Everybody wanted health care reform. So what happened?
What promised to be a consensus-building search for solutions to America’s unsustainable fragmented health problems has turned into a debacle. Make no mistake about it, this is the fault of the President — no one else. I say this as a supporter of President Obama. I’m a lifelong Democrat. I voted for Barack Obama with enthusiasm and I still have his bumper sticker on my car and pickup truck.
I can tell you that his first mistake was to discount the good advice he was getting from rural senators on both sides of the aisle. Obama is an urban president and he’s been looking to the coasts for direction. He should be looking more to the Plains.
Before I get into specifics, I want to recount a conversation from about four years ago. I was in my first meeting as a member of the Kentucky Chamber of Commerce’s Health Care Committee. I said, “If we don’t do something, health care in America is going to crash and burn.” It was nothing original. I had heard this more than once from others.
Being a moderate to liberal Democrat in a room with health care providers and some fairly conservative business people, many of whom were Republicans, I wasn’t sure what kind of reaction I might get. But just after I finished, Ron Sanders, a Republican businessman from my home town, repeated, “If we don’t do something, health care is going to crash and burn.”
Absolutely no one took issue with me. I became convinced that day that the time was finally right to address the profound problems with American health care. Since then, I have become chair of the Chamber’s committee. Ron is my vice chair. While we haven’t agreed on many things — like who should be President — we do agree that collectively we all have to address health care, and we have worked with our Chamber of Commerce to craft a package of proposals.
I firmly believed that this conversation would be played out all over the country and that consensus-building reform was possible. In public and in private, providers and people at large were talking about the need to do something. There was nearly universal agreement that everyone needed to take some personal responsibility for their own health. This was particularly critical to us, since Kentucky has about the unhealthiest population in the nation.
There was little disagreement that the rising cost of health insurance was hurting many Americans and that it was making American business less competitive in the world. There was little disagreement that having 40-plus million Americans uninsured was unconscionable. Finally there was little disagreement that much of what was being done in health care was unnecessary and/or duplicative. This point was not disputed by the providers. They were all ready to do something about it, so long as they wouldn’t be going it alone while their competitors got “a leg up” on them.
During the presidential campaign I thought that candidate Obama got it. In his 2006 book, The Audacity of Hope, then-Sen. Obama wrote:
“(I)f we commit ourselves to making sure everybody has decent health care, there are ways to accomplish it without breaking the federal treasury or resorting to rationing…(W)hatever reforms we implement should provide strong incentives for improved quality, prevention, and more efficient delivery of care.”
In his inaugural address President Obama only made two very vague statements related to health care. First, in listing indicators of crisis, he said, “Our health care is too costly.” Second, he said, “We will…wield technology’s wonders to raise health care’s quality and lower its cost.”
Being an optimist I thought that he was laying back, not wanting to get into too many details, a lesson learned from what had happened to the Clinton reform fifteen years earlier.
Obama’s selection of Tom Daschle to be Health and Human Services Secretary and head of the White House reform effort offered significant reassurance. Last year Daschle, the former Senate Majority Leader, published a short (206 page) book entitled Critical: What We Can Do about the Health-Care Crisis, in which he offered his thoughts and opinions on health care. What he had to say was very compatible with what I thought I knew about President Obama’s thinking.
Daschle spent some time explaining how he saw the “crisis,” how we got where we are, and why “reform” efforts of the past had failed. He rejected the single-payer plan, supported by the left, and exclusive reliance on health saving accounts and market solutions, supported by the right, as unworkable. Instead he offered what he called “hybrid” and “politically and practically feasible” solutions that would “build on existing public and private structures.”
Besides what he had written, Daschle seemed to be a key part of any consensus building plan for a couple of reasons. Although he had been in Washington a long time, he was from a rural state that had some history in health care delivery. He also knew the Senate and was expected to be able to bring in enough Republican votes to pass a good reform bill.
Even after Daschle withdrew his nomination over some income tax issues, I was still optimistic. I had read the 89-page report of the Senate Finance Committee entitled Call to Action: Health Reform 2009. This November 2008 report was the result of nine hearings and a day-long summit on health care reform. Called the Baucus Plan — after the chairman, Sen. Max Baucus of Montana — it contained detailed recommendations that seemed to be in line with the thinking of the President and Daschle. The plan stated the belief that all stakeholders were ready and willing to engage in comprehensive reform. The plan made it clear that it was a starting point for dialogue and debate and was not to be a take-it-or-leave-it proposition.
I can’t help but feel that the White House ignored the Baucus plan because he and the ranking Republican on the committee, Senator Grassley from Iowa, were from rural states and didn’t have the clout with the President and his team that the elite East and West coast urban liberal Democrats held. This is symptomatic of the President’s first crucial mistake — assuming that his election was a mandate for a major shift to the left in the country. It was not. It was a repudiation of eight years of Bush and Cheney and it was a win by a person with tremendous charisma and a personality as big as the great outdoors.
At this point the president made his second crucial mistake. Instead of handing the Baucus plan to House and Senate leadership as a place to start, he basically said, “We need health care reform; please go write something.” From that day forward he’s been trying to explain and sell a plan that does not yet exist.
Had Lyndon Johnson handled Medicare this way it would have never been enacted. This approach turned three House Committees and one Senate Committee loose to try to outdo each other in bringing out every idea held by any Democrat in the past thirty years and sticking them in a bill. My congressman, Ben Chandler, told an audience in Lexington, Kentucky, that “there is no actual bill for anybody to vote on.” This is an absurd position for a member of Congress to have to be in.
The President’s third crucial mistake was to pick sides and start identifying villains. I learned this lesson in 1993 when Kentucky Gov. Brereton Jones tried to tackle health care reform and was meeting with resistance on all sides. In one meeting he had a couple of political consultants in to offer advice on how to sell reform. One said, “Like James Carville says, pick a side.” The other said, “No, in this case your task is to equally offend everyone.” When President Obama decided to pick sides — with the House Democrats and against the insurance industry — he abandoned all hope of equally offending everyone while getting them all to give up something in return for the greater good. Imagine what would have happened in Europe at the end of World War II if President Truman had not worked with Republicans to create the Marshall Plan.
I will end here with another quote from Ron Sanders. I think he is totally right:
“Obama really screwed up by tasking the plan to (House Speaker Nancy) Pelosi and (Senate Majority Leader Harry) Reid.” I totally agree.
He continued: “Now I think this plan is in full retreat and all the time and energy spent thus far may prove to be a complete waste. Furthermore, Obama has spent a considerable amount of political capital that cannot be recovered. He has alienated the Republicans and will pay a price to get them engaged in bipartisan solutions at this late date. The Republicans are mad and now they smell blood in the water… and it ain’t their blood.”