Thursday, February 25, 2010

The Health Care Summit: Analysis and A Way Forward

A very interesting day indeed. On the substance, both sides scored points and put forth thoughtful and credible arguments about how to move forward on health reform. Before going any further, let's stop and celebrate that point alone. How refreshing! Real dialogue and debate on meaningful issues. Sure, there was some posturing and demagoguery, but no talk of death panels (at least not that I heard) or other misinformation and distortion that has been spewed about over the past year. That alone is a big win for our country.

In the end, score it a tie on the substance. Few will be moved from their positions by the substantive arguments. But here's the interesting thing. This public debate has not been about the substance. The irony is that the public hates the bill, but likes everything in it. The debate, sadly, has been more about process and size and scope. The public is incredibly confused and, given the economic climate, quite scared about what they perceive (correctly) to be a massive change that may cost a lot of money. And that has been fully and effectively manipulated by Republicans in saying it is too big and we should start over. (It is also quite cynical because you have to be from Mars to not know that their true goal is to cause a massive failure by the President, then criticize him for wasting everyone's time and not getting anything done while he had a majority, all in the hopes of gaining seats in November).

And this leads to my reason for believing that politically, today will prove to be a huge win for the President. First, he demonstrated to the country he is serious about these issues, wants to engage in real dialogue to try to forge a compromise, and showed courage to put himself out there to the World to debate the substance of such important topics (could you imagine George W. Bush doing this?). And as usual, he was quite articulate and came across as very sincere. The public likes him and this will add greatly to his credibility on this issue. Whether or not they agree with everything that is in the bill, they will believe that he really does want to do the right thing for the country and for them (and they will likely respect and reward that, notwithstanding their concerns with the bill, in the same way the country did not like many of Bush's policies after 9-11, but nevertheless respected and rewarded him for wanting to do everything he could to protect them. I believe this is the main reason Bush won the election in 2004).

Second, the Republicans were in a bit of a bind. They have been saying all along the entire legislation is crap. Yet today they engaged in a serious debate about issues in these bills and actually reached agreement in several areas, thereby giving validity to at least certain portions of the bills. The fact is that many provisions of the bills were put in at the request of Republicans. So they have now conceded (implicitly or otherwise) that there are some substantive and serious provisions in the legislation. And given the fact that the President took the initiative to proactively reach out to them to forge a compromise, they will be under intense pressure now to actually make some compromises of their own or they will truly look like the "Party of No." Thus, no longer will they be able to effectively pursue their slash and burn agenda of dismissing and trashing the whole bill.

Now for the way forward. As I have said all along, the House should pass the Senate bill.  But here are three specific ways they should improve it. First, they should remove all of the most egregious "special deals." Even though these deals exist in all legislation, this issue has done more than anything else to infect the process and distract and outrage the public. And there is no substantive defense to most of it. It undermines the Dems efforts to try to act with integrity in the best interest of the country at large. And of course stripping the bill of these deals removes the best talking point of the Republicans. Second, the Senate should agree to other modest changes by the House to give them a "win" and allow them to claim victory in making improvements to the bill. It won't change much about the substance, but it will go a long way to making house members feel better and give them something to run on in November (i.e., "thanks to my insistence, we actually improved the bill."). 3. Finally, and this will be most controversial, the Democrats should add a serious and meaningful provision on malpractice reform. It is simply indefensible, in this age of out-of-control healthcare costs, to not take on this issue. It is true that actual malpractice costs add relatively little to the cost of health care. But defensive medicine (the practice of ordering tests and procedures for fear of being sued if you don't) adds quite a bit. And by not taking it on, you appear as if you are trying to curry favor with trial lawyers. The fact is that everyone must give their pound of flesh if we are to succeed in this effort and the failure to address this issue in such a comprehensive bill is a huge and unacceptable void.

If the Dems do these three things, they have preserved the "heart" of their comprehensive reform, which is good for the country. But they have also improved the bill, stripped it of its most insidious components, and added an issue that should have been in from the beginning. They will also being showing real compromise, which will improve public support, and they will put the Republicans in a real box. How could the Republicans ever say the Dems did not compromise in good faith when they added perhaps their number one priority (malpractice reform). This will probably result in a few Republican votes. But even if it doesn't, the Dems will gain the upper hand politically and can move to reconciliation in a far better posture to defend their actions come November. One can hope. What say you?

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