Obama Aims To Avoid Bill And Hillary's Mistakes On Health Care
The Boston Globe reports that the Obama team is being careful to take a very different approach to health care reform than Bill and Hillary Clinton did in 1993 and 1994, mainly avoiding one big mistake: The Clintons' virtual exclusion of Congress from policy deliberation.
Instead, the new White House is going to lay out parameters of what they want done, and then let Congressional leaders do the actual work of writing a bill that is acceptable to the members. A key player in this will be Tom Daschle, who served in the Senate during the failure of the Clintons' bill in 1994, and will now work with his former colleagues in Congress in his new role as Secretary of Health and Human Services.
"Congress did not want to be told what to do," said Sen. Max Baucus (D-MT), who is planning to take a key role in the upcoming health efforts. "They're very cognizant of that and they don't want to make the same mistake."
This really doesn't sound like leadership to me. Once you have put your proposal out there, that is the time to work with congress. We need real change, as in eliminate the insurance companies and create a single payer government run program in the model of Medicare or the VA. I fear that with the influence lobbiests have on Congress we are going to end up with a watered down version of "reform" that will only make things worse.
December 26, 2008 11:52 AM | Reply | Permalink
Yes. True leadership is going behind closed doors and shutting out governors and congress to write a convoluted 1000 page health care bill then saying to congress "now pass it, bitches!" That worked brilliantly in 1993 and is why we have healthcare today. Oh, wait. It didn't work and we don't have healthcare.
When you have passionate healthcare advocates in Congress like Kennedy and Baucus pushing for this, you work with them behind the scenes then let them take the lead on crafting a plan that's guaranteed to pass Congress. Then you sign it. That's how we got SCHIP and the Family Medical Leave Act.
Clinton's biggest problem was that he didn't know how to work with congress and didn't realize how important it was to do so until it was too late.
December 26, 2008 12:08 PM | Reply | Permalink
No, Clinton's biggest problem was the plan was too complicated. All the other complaints were simply excuses. The secrecy, etc... of the famous Hillary plan didn't cause problems. It was too complicated. Now, Obama proposes to repeat the same mistake. Henk is right. Additionally, SCHIP and the Family and MEdical Leave Act neither constitute major legislation or legislative victories. In the case of the family and medical leave act, the law is a toothless tiger almost universally unobserved and unenforced. Even if it were, being a mere shadow of such laws in civilized countries it doesn't provide for pay during the leave nor does it do anything to effectively maintain job security for the person who actually takes the leave upon their return. In other words, it's not much of a model for what any of us want to see come down in the realm of health care. FDR did not let Congress remain in control of the major New Deal legislative efforts, Truman did not allow Congress to fashion the Marshall Plan, and LBJ did not allow the Congress the opportunity to screw up the creation of Medicare by putting them in the driver's seat on the legislation.
December 26, 2008 3:46 PM | Reply | Permalink
Wait. Obama is going to let Congress write the healthcare legislation instead of having it drafted in the WH or by cabinet officials, yet you say he's about to make the same mistake as Clinton?
Do you realize how stupid that sounds?
Do you realize how contradictory that is?
If you think the secrecy didn't have anything to do with the failure of Clinton's healthcare plan, ask Ted Kennedy and Orin Hatch and Jim Cooper and Doug Wilder and any other Democrat who was in Congress at the time. They'll tell you.
December 26, 2008 7:25 PM | Reply | Permalink
It wasn't the secrecy (in case you didn't get it the first time around) it was that the legislation was too complicated and was picked apart on that basis. The secrecy didn't help but was by no means the primary reason for the failure of the Clinton plan.
December 27, 2008 9:57 AM | Reply | Permalink
Your posts are absurd. You say that Obama is making the same mistake the Clintons made which (according to you) was putting forward legislation that was too complicated and was picked apart in Congress.
Obama is not going to put forward the healthcare legislation--complicated or otherwise. He wants the legislation to come FROM Congress and he will sign it. So, please explain how he's guilty of making the same mistake Clinton made?
