Comprehensive or incremental

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By Consumers Union on Friday, November 21st, 2008

Robert Laszewski, a healthcare consultant and former insurance industry official over at Healthcare Policy and Marketplace Review, made a strong case last week for incremental rather than comprehensive healthcare reform. So I wanted to take a moment to respond.

“it is not apparent to me that we have either the consensus on what a mega health plan would look like, the solid voter support for real healthcare change, or the money to do it.”

These are serious concerns, so let’s go through them.

Consensus on what a mega health plan would look like: While the various plans — from Obama’s campaign outline, to the recently released Baucus plan, to the Wyden plan, to the plan outlined in newly named HHS chief Tom Daschle’s recent book — differ considerably, they are all comprehensive.

The one thing people do seem to agree on right now is that reform must be comprehensive in order to get costs under control and improve outcomes. We are all tired of incremental reforms that leave most Americans slowly worse and worse off as prices rise and coverage shrinks. In fact, with the exception of some unrepentant free marketeers who reject any government effort to address the breakdown of our healthcare economy, many conservatives now take very seriously the need to do something big. Wyden’s statement of principles (and the bipartisan support for those principles) bodes well for real, comprehensive reform in the near term.

Solid voter support for real healthcare change: After a long, long campaign season, I for one am a little tired of the polling wars. That said, I think Kaiser identified something very significant in their most recent tracking poll, and soon to be released Consumer Reports polling backs them up. The economic downturn has sharpened the need for comprehensive reform, not shoved it onto the back burner. In October, nearly half of the public reported that someone in their family limited medical care due to the cost. That tells me that people’s personal experience of the failures of our healthcare economy go broader and deeper than statistics on the number of uninsured would indicate.

In the 1990s, many of us felt that health reform failed in part because the vast majority of people with employer-based health coverage were largely protected from spiraling healthcare costs. That protection has evaporated. Support for reform will solidify when people see that it addresses the real system failures that they have experienced for themselves.

The money to do it: Well, I’m not an economist, but some really good economists are now starting to recommend that Americans prepare for increased spending by government–and that the increased spending is key to our national economic recovery.

No one believes that a better healthcare system will be free. But once Americans opened their wallets to inject capitol into banks, it is no longer such a leap to think we should open our wallets to create a healthcare system designed to control costs over the long term and give families the security they need to change jobs, start small businesses, educate their children or retire.

There’s a lot of talk about rebuilding our infrastructure–roads, bridges, broadband communication–because it will create jobs and bring the U.S. finally into the new millenium. All those same arguments are true about healthcare, which already accounts for nearly 10 percent of all jobs. Healthcare is a key infrastructure that we need to invest in as a nation so that families can come out safely on the other side of this recession.

Laszewski offers one more reason we can’t pass comprehensive health reform, which he recently reprised for the Wall Street Journal. According to Laszewski, a health reform bill will be long, 1000+ pages, and Congress can’t pass long bills because there will be something in there for everyone to hate.

If everyone who has stepped up to support reform isn’t ready to really enter into a dialog–and give up something in the process–than Laszewski could be right. But compromise is likely, and Tom Daschle is a great choice to lead the process. I too remember the fall of the Clinton plan in the 1990s. The healthcare economy was broken back then, but the pain has now spread to nearly everyone. That means the powerful interests arrayed against reform then have rearranged themselves this time, and the voice of ordinary Americans speaks more clearly than ever before. Consumers Union spent the summer listening, and I recommend that Mr. Laszewski listen too. He may decide to stop nay-saying and join the comprehensive reform effort.

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