Health care reform, as it was for the Clinton administration, is obviously on its way to becoming the crucible on which Barak Obama’s presidency will be judged. The failure of their first and most important initiative left the Clintons, Bill and Hillary, historically in the lower reaches of White House achievers and a similar fate could easily befall Obama should he fail in overhauling a system that’s makes up one-fifth of the nation’s economy.
And while an overwhelming majority of Americans say they want health care reform, that support declines precipitously when it is put into terms of personal sacrifice, including new taxes and the potential demise of private insurance, both of which detractors see as probable consequences under a variety of proposals now being argued in Congress.
As the debate escalates, one can’t help but notice a striking similarity to the pros and cons put forth over two decades leading to the ultimate passage in the mid 1960s of Medicare and its stepsister, Medicaid, the sweetener that ultimately broke down the long standing opposition of the medical community to government intrusion into health care. The plans were hailed as sinecures at an affordable price for the health needs of the old and the needy and a miraculous solution to an underperforming, often callous system.
The late Sen. John Williams of Delaware, ranking Republican on the Finance Committee, expressed his skepticism at cost estimates at the time. "Figures don’t lie, but liars figure," he chided the Johnson administration, noting that the air was thick with promises of unsubstantiated cost containment. It took only a few years for that assessment to become painfully accurate as medical costs continued to accelerate at a 10 percent to 12 percent annual rate and the price tag for the two programs headed for the stratosphere, carrying with them fraud and abuse costs estimated at 10 percent annually.
The White House, in its zeal to rush through Obama’s main campaign pledge for providing care for every American, including up to 40 million who are not insured now for a variety of reasons, has promised a system where the continuing high rate of growth finally would be brought under control and the enormous price tag of Obama’s proposal would be paid for by a series of tax hikes and savings.
Rahm Emanuel, White House chief of staff, told reporters recently that those opposing his boss’s initiative are defending the "status quo" in which 14,000 citizens lose their health care every day.
Republicans and segments of the industry argue, however, that there is only one way to significantly lower costs — limit care. Once Americans get the full picture of what this means, they may not be as enthused. Polls already show a large amount of confusion among most Americans over various aspects of the proposals. And despite a slew of presidential town hall meetings before friendly audiences and ginning up their Internet supporters, the White House faces growing unrest on Capitol Hill.
Opponents of an alternative government insurer to the private carriers charge that such a creation ultimately would end private participation. It does seem reasonable that any unrestricted public plan, if it cost less, soon would result in a huge migration from the private carriers.
The president has said he wants this gigantic measure on his desk by November. That is an incredibly ambitious timetable even with his party’s majorities in Congress. Also, it may not be healthy either from the standpoint of politics or efficiency. Meeting that timeline probably would cost any semblance of true bipartisanship without some major compromises, leaving the potential failures of too hastily drafted legislation the complete responsibility of the Democrats.
Will there be "reform?” It seems inevitable despite warnings from the nonpartisan Congressional Budget Office that it would add enormously to the deficit without major spending cuts elsewhere. So 16 years after it was first proposed by Bill Clinton and conceived by his wife, some sort of baby is going to be born, if for no other reason, according to Emanuel, that it is a different time — one in which many of those in the industry are no longer opposed to change. We can only hope this reinvented wheel doesn’t prolong the economy’s stay in the Intensive Care Unit.
(E-mail Dan K. Thomasson, former editor of the Scripps Howard News Service, at thomassondan(at)aol.com.)