Is There Hope for Health Reform?
The Post asked former lawmakers and political experts whether the plan President Obama outlined to Congress can pass. Below are contributions from Mack Mclarty, Scott Keeter, Bob Dole, Kiki Mclean, Tony Fratto, Denis Cortese, Al From and Donna Brazile.
Chief of staff to President Bill Clinton from 1993 to 1994
Tuesday I wasn't sure. Today I am. President Obama's speech reset the debate on clear and moderate terms: no increase to the deficit; no funds for abortions or for illegal immigrants; a public option that he made sound reasonable but also quite expendable. Politically, he drew the Democrats together. Just as important, I believe, he made the case to independents and moderates who were lost or wavering.
What next? He has to take full charge of the process. Sen. Max Baucus (D-Mont.) and the "Gang of Six" may produce a package this week -- the fifth committee bill -- but Obama has to take the best of all five and present a plan that is clearly his own, down to the details. That plan should follow the moderate lines of his address to Congress. And then he should not relent until it is passed. In 1994, we simply ran out of time. With 14 months until the next elections, in the fullness of his power, with the right plan and with congressional majorities in both houses, the president can and should get this done.
Director of survey research at Pew Research Center
The public remains divided when asked in general terms about the proposals before Congress. But significant majorities support most of the major reform elements outlined in the president's speech: requiring all Americans to have health insurance, requiring businesses to cover their employees or pay a fee, providing government assistance to those who cannot afford coverage, and curbing insurance company practices such as refusing to cover pre-existing conditions.
Still, the public finds the debate confusing and expresses anxiety about unintended consequences. Indeed, when it comes to public opinion, perhaps the most significant obstacle to reform is that most people have health insurance, and many -- even those who believe reform is needed -- worry that reform will hurt them.
Although strong opponents outnumber strong supporters, many people who say they oppose the plan aren't dug in. But public support for reform is not likely to increase until its proponents in Congress can unify around a bill and communicate that support to the public. Throughout the summer congressional opponents have been unified in their criticism and proponents have been divided. Little wonder, then, that the president's address was aimed more at unifying supporters than converting his opponents. Reform's prospects will depend on how well he succeeds at the former task.
Senate Republican leader from 1985 to 1996
The president has spoken. In doing so he has taken ownership of the product and should be calling the shots. There are now four committee bills, and we are awaiting final action in the Senate Finance Committee. All have elements the president has spoken about and can be merged with his plan.
Unfortunately, the president's speech was short on specifics, particularly how we pay for this radical change in our health-care system. It is misleading to claim much of this will come by reducing fraud and abuse.
Here is what must happen now: First, drop the public option or other suggestions leading us to the same result. This is not a bargaining chip. Second, make one more effort to reach out meaningfully to the Republican leadership. Third, Republicans need to come to the table with proposals to fix problems in our health-care system in a way that does not add to the deficit and controls the rising costs of care. Solutions need to truly change incentives in the system, which currently encourage high-quantity care rather than high-quality care. Republicans should also offer ideas on how best to cover everyone with a basic package of benefits, except for those who are in the country illegally. The president, in turn, needs to give the Republican leadership a real reason not to kick the can down the road. Chuck Grassley (R-Iowa) cannot lead in the Senate if he has but three or four followers. Fourth, the president must make a serious effort at tort reform, not simply demonstrations. This could really bring more Republicans to the table.
Democratic strategist; partner at the public relations firm Porter Novelli
Congressional negotiators now have the guidance and the room they need to forge effective and successful health-care reform legislation. The specific elements President Obama outlined to Congress did three things necessary to make passage possible:
First, the president gave clear direction to both the left and the right to lay down their litmus tests and concentrate on the core problem. This makes it possible to consider new approaches in what amounts to a political demilitarized zone. Second, by promoting issues such as malpractice reform he demonstrated a level of respect for the political opposition that gives members of the minority a reason to return to the table. Finally, he called out the professional political opposition and warned those who oppose reform simply for political gain that they will be held accountable. He received some unexpected help from Rep. Joe Wilson, making it much easier to expose those who have engaged in untruthful opposition. This will make it easier to honestly debate legitimate questions about the impact, cost and quality of health reform for both lawmakers and citizens.
