But politically, they're just about the only way forward. What those three planks translate into are three arguments that will undergird the case for reform: If you like your current health-care coverage, nothing will change; if you're not satisfied with your current coverage, you can buy into the same health-care plan that members of Congress use; and no matter what you decide, you will have more choices than you have now. That is how health care will be explained: no forced changes to your current insurance, the same coverage that those fat cats in Congress enjoy, and a broad menu of new choices offering an unprecedented array of options to those who want them. ...

For the first time in decades, congressional power players are talking seriously about concrete health-reform legislation. "To grow a healthy crop, you have to prepare the soil," says Sen. Max Baucus, now chairman of the Senate Finance Committee. "The Finance Committee will hold an aggressive series of hearings next year [2008] on comprehensive health-care reform. ? Next year can be a prime time for ideas, a time to lay the groundwork for immediate action when a new president and a fresh Congress take the field in 2009." Whatever the legislation that may emerge from this process, the momentum for change is certainly building. Additionally, the Democrats know they need to actually pass a bill, rather than simply fight for their perfect plan. "It will take full-court press by the White House," says Rep. Pete Stark, chairman of the Health Subcommittee in the House, and a longtime champion of Medicare-for-All, "and a lot of compromise, even from people like me. It couldn't be single-payer or raise a huge amount of taxes." Seeing all this, former Senate Majority Leader Tom Daschle can only marvel in appreciation. "I don't think there's any question that more and more members on the Democratic side are aware of, and committed to, the need for health reform," he says. "It's a better legislative environment than we had before."

"My [personal] index," says Len Nichols, director of the New America Foundation's health-policy program, "is the ratio of family premiums to median family income. In 1987, it was 7 percent. Today it's 17 percent. That fundamental dynamic, that health-care costs are growing so much faster than economic productivity, means that even though unemployment is so low and the macroeconomic indicators are good, there's still intense, acute anxiety." In economics, there's a famous dictum known as Stein's Law, which states that when something cannot go on forever, it will stop. Our health-care system, as currently composed, cannot go on forever. It will wreck our economy, collapse our businesses, render both private and public insurance unaffordable. And so, it will stop. Reform is not a question of if, but when and how.