December 27, 2008 11:02 AM | Reply | Permalink
I agree we need single payer. There is zero chance this or any other president could get it passed any time in the near future. If we can get close to universal coverage and some cost controls I would call that real progress. And of course the administration would have influence on what was ultimately legislated. I think the point is recognizing Congress as a partner in the process.
December 26, 2008 12:14 PM | Reply | Permalink
The real source of the resistance, it would seem to me, is that government run health insurance poses as an existential threat to existing health insurance companies. That means they'll spare no expense in fighting the legislation.
For the people who own stock in such companies, Health Care reform is equivalent to a takings.
A more realistic, intelligent approach to health insurance would acknowledge this fact.
A better approach might include something like this: The government will direct the healthcare companies to merge into one big single healthcare monopoly. It will then do one of the following:
1. Allow that monopoly to provide single payer universal healthcare though heavily regulate it (similar to the telecom model circa 1979).
2. Make the monopoly a not-for profit corporation
3. Nationalize the monopoly and run it along the models of: The Post office or the Social Security Administration or simpy disband it and allow medicare for all.
Another approach would be to centralize health care insurance processing by a government controlled entity - turning the existing insurance companies into nothing but banks.
The way this works is, You might keep your current health insurance company. You pay them your monthly premium - it goes into their vault, but when you go to the doctor the doctor files his claim with the government. The government pays him x dollars by withdrawing x dollars from your old insurance company's vault. This way you have single payer universal insurance and you still have the insurance companies (if they want to stay in business). They function merely as banks. Like a bank they can't control when deductions are made from their vault. The Government and your doctor controls that. I believe this is how things are done in South Korea.
December 29, 2008 9:32 AM | Reply | Permalink
May I humbly suggest that is because you do not recognize leadership when you see it. Getting people together to accomplish a difficult task, and shepherding them to come to the conclusion you want while allowing them to feel as if they arrived there on their own is exactly what leadership is.
That, and understanding that politics is the art of the possible.
December 27, 2008 10:39 AM | Reply | Permalink
This is actually what I assumed would happen, and why I didn't buy into any of the argument between Hillary's plan and Barack's. In the end, what will emerge will be dependent on Congress. As long as it does what it should, i.e. covers every American, is portable and affordable, it will go a long way towards where we need to go.
I am for single payer, but unfortunately, that doesn't have as much support as it should. My ideal would be a single-payer plus system, wherein people could pay for insurance if they choose to, but everyone is covered for the basics.
December 26, 2008 12:02 PM | Reply | Permalink
Single payer plus will work as poorly as Medicare works. Medicare provides far too little, so we seniors have to purchase Medicare Supplemental Insurance in order to actually be covered by Medicare. Those policies cost money and still leave us having to pay large deductibles.
Congress will salvage the insurance companies by making sure we all have to buy policies from them, and the end result, like Medicare, will be a big reduction in health care cost, but not big enough to make health care truly affordable for those with limited incomes. And, the primary beneficiaries will be the insurance and medical care industries, not the people.
In my opinion the only way around Congress on this is for Obama to make it absolutely clear that our country is going to fall into the mother of all depressions unless some very drastic steps are taken, one of which is to reform health care to eliminate this as a cost to corporations. Along with that, setting up the single payer system will generate a lot of jobs, further helping the economy. And, adding government health care centers all over the country for simple medical needs will generate still more jobs.
But, before that could happen we would need a liberal president. Obama is a centrist. A liberal would not have been elected.
December 28, 2008 11:48 PM | Reply | Permalink
My hopes for the future are lots of seemingly boring headlines such as "President Working With Congress". Ninety percent of government should be simple competence. No drama, good, honest, work-a-day competence. This sounds like a good start.
To henk, above: I don't imagine that Daschle will just lay out the parameters and walk away. Clearly, if Congress has a lack of ideas I imagine the HHS will have a template they offer. He knows what's involved with getting legislation written, and he's been working on healthcare policy for years.
December 26, 2008 12:34 PM | Reply | Permalink
...
Just after Clinton was elected president, he convened a meeting of economists, CEOs, labor leaders and many others in Little Rock. The purpose of the meeting was to argue out what should be done about the ailing economy, with many of the ideas expressed there later becoming part of Clinton's successful 1993 economic recovery package. The whole thing was on television.