Deputy assistant to the president and deputy press secretary from September 2006 to January 2009
President Obama had a chance to clear up confusion in the minds of Americans who have been following the health-care debate, and to lead -- by truly proposing a middle path that would garner bipartisan votes.
As it turned out, he accomplished neither goal, and we appear to be no further along in achieving comprehensive bipartisan legislation than we were before Wednesday's speech.
While the president was his usual eloquent self in passionately describing the problem, the speech did almost nothing to clear up confusion over the key points of contention: fiscal cost, taxes, Medicare cuts and the proper role of government.
Obama did throw a small bone to Republicans in acknowledging that medical malpractice tort reform needs to be addressed, but the overall package -- which he now describes as "his" plan -- remains an unprincipled, ad hoc cobbling together of wishy-washy views on his most important domestic priority.
It's staggering to me that at this late stage in the debate, few Americans and only marginally more policymakers, members of Congress and journalists can accurately describe what exactly the president's plan is, let alone how it would be paid for, its impact on the budget or its impact on the delivery of health services in the United States.
President and chief executive of the Mayo Clinic
The key to reaching agreement on health-care reform this year is to keep the needs of patients at the center of every discussion. Almost everyone agrees that the health-care situation in the United States is unsustainable; we pay too much for too little.
It is critical that everyone have access to affordable, high-quality health care that offers choice and security. To accomplish this, we must focus first on two areas of reform: health-insurance reform and reform of health-care delivery.
Health-insurance reform must offer affordable coverage to everyone, remove exclusions for preexisting conditions, be individually owned so it isn't tied to employment, and offer patients choice in the amount and type of coverage they buy.
Health-care delivery reform must look for better value in our system consisting of better outcomes for patients, safer care and better service at a lower cost over time. Payment should be tied to better value; providers who achieve better patient outcomes, safety and satisfaction at lower costs should be paid accordingly and those who don't should have incentives to improve.
Many high-value providers across the country, including the Mayo Clinic, are held up as examples because they have made the focus of all their efforts providing the most efficient and most effective care for patients. If this principle becomes the foundation of our discussions and efforts, there is a real chance for successful health-care reform.
Principal of the From Co.; founder of the Democratic Leadership Council
To pass health-care legislation this year, President Obama should cut a deal with centrist Democrats in the Senate on a plan that jettisons the public option and contains real reforms to cut health-care costs. The outlines of such a bill are already clear:
-- An individual mandate requiring all Americans buy insurance.
-- A health exchange, like the successful Commonwealth Connector in Massachusetts, to connect consumers with a choice of competing private insurance plans.
-- Subsidies paid for by government, business and patients that ensure that everyone can afford a basic plan.
-- Fees, like the president proposed, on Cadillac plans.
-- Requiring insurance companies to insure people with pre-existing conditions and preventing them from dropping coverage on people who become sick.
-- Incentives to replace fee-for-service payments more cost-effective models.
-- Limiting abuses in medical malpractice suits.
Such a plan could meet the objectives the president outlined -- to expand coverage, lower health-care costs and improve quality -- without adding to the federal deficit. With centrist Democrats bought in, it could garner the 60 votes necessary to pass. Even without a public option, it would achieve much that liberals have long fought for. Open-minded Republicans might even find it hard to resist.
Author and political commentator; manager of Al Gore's 2000 presidential campaign
With a major assist from South Carolina Rep. Joe Wilson, President Obama's address accomplished what he needed to do.
Obama connected health-insurance reform to the nation's overall economic recovery, its vitality to the well-being of working Americans and, finally, delivered the specifics of his plan.
The president also outlined the risks of doing nothing, specifically how the federal budget deficit would continue to mushroom. He urged a civil debate and opened the floor to reasonable alternatives from others -- something the Republicans should try to do without further rancor. Now.
This speech raised the stakes and has made it hard for lawmakers to do nothing. The challenge for passing reform is for the president to bring warring factions in his own party together. He must also keep a deficit-weary public motivated to get this done.