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 we 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 analyses 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 reform 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 whether we’re losing the collective momentum we possessed one year ago. The clock is ticking. If the current reform effort fails, it’ll likely be years before we regain the political will to 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.
There is healthcare cost reform, there is health insurance reform, and then there is healthcare power and control. The bill passing thru Congress touched little on the first two items and placed a large emphasis in the last item. Much of the policies, procedures and protocol in the bill were to being given to the bureaucrats, under the direction of the HHS Secretary, to write of what healthcare was going to be. Much has not been written at this point, as far as we know, but then again, maybe, it has but not released to the general public of what was going to be written and administered. Not one part of the bill said how costs were going to be reduced and that concerned a lot of people. The sweet heart deals caused many to say whoa, this is not right. Reform, yes, not takeover and control with out telling us the details.
Well, Ann, the problem is that the whole thing was a capitulation to private insurance companies (which put profits before patients) and to Big Pharma (led by lobbyists like the former Louisiana Republican politician Billy “Tarzan” Tarzin).
I am a health care provider and recently had a patient admitted for treatment–and denied–by Blue Cross, Blue Shield of–get this!–Nebraska. Of Ben Nelson fame. The patient didn’t meet their restrictive criteria–and knew that the patient would be flipped over to the public option (M.A.) anyway. They’re opposed to the public option when it comes to competition–but use it–throw the burden on the bleeding backs of taxpayers–to preserve their heinous and unseemly profits.
Welcome to America!
You won’t see health care–or any other–meaningful policy emerge from a Senate which is totally dysfunctional (and intentionally so), hiding behind its procedural rules to prevent meaningful action and decision-making. Profiles in Courage be d—med.
Thanks for your thoughtful opinion pieces.
There’s reform, and then there’s meaningful reform. My sense is that if we’re going to change anything about the American health care system, most people would prefer to see meaningful change rather than tinkering around the margins in ways that don’t make any substantial difference.