Healthful Strategy

Posted Dec. 28, 2009, at 7:19 p.m.

A health care reform bill likely will pass Congress, so an analysis of the strategy that led to its success is appropriate. After all, a comprehensive federal management of health care was first proposed by President Theodore Roosevelt, and raised again and again in more recent Democratic administrations. So politically speaking, what worked, what didn’t and why?

The key goal of the reform effort was to reduce the collective cost of health care we all bear. Expanding coverage is part of that goal. Reducing the cost of Medicare and Medicaid is as well.

A strong moral argument can be made to support expanding enrollment and ending reprehensible insurance company practices such as denying coverage for pre-existing conditions. But the central aim was economic — businesses pay too much to provide health insurance to their employees. The self-employed, who may someday employ dozens, also struggle to pay their health insurance, let alone provide it for their employees.

Democrats and the Obama administration could have done a better job making this point. Far too much of the economy — one-sixth of the gross domestic product, on its way to becoming one-fifth of GDP — is related to health care. Some observers have said the president should have launched his jobs initiative and quickly followed it with the health care reform push, thereby linking the two.

Strategically, Mr. Obama and congressional Democrats might have done better to start with a simple, but bold proposal, the so-called Medicare For All plan, which would have expanded Medicare to everyone on a buy-in basis. Most people understand how Medicare works, and it is generally viewed as a cornerstone of personal economic security. It might have been an easier sell.

A fallback position would have been lowering Medicare eligibility to age 55 or 50, or to offer it to those 21 to 30. Another fallback could have been the public option.

Mr. Obama did not present a draft bill to Congress, but rather outlined goals and let committees of jurisdiction create their own versions. This was a response to the failed Clinton administration health care bill, which was created in the West Wing. The thought was that Congress would be more likely to buy into passage if it created the bill. That strategy may have worked.

Mr. Obama sincerely sought bipartisan support, and pledged to include sensible GOP ideas in the bill. He may have been naive. Congressional Republicans have largely fought reform and not offered practical alternatives. In the end, this bill may be like the bill that created Medicare, which passed without strong GOP support.

At his death, many colleagues of Sen. Edward Kennedy recalled his knack for knowing when a bill was still “half a loaf,” and therefore worth grabbing. As compromised as this bill is, one wonders what he would have thought of it. Whatever ails it must be fixed in subsequent sessions, and whatever works to lower the cost of health care to the nation’s economy must be defended.

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