Thursday, October 11, 2007

Onward Through the Fog (Or: The Urgent Need to Reform Health Care In America)

There was a brief moment in the debate over expanding the S-CHIP program when the clouds parted and something of a consensus emerged that the crisis in American health care has brought to ground not just the poor but middle-class families like that of Halsey and Bonnie Frost. Then the swiftboating of their 12-year-old son began.
Well, the right-wing blowhards who pulled the rug out from under the people who opposed expanding S-CHIP for legitimate if arguable reasons finally are retreating back into their caves to prepare for the next attack on A Hapless Soul to Be Named Later, unaware of or not caring about the damage they inflicted on their cause by framing the debate in Roman Coliseum blood sport terms.
No matter, the need for health-care reform in America has become so urgent and so difficult to ignore that in 2008 -- or perhaps the following year after the probable coronation of a Democratic president -- the people who have blocked reform year in and year out will be confronted with having to get on board or get trampled.
Who might those people be?

In order of importance, Republicans, private health insurers, for-profit hospital corporations and pharmaceutical companies.

In order of influence, private health insurers, for-profit hospital corporations, pharmaceutical companies and Republicans.
The one certainty is that whatever steps are taken, they will be relatively modest and a far cry from what Hillary Rodham Clinton tried to ram through 14 years ago.

* * * * *

It was the spring of 1993, Washington's famous cherry blossoms were in full flower and change was in the air.

I was at the White House for a press briefing. Bill Clinton, in office less than a week, announced the formation of the Task Force on National Health Reform. Its goal was to prepare health-care reform legislation to be sent to Congress within 100 days. Clinton's wife, Hillary, would head the task force, sending a strong signal that if anyone wanted to mess with the initiative they'd have to mess with the president.

My editors had told me that I was to cover the reform initiative fulltime. I was excited because history was about to be made, and I was already well into the massive briefing book I'd been given as the Amtrak train hurtled up the Northeast Corridor to Philadelphia that evening.
One hundred days later, the reform initiative and its centerpiece -- health care for all Americans -- were dead on arrival.
The imperious Mrs. Clinton and her task force had committed a cardinal sin by working behind closed doors. Vice President Cheney and his Energy Task Force would do the same thing a decade later, but Congress was not as forgiving of the outsider First Lady as they would be of the veteran insider veep.

But that was not the primary reason for this spectacular crash and burn.
While many Americans endorsed universal health care, Congress (Democrats and Republicans alike) and the powerful health-care and pharmaceutical lobbies to which they were beholden were adamantly against it, and they were the tail wagging this particular dog.
* * * * *
Universal coverage remains my solution of choice for dealing with America's health-care ills, but would seem to stand as little chance as it did in those heady days when the Clintons were going to shake up the Washington establishment.

There are two primary reasons:
* The devil's deal between Congress and the big-bucks lobbies would seem to be stronger than ever.

* Health care has become increasingly balkanized because of market forces, which is to say that it has become even more profit driven. Fewer corporations own more hospitals. Fewer health insurance companies cover more Americans. Fewer pharmaceutical companies control the market, stifling innovation in new antibiotics, for example, while spending extraordinary sums on erectile dysfunction medications.
If there has been a change in the political equation, it has been the emergence of a pro-reform alliance between old labor organizations and new pressure groups who may not have as deep pockets as the health-care lobbies but have the wind at their backs.

What then to do?

My prescription is to work toward the kind of near-universal coverage that is now law in Massachusetts and California may soon adopt.

The Massachusetts plan, hammered out by former governor and Republican presidential wannabe Mitt Romney, a Democratic legislative majority, patient advocates and insurers, takes a carrot-and-stick approach: Health insurance is easier and cheaper to purchase, but uninsured residents are faced with having to pay a hefty penalty if they fail to fall into line.

There are a slew of reasons to oppose telescoping the Massachusetts model out onto a national scale, including the creation of yet another federal bureaucracy to administer it, the attendant paperwork, which will denude huge swaths of forest, and the built-in opportunities for waste, fraud and profiteering.
But over 40 million Americans remain uninsured, and even if President Bush’s S-CHIP expansion veto is overridden several million children still will be among them. What was long a crisis for families on the other side of the tracks that well-meaning folk could tut-tut about has motored up Main Street and arrived on their doorsteps, or perhaps their neighbors’.

Something has to give – and I believe finally will.

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