Health reform is next big goal

The administration’s main achievement to date has been to get health insurers, doctors, health workers and other interest groups together at the White House earlier this month, where they pledged to find ways to reduce costs by about $2 trillion. It may seem like rhetoric, but they make up the biggest lobby in Washington and were the main force behind the campaign that squelched President Bill Clinton’s 1990s health care reform plan.

It is notable, observers say, that spending on pro-reform ads is running 8-to-1 ahead of opposition messages, and that so far there have been no industry-sponsored campaigns such as the devastating “Harry and Louise” television spots of 1994. They featured a couple at their kitchen table contemplating a health care system run by government bureaucrats and lamenting, “They choose, we lose.”

This time, instead of waiting for a political showdown, industry groups would rather volunteer for cuts while Congress is focused on expanding health care coverage, which could ultimately bring them more business, said Len Nichols, a health economist and director of the health-policy program at the New America Foundation, a research group in Washington.

“What’s impressive is how many people who are knowledgeable about the system understand that we need to change and are willing to say so,” Nichols said.

“That was not true in ‘93-‘94.”

For the administration, industry cooperation helps assuage public concerns about a government-run system supplanting private enterprise.

Despite the health care industry’s cooperation with Obama and the Democrats, the old concern about socialized medicine, with its spectre of government rules limiting doctor-patient relationships and care decisions, remains strong among Republicans in Congress.

They contend that Obama’s proposal, which calls for maintaining private health care choices while subsidizing care for the un- and under-insured, is simply a stalking horse for such a government takeover. GOP leaders cite studies predicting that those with private insurance will drop it en masse if a government-subsidized plan becomes available. That, they says, would kill competition and pave the way for drastic changes.

“The American people don’t want their care rationed,” House Republican leader John Boehner told CNN last week, suggesting the health industry will come back around. “We’ve got the greatest health care delivery system in the world. Why do we want to jeopardize that with a big government-run health care system?”

A more widely shared concern is that efforts to increase revenues will founder and Obama’s embrace of voluntary cost controls won’t generate the savings needed to sustain the choice-based health-care system to which most Americans have become accustomed.

“The fact is none of these ideas address the real problem,” said Joseph Antos, a health-policy expert at the American Enterprise Institute, a free market-oriented think tank in Washington. “If you’re going to save money in health care, you have to deliver fewer services. It’s that simple, and it’s that hard.”

Though interest groups are making commitments to find solutions, the details are daunting.

“Everyone wants to play, and play constructively,” said Christopher Jennings, a health policy lobbyist who was a White House adviser during Clinton’s reform effort. “But that doesn’t mean at the end of the day that will happen. They want to see specifics.”

The biggest challenge is figuring out how to pay for expanding health care coverage —- an estimated $1.2 trillion expense over the next decade. Last week, the Senate Finance Committee began exploring options —- and taking fire —- as it looked at taxing soft drinks and increasing levies on alcoholic beverages. Already opposing the idea is the American Beverage Association, whose members include Atlanta-based Coca-Cola.

More likely, The Washington Post quoted unnamed Democrats as saying, is a new tax on employer-provided health insurance. That’s potentially sticky for the administration, given that Obama opposed the idea when it was proposed by his Republican opponent in the presidential race, John McCain. But the Post’s sources said it won a surprising degree of acceptance during a closed-door meeting of the Senate Finance Committee. And once-fierce opposition among House Democrats is softening as lawmakers confront their limited options for raising the needed revenue.

Progress so farWhat’s aheadOpposition

The House is taking a breather this week for the Memorial Day holiday. When it returns, it will face a daunting goal: passing a health care reform bill by the end of July, when another, monthlong break begins.

The Senate is to weigh the issue in September and October, with a target of having a reconciled bill ready for President Barack Obama’s signature by year’s end.

It’s a massive task for Obama and the Democratic majority: lowering health care costs and providing coverage for those who can’t afford insurance. Conservatives face their own challenge in trying to prevent it from being done in a way that will limit the choices and quality of care for those already able to pay.

Despite health care reform’s central place on Obama’s domestic agenda, he is taking an unusual approach by laying out the big picture and letting lawmakers and the health care industry fill in details.

That’s a striking change, Washington veterans say. “The administrations that I have served since 1980 were far more agitated about details and making sure it was their way,” said Sen. Charles Schumer (D-N.Y.), a key ally on Capitol Hill. Obama aides have a “confidence they don’t have to control every single detail and things will turn out all right,” he said.

Officials are sure to weigh in along the way. But the White House point person on health care says the president will be happy if the plan accomplishes his big-picture goals. “Lower costs and a path to covering everyone. If we achieve those two principles, it will be a victory,” said Nancy-Ann DeParle, director of the White House Office on Health Reform.

Will the unorthodox approach break the barriers that have held back health care reform for the past two decades? Here’s where the issue stands and the challenges ahead.