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The Inevitability of Health Care Reform

Armen Hareyan's picture

Rummaging through my extensive files (i.e., drawers of paper), I came across this January/February 2001 issue of Healthplan, the magazine of the old American Association of Health Plans before it gobbled up the Health Insurance Association of America and became AHIP. It heralds the results of the 2000 election as an opportunity for Republicans and Democrats to work together on health care reform.

Of course, while George W. Bush did run for president as a compassionate conservative, Texas led the nation in the percentage of uninsured throughout Bush’s term as governor. Even pre-Sept. 11, health care was never a burning issue for Bush.

As Inauguration Day 2009 nears, talk of bipartisan reform is again in the air. Those with long memories are torn between giddiness and caution. Reform was “inevitable” in the early 1970s — a former boss of mine was told by the health plan where she worked that her task was to help manage the impact of universal health insurance.

Two decades later, AMA editor George D. Lundberg famously wrote in 1991 that there was an “aura of inevitability” surrounding health care reform; in 1992, “the aura of inevitability intensifies; and in 1993, “the aura of inevitability becomes incarnate.”

The aura was real; actual reform was another matter. “Incarnate” or not, health reform died stillborn — never even put to a vote – in 1994. The cause of death was GOP attack politics abetted by Clinton administration political mismanagement.

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Following last week’s choice of former Sen. Tom Daschle to be both Secretary of Health and Human Services and head of a new White House Office of Health Reform, the New York Times examined the politics of health care reform in the incoming Obama administration. The president-elect is already positioning reform as an economic necessity, not just a moral one, arguing that health care cost containment and universal coverage constitute both a safety net for today and a critical engine of economic growth tomorrow.

Despite the strength of this administration’s commitment to change, Obama and Daschle must show they can handle the political opposition that will inevitably emerge once details of their plan are laid out, according to Jonathan B. Oberlander, who teaches health politics at the University of North Carolina at Chapel Hill.

“The history of health reform is replete with instances of reformers believing this time it’s inevitable,” Mr. Oberlander is quoted as saying. “Those prior tipping points all turned out to be mirages.”

Maybe I’ve been in the desert too long, but I think the Obama strategy has a strong chance of succeeding. Back in June, before the stock market plunge turned paper profits into confetti, I wrote this for The Washington Post:

"The major obstacle to change? Those of us with insurance simply don't care very much about those without it. It's only when health care costs spike sharply, the economy totters or private employers begin to cut back on benefits that the lack of universal health care comes into focus. Noticing the steadily growing ranks of the uninsured, the broad American public -- "us" -- begins to worry that we'll soon be joining the ranks of 'them.'"

Today, in the midst of deepening recession, growing unemployment and financial turmoil, a fast-growing number of “us” fear becoming one of “them” – or have already had it happen. The powerful political self-interest of the middle class should give health care reform the clout it needs to come to pass at last.

Reprinted from The Health Care Blog under Fair Use.