Sound familiar? This is essentially what Obama is proposing for health care. If Hillary Clinton had done this on health care in 1993—instead of convening a secret task force—she might have been able to build a stronger public case for reform.
Obama's idea is a better one: Get every special interest out in the open on television, where the new president can cross-examine them and expose their phony rationalizations for charging $100 a pill or denying coverage to sick people. Then, having triumphed over the drug and insurance companies in the court of public opinion, the legislative victories will follow. It is, indeed, a fantasy to think these interests will roll over entirely, but they will get a much worse deal.
...
-Jonathan Alter
http://www.newsweek.com/id/80882/page/1
December 26, 2008 2:10 PM | Reply | Permalink
...
Just after Clinton was elected president, he convened a meeting of economists, CEOs, labor leaders and many others in Little Rock. The purpose of the meeting was to argue out what should be done about the ailing economy, with many of the ideas expressed there later becoming part of Clinton's successful 1993 economic recovery package. The whole thing was on television.
Sound familiar? This is essentially what Obama is proposing for health care. If Hillary Clinton had done this on health care in 1993—instead of convening a secret task force—she might have been able to build a stronger public case for reform.
Obama's idea is a better one: Get every special interest out in the open on television, where the new president can cross-examine them and expose their phony rationalizations for charging $100 a pill or denying coverage to sick people. Then, having triumphed over the drug and insurance companies in the court of public opinion, the legislative victories will follow. It is, indeed, a fantasy to think these interests will roll over entirely, but they will get a much worse deal.
...
-Jonathan Alter
http://www.newsweek.com/id/80882/page/1
December 26, 2008 2:11 PM | Reply | Permalink
Being something of a policy wonk I watched the conclave of business leaders you recall in your post. I think I was about the only person and it had absolutely no real impact. Your wish of exposing the special interests is nice, but wouldn't tell anybody out there in the great unwashed what they don't already know. Far from advancing the cause of health care for all, this approach will tie up the concept hopelessly in a morass of Congressional rules and technicalities that will result in yet another victory for the insurance companies and more expenses and/or continued lack of any coverage for millions and millions of Americans.
December 26, 2008 3:34 PM | Reply | Permalink
Unless Obama proposes a real national health insurance plan such as those in the european democracies or in Canada I can think of no other group of people I trust less with this question than the Democratically controlled congress of the United States. They are spineless cowards who, collectively, don't have a pair of balls amongst them. Trusting them to stqand up to any special interest group is folly on a scale that is too large to even attempt to describe. Allowing them to call the shots on health care guarantees the winner in advance: the health insurance companies.
This is NOT the change anyone who voted for Obama is looking for.
December 26, 2008 3:29 PM | Reply | Permalink
>>This is NOT the change anyone who voted for Obama is looking for.>>
You know this because you've polled everybody who voted for Obama? I voted for Obama. Where do you get off telling me what I did and did not vote for?
December 26, 2008 7:29 PM | Reply | Permalink
I know this because my head is clear. I don't drink the kool aid like you apparently do.
December 27, 2008 10:00 AM | Reply | Permalink
Perhaps you should speak for yourself, oh ye of clear head, and stop speaking for the entire electorate by telling the rest of us what WE voted for, something you couldn't possibly know.
Also, you should use your "clear head" to come up with something a bit more original than right-wing talking points about kool-aid. How utterly lame.
December 27, 2008 10:58 AM | Reply | Permalink
Considering that Ted Kennedy has a team that has been working on a healthcare bill as his last and most enduring legacy as a senator, I'm not at all surprised that the Obama team would be respectful of that effort, especially since Carolyn and
Ted Kennedy's endorsements came early and were very helpful to Obama.
December 26, 2008 5:47 PM | Reply | Permalink
Those who favor single payer (as all should) need to tell their Reps to support the Conyers bill HR 676--the only single payer legislation out there. Last session, 93 Reps signed on as have hundreds of unions. Check it out at Conyers' website.
December 26, 2008 6:33 PM | Reply | Permalink
.
Hey Hey . . .
