Winston Churchill once declared that, “Americans will always do the right thing…after they’ve exhausted all the alternatives.” Today we are on the verge of doing the right thing when it comes to comprehensive health care reform, the “holy grail of progressive policy,” said Karen Davenport, Director of Health Policy at the Center for American Progress, at a CAP event yesterday.
The event, “Change in Turbulent Times,” featured presidential historian and author Robert Dallek and Chris Jennings, president of Jennings Policy Strategies, and coincided with the release of a report, “The Economic Imperative for Health Reform,” by James Kvaal of CAP.
“Does Obama have a chance for major reform? Decidedly so,” said Dallek. The current economic crisis mirrors the dire circumstances that faced both Franklin Roosevelt and Lyndon Johnson when they passed similarly historic domestic programs. Those two presidents represented “paradigm shifts” in the change they achieved, and Obama is likely to be successful if he learns from their achievements.
Dallek offered Obama advice drawn from the previous pivotal moments of great change. First, Obama must focus on “creating a consensus for the change” that he seeks in health care. This is not just consensus in Washington, but shared goals for all Americans. Lyndon Johnson billed his Great Society, for example, as “not simply a poverty program, but a change that benefits all Americans,” according to Dallek. Franklin Roosevelt used the bully pulpit of the presidency to “create shared goals” that ultimately helped the public to accept and support the New Deal.
To be sure, Obama will face opposition and challenges. Dallek also cautioned that the administration should take action quickly, as war abroad, or quick escalation in Afghanistan, could dampen the prospect for comprehensive health care reform.
Jennings was also optimistic about the prospects for comprehensive reform, noting that there is an increasing understanding that comprehensive reform may be even more viable than incremental reforms. This was one of his nine reasons that health care reform is possible in 2009. These reasons developed out of Jennings’ experience with the factors that contributed to the failure of comprehensive health reform in 1993-94.
The economic crisis is one driving force that “opens the floor to broader debate,” said Jennings. Leading economists agree that taming the health care system is necessary for economic renewal. Polls show that affordable health care is a leading economic concern for many Americans. And businesses, both large and small, are aggressively pushing for health care today.
The other reasons that the country is currently primed for reform are more political. Strong bipartisan support exists today in both houses of Congress—support that didn’t exist in 1994. Special interest groups—drug companies and insurance plans in addition to consumers and other stakeholders—are also ready and willing to engage in the reform process.
Policies that provoked political objections have been removed from most proposals, as a result of lessons learned 14 years ago. That’s one reason that Obama’s proposal allows insured Americans to keep their coverage instead of switching, if they choose. Americans want to see change, Jennings said, but they also “don’t want to lose what they have until they see what the alternative is.”
The debate about how to control escalating costs has also shifted since 1994. Then, the focus was on cost containment measures. In the past several years, there has been a growing recognition that greater quality and value in care are the measures that will ultimately control costs. One study found that one-third of health care spending does not improve outcomes. That’s about $700 billion each year. There is also widespread acknowledgement today that coverage for the uninsured and underinsured is necessary as a precondition to achieve affordable and accessible care for all Americans.
All of these factors provide us with a window of opportunity for comprehensive health reform. To capture the historic moment, the president-elect must appeal “not just to special interests, but the national well-being,” said Dallek. Obama should “maintain a vision and broad goals, but also have the flexibility” to achieve them.
As Jennings noted, if health reform is to succeed, it “can’t be an Obama health care plan, can’t be anyone’s health care plan. It has to be America’s health care plan.”
Karen Davenport, Director of Health Policy, Center for American Progress
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