In just one year, what a difference. A year ago at this time, there was a sense of – well, maybe not exactly optimism, but a sense of hope that weÂ might accomplish meaningful health care reform in the U.S.
Now the reform initiative is on life support, and it’s not clear what Congress might be able to salvage.
How did it all go wrong? Various commentators have been examining that question this past week. One of the most insightful analysesÂ comes from Kaiser Health News, which points to congressional deal-making, the cost and complexity of the health care bills, and a failure to connect with the American public as the key reasons why health care reform legislation has faltered:
“There’s nothing in it the average person could understand about why your costs would be lower,” says Robert Blendon, professor of health policy at Harvard’s School of Public Health. “They don’t even have good illustrations about how it would be cheaper. They did not find a way to save money for people with job-based insurance.”
… Certainly, relentless attacks by the Republicans – as well as the Democrats’ own inability to clearly articulate the benefits of the legislation – are partly responsible for the legislation’s lack of popularity. So are crucial policy decisions made by Democratic leaders as they struggled to push the legislation through Congress, according to experts of different ideological persuasions.
Does this mean the public no longer supports health care reform? Not so fast, cautions Bob Doherty, who blogs about health care policy for the American College of Physicians. Recent opinion polls suggest the real issue is that people are becoming doubtful and skeptical, Doherty blogged last week:
In my mind, the polls show that opponents have been most effective in raising doubts among Americans on two of the core claims for health care reform: that the bills will lower their costs while improving (or at least not hurting) the quality of care they receive. But I don’t think that the polls show that there has been a wholesale rejection of the need for health care reform, or that most Americans buy into the view that it is too liberal and will lead to government-run health care. Instead, they don’t trust that the bills being debated will deliver on the promises of better care at lower cost, and that is why a majority now oppose them. The proponents of health reformÂ have not yet figured out how to make them feel otherwise.
It’s worth noting that the MoveOn political action committee is holding an emergency rally at Rep. Collin Peterson’s office in Willmar tomorrow to continue pushing for a meaningful health care bill, along with measures to support economic recovery. Clearly at least some among the public haven’t given up yet, and don’t want to see Congress scale back or abandon its efforts at health care reform. But is it going to be too late?
What I’ve seen (and heard) is that many people still care deeply about this issue and want to see genuine change. Many of them, however, have a hard time whole-heartedly supporting the bills on the table. Some of the disagreement seems to be ideological, but I also hear thoughtful people who are questioning whether the current version of reform will come at too high a price and create unintended – and damaging – consequences. Mostly, they’re not sure how it’ll affect them personally, and this uncertainty leaves them worried.
I blogged about this back in July but I’ll say it again: Much of the process seems to have been dominated first by policy wonks and then by politicians. I’m not sure whether consumers or clinicians have truly had much say or whether they’re actually being heard – a fact that was communicated loud and clear during the contentious town hall meetings last August. People are feeling disenchanted, and when they get disenchanted, they start to disengage.
Some of the controversy, I think, was to be expected. There’s really no way to accomplish meaningful health care reform without goring a few oxen along the way. The question is whetherÂ we’re losingÂ the collective momentum weÂ possessed one year ago. The clock is ticking.Â If the current reform effort fails,Â it’ll likely be years before we regain the political will toÂ give health care reform another chance.
Update, Jan. 29: For a collection of commentaries on the future of health care reform, check out Room for Debate at the New York Times.