Check out the full bill right here:
thomas.loc.gov/cgi-bin/query/z?c109:H.R.676:
~OGD~
December 27, 2008 1:27 AM | Reply | Permalink
I'm skeptical of Congress's will to fundamentally change our health care system. As persuasive as President-elect Obama can be, Congress has proven time after time money talks. The insurance and drug companies have the money, not to mention the hundreds of lobbyist, to keep Congress in check.
If Obama really means change he needs to construct a health plan that establishes some real fundamental changes; government run, elimination of the for profit stakeholders, and strong regulation of the drug industry, for example. Making a paradigm shift, and presenting to Congress these fundamental changes as non-negotiable, he then can include Congress, and say, help me make this work.
Congress won't do it without hearing from us of course.
The change has to start with us.
Voting for Obama was easy. I think the real question is do WE have the will to do what it takes to make a real change?
December 26, 2008 11:07 PM | Reply | Permalink
I participated in two healthcare discussions via change.gov. At each, loud and clear, the participants shouted for Single Payer. Out with the insurance companies. I have heard from other groups the same thing happened. Obama's own website, however, deftly moved Single Payer off the table - going back to the tired old meme of tweaking the for-profit insurance rules so they cover pre-existing conditions and offering incentives for lower income folks and unemployed to purchase policies from corporate entities. Years of academic research proves that insurance premium are 30% over cost of care to allow for profits and administrative costs.
I knew, knew, knew when he picked Daeschle for HHS, he had already made up his mind on the approach. Whatever his merits, Tom D is not in any sense of the word a healthcare visionary - no new ideas there, no evangelizing. The selection of ex-Majority Leader for that means he needed someone to push HIS PREFERENCE FOR OUR CARE through COngress.
I am pissed, but not surprised.
December 27, 2008 11:27 PM | Reply | Permalink
The healthcare discussion I attended via change.gov also include a lot of applause for single payer systems, but each person who spoke up backed away from that. The nurses union person was clearly out to make sure the nurses were not shafted. The human rights group persons wanted to hold another discussion with the homeless running the discussion. Most others just wanted to tell their sad story about their disease and the cost of it. No discussion whatever went into the real meat of a single payer system, which is the cost and how it is paid.
No plan can get anywhere without an open, aboveboard discussion of the costs to taxpayers for whatever plan is adopted. That means first deciding how we pay for this.
The suggestion about that we support Conyer's plan doesn't appeal to me either. As I recall Conyer's play is not a true single payer system, but one where we all have to buy an insurance policy.
This problem isn't going to be solved easily.
December 28, 2008 11:58 PM | Reply | Permalink
Eisenhower attempted to advocate for extending the VA health care benefits to everyone after WWII ended, when England instituted their National Health. McCarthy promptly called him a Communist amidst his witch hunt hearings and a very timid congress backed away. Time after time as universal health care has been approached, one group or another has spent lavishly to kill it. As long as we have government by bribery, er I mean lobbyists, it will never come and we will be stuck with this hodgepodge mess owned by the insurance and drug companies. I have no hope. Boo hoo.
December 29, 2008 12:04 AM | Reply | Permalink
Eisenhower attempted to advocate for extending the VA health care benefits to everyone after WWII ended, when England instituted their National Health. McCarthy promptly called him a Communist amidst his witch hunt hearings and a very timid congress backed away.
Time after time as universal health care has been approached, one group or another has spent lavishly to kill it. As long as we have government by bribery, er I mean lobbyists, it will never come and we will be stuck with this hodgepodge mess owned by the insurance and drug companies. I have no hope. Boo hoo.
December 29, 2008 12:06 AM | Reply | Permalink
The only interesting development that the drug companies should have anticipated but didn't was that most Medicare Advantage companies are refusing to include non generics in their formularies. Raising prices on brand name or non generics every three months, as they have done, is finally killing the goose that laid the golden egg. No one wants to cover a new drug when even a not as good generic one exists. So we are going backwards. A few rich patients can afford newer drugs, but there won't be the mass market to make the usual profits on them. So perhaps even the drug companies will, grudgingly, lower prices themselves.
December 29, 2008 12:14 AM | Reply | Permalink