Last year at this time all we heard about was the credit crisis and the fact that the credit markets were “all clogged up”. 12 months later we’ve got the same problem, although this time its health reform that is paralyzed.
The culprit right now of course is the government run option. If the President wants reform he will very soon need to articulate a final position on the isse one way or another. If he stands firm for it, we will have a fight to the death (possibly through budget reconciliation) and in the aftermath we will define with crystal clarity exactly where we stand as a nation on his brand of governent and–for once and for all, articulate our true values on this most crucial of public policies.
But alas… as defining as that war would be, we are far more likely to see capitualation and compromise if the President truly wants reform. Specifically, the abandonment of the government plan altogether could start the ball rolling to the path to victory as outlined in an article by Charles Krauthamer that I referred to a while back. In this scenario we are guaranteed a number of very spirited but far less encompassing battles that will make for a smoother path for the legislation but whose outcome will nonetheless define (in smaller steps) our national attitude toward government and healthcare.
Which really means ideological warfare, as opposed to the far more practical political war being waged to date. Take the most basic issue on the table: exclusions for pre-existing conditions. Virtually every potential plan under consideration includes a stipulation that prevents insurance companies from denying coverage to individuals with chronic or ongoing medical conditions. On the surface, there is really no opposition to this idea, even from insurance carriers.
The reason for this is because this measure is married to the “Individual Mandate”, the proposed federal requirement that all Americans carry health insurance coverage or pay a substantial tax as a penalty. The theory is that requiring all Americans to carry insurance would greatly expand the market for individual coverage and thus substantially reduce the adverse financial implications of insuring those with serious ongoing conditions as the pool would include more of the the healthy to go along with the unhealthy. Without the mandate, banning the practice of exclusions for pre-existing conditions would cause premiums to skyrocket for the 27 million Americans who purchase their coverage directly from the carriers, and exacerbate the cost problem. Bad idea.
Which is why we see the individual mandate paired with the elimination of pre-ex. While it is good policy to marry the two issues, it is also likely to spar one of the bigger little battles in the debate. Ideologically, the idea that the government could compel Americans to spend their money on specific goods and services is an affront to our freedoms, and an issue that will generate very substantial grass roots opposition as witnessed in the Town Hall demonstrations this Summer. One example of a little issue that is below the rader screen right now that will rise to the surface as the reform process “unclogs”.
And after the mandate fight, we’ll look forward more mundane battles on issues like Comparative Effectiveness Research (government dictating specific treatments for specific conditions), personal privacy (mandatory electronic medical records) and the Healthcare Advisory Board (federally mandated minimum benefit levels), just to name a few. And all this before we spend any time on the real big issue: how do we pay for reform????
With all this to look forward to, it’s no wonder President Obamahas been reluctant to unclog the process!!!
