By Evan Falchuk
The other day, Ezra Klein of the Washington Post wondered if the reason health care reform was running into so much trouble was because of a sort of conspiracy. According to Klein, it was the forces of the “health care industry,” with their economic and political power, blocking reform, like they had for decades.
Today we can see how very deep this conspiracy really is.
By Evan Falchuk
Why has health care reform run into so much trouble?
Well, it could be because people think reform plans will affect them in ways they aren’t going to like. Or because people don’t believe politicians in Washington who say that spending huge amounts of money will actually save money. Or because confusing mixed messages and ever-shifting sales pitches create a lot of anxiety about what’s really going on. It could be all of those things.
Or, it could be something more….sinister….
By Evan Falchuk
So the President gave a speech yesterday in which he said he would push, with Democrats in Congress, to pass a major health care bill through a process called “reconciliation.”
I don’t think most of us know what that is, exactly. The meaning of it is simple, though: they can pass a bill with a simple majority vote. They can eliminate a Republican filibuster in the Senate. It’s been called the “nuclear” option, well, at least since Republican Trent Lott dubbed it that some years ago.
Some people are appalled that this could happen. Should they be?
I don’t think so.
By Evan Falchuk
Warren Buffet is talking and reform opponents love what the unofficial Obama adviser has to say. He says the President should scrap the whole thing and start over.
He says health care costs are a “tape worm” eating at American competitiveness. His prescription: a “united effort,” a “national emergency” that will allow us, finally, to focus on “costs costs costs” above all else.
Buffet is a brilliant man, and he makes a very good point about how botched the sales job on reform has been. But he’s missing something very important:
We have been focused on health care costs in America. For decades.
By Evan Falchuk
Today the Commonwealth Fund came out with a chart that it says is a “grim reminder” of what happens when health care doesn’t get reformed.
If only we had listened to Richard Nixon or Jimmy Carter. We would have saved tens of trillions of dollars in health care spending.
Click to enlarge
By Evan Falchuk
So the big, long health care summit in DC is over- here are my quick five quick reactions to it:
1. It should have happened a long time ago, but it couldn’t have. It was a substantive conversation. David Gergen said that, intellectually, “the Republicans had their best day in years” (he meant it as a compliment). The bills that came out of Congress probably would have been a lot better if they had been discussed like this before they were drafted. The trouble is, representatives on both sides weren’t at all up to speed on health care back then, so they couldn’t have had a conversation like this. So we end up with bills first, smart talk later. I think there’s a movie coming out about that kind of thing next week.
2. It was still riddled with silliness. Nancy Pelosi said the plans would create 400,000 jobs “almost immediately,” and would overall create millions of new jobs. Meanwhile, John Boehner kept insisting that the plans were a “government takeover” of health care. It wasn’t clear if Pelosi or Boehner were talking about the House bill, the Senate bill or the President’s new plan. Actually, it wasn’t clear what they were talking about at all. What always surprises me is the extent to which many politicians just say stuff that they can’t possibly believe to be true. It’s one reason why a lot of people don’t want to trust them with important things that directly affect their lives…like health care.
3. You can’t put reform in a box and say you’re for it or against it. Well, I guess you could do it literally with the 2,000+ page bills, but I mean it figuratively. They talked about a huge number of topics. The uninsured, medical malpractice, rising health care costs, Medicare, Medicaid, comparative effectiveness, health insurance premiums, insurance mandates, state versus federal insurance regulation, interstate sales of insurance, pre-existing condition exclusions, uncompensated care, over-use of the ER, and on and on and on. It’s the trouble with the so-called “comprehensive” plans- there’s no “system” to comprehensively reform. So the bills aren’t “comprehensive,” they’re just long – a giant collection of stuff that will impact the health care system, some for the good some for the bad.
4. It’s another cog in the anxiety machine. The fact that all of America’s top leaders, in the midst of a terrible economy and two wars, would meet for an entire day about health care sends a message that this is a hugely important issue. And it is an important issue. But the trouble with reform from the beginning has been that voters don’t understand what’s happening and are worried about it. Today, as a friend suggested to me, was like porn for policy wonks. But I think to regular people it just sounds like trouble. Something big is happening which I don’t understand but which I know will affect me in ways I’m not going to like. I’m sure representatives from vulnerable districts didn’t like it when the President said near the end that if the voters don’t like it they can vote in November.
5. Republicans shouldn’t misread what’s happening. Republicans clearly have read the polls showing opposition to the reform plans. But like in Massachusetts, rising support for Republicans isn’t because Americans are suddenly turning to their ideas. I think voters just want this long, long, long health care saga to end. As James Carville might have said, it’s the health care, stupid.
By Evan Falchuk
Barely a week after Massachusetts Governor Deval Patrick said he wants state controls on the price of health insurance, President Obama apparently wants to do the same at the federal level. Both men must believe it’s good politics, because there are about 4,000 years of evidence that it’s not good policy.
But the trouble for reformers has never really been about policy. It’s been about a fundamental misunderstanding of how people view health care and the very bad things that happen when you give people the impression you’re going to mess with what they have.
In this sense, the reform bills are like perpetual anxiety machines. Contraptions that continually produce more public anxiety than they consume.
But why is this?
By Evan Falchuk
Massachusetts Governor Deval Patrick announced this week he has had enough of rising health care costs.
So he is proposing a novel solution: make them illegal.
By Evan Falchuk
“I’m from Massachusetts,” I told the audience. “So depending on how you feel about reform, I will say either ‘sorry,’ or ‘you’re welcome.”
The audience, made up of large employers and benefits professionals seemed to like this. But it was clear that they were pleased that the health care reform legislation is Congress is pretty well dead now.
Now, if it’s true that health care costs are rising (they are) and this heavily impacts employers (it does) why would the death of a bill meant to address this problem make those people happy?
