http://www.latimes.com/news/la-na-healthcare1-2008dec01,0,823075.story?track=ntothtml
From the Los Angeles Times
Consensus emerging on universal healthcare
The prospect of bold government action appears to be
accepted among players across the ideological and political spectrum, including
those who opposed the idea in the 1990s.
By Noam N. Levey
December
1, 2008
Reporting from Washington — After decades of failed efforts to
reshape the nation's healthcare system, a consensus appears to be emerging in
Washington about how to achieve the elusive goal of providing medical insurance
to all Americans.
The answer, say leading groups of businesses,
hospitals, doctors, labor unions and insurance companies -- as well as senior
lawmakers on Capitol Hill and members of the new Obama administration -- is
unprecedented government intervention to create a system of universal
protection.
At the same time, those groups, which span the ideological
and political spectrum, largely have agreed to preserve the employer-based
system through which most Americans get their health insurance.
The idea
of a federal, single-payer system patterned on those in Europe and Canada, long
a dream of the political left, is now virtually off the table.
Rejected
as well is the traditionally conservative concept, championed by Sen. John
McCain (R-Ariz.) during the presidential campaign, of reforming healthcare
mainly by giving incentives for more Americans to buy insurance on their
own.
There also is a widespread understanding that any expansion of
coverage must be accompanied by aggressive efforts to bring down costs and
reward quality care. And key players in the healthcare debate increasingly back
a massive investment of taxpayer money for healthcare reform despite the
burgeoning budget deficits.
Beyond those areas of basic agreement, the
details of what would be one of the most momentous changes in domestic policy
since World War II remain vague.
As a presidential candidate, Barack
Obama embraced both expanded insurance coverage and preservation of the
job-centered system, but since he won the White House he has provided few
specifics about his plans once he takes office.
Disagreements over
specifics could again lead to a stalemate. Even the most sanguine advocates of
sweeping reform concede that difficult negotiations lie ahead.
But what
is taking shape is a debate very different from previous discussions about what
America's healthcare system should look like.
"A lot has changed," said
Karen Ignagni, president of America's Health Insurance Plans, or AHIP, a leading
trade group whose members helped kill the Clinton administration's healthcare
campaign in the early 1990s.
AHIP is participating in talks with other
interest groups to build consensus before Obama takes office in January and
Congress begins debating any healthcare legislation.
Unresolved
issuesAmong the issues to be decided as more concrete proposals
emerge in the months ahead is whether the roughly 46 million uninsured people in
the U.S. will be pushed to buy private coverage or will be enrolled in a
government insurance program, as some consumer groups want.
Hospitals and
doctors fear another public program would reduce what they are paid, as Medicare
and Medicaid have done. Insurers worry they could lose customers to the
government.
Also unresolved is what mechanisms might be created to force
individuals or businesses to get insurance, both potentially contentious
subjects.
And few have tackled how the government will control costs and
set standards of care, proposals that raise the unpopular prospect of federal
regulators dictating which doctors Americans can see and what drugs they can
take.
"There are some very big questions and some very big stumbling
blocks," said Stuart Butler, vice president for domestic policy at the
conservative Heritage Foundation, who has been watching the healthcare debate
for three decades.
"Once you get into the details, the consensus is going
to vanish pretty quickly, I suspect," he said.
At the same time,
advocates for a single-payer system, including the California Nurses Assn., have
vowed to continue pushing the idea next year along with many Democrats on
Capitol Hill.
Republican lawmakers, still reeling from their election day
losses, have signaled discomfort with a major expansion of government spending,
a position many in the GOP hope will help return the party to
power.
"Increasing access for the uninsured is not going to come cheap,"
Sen. Charles E. Grassley (R-Iowa) said at a recent hearing on healthcare reform.
"And it's clear to me that our economy cannot stand much further deficit
spending."
Nonetheless, the current agreement on principles contrasts
markedly with previous reform efforts. Today, many of the key players in the
debate see the importance of preserving elements of the current healthcare
system that many Americans say they like.
"There is a growing
understanding that you have to give people choice and you can't take away what
they have," said Ron Pollack, head of Families USA, an influential advocacy
group for healthcare consumers that is working with a diverse collection of
interest groups to build consensus. "One of the big no-nos is that you must not
ever threaten the coverage that people have."
The Clinton
effortFifteen years ago, there was much less agreement about
preserving an employment-based system that now insures about 177 million
people.
Opponents of President Clinton's plan were able to sink it by
raising the specter that government would take away consumers' choices in a new
system that would force them into inferior health insurance.
But now the
prospect of bold government action to address the healthcare crisis appears to
have been accepted far more broadly by many of those involved in the
debate.
Even business leaders traditionally wary of government
intervention now are pushing for the federal government to act decisively to
reshape the healthcare marketplace -- in large part because of the increasing
burden imposed on them by rising costs.
"Doing this piecemeal is not
going to work," said Todd Stottlemyer, president of the National Federation of
Independent Business, which was also instrumental in defeating the Clinton
plan.
Many involved in the healthcare debate, including Democratic
lawmakers and members of Obama's team, also see healthcare reform as part of a
broader economic picture.
Democratic leaders on Capitol Hill have begun
sketching out plans for healthcare reform that, like Obama's plan, preserve the
employer-based system and create a new system for those without
insurance.
Last month, Senate Finance Committee Chairman Max Baucus
(D-Mont.) outlined such a plan in an 87-page white paper titled "Call to
Action." Similar approaches have been endorsed by House Democrats.
In
contrast, the Clinton administration drew up its healthcare reform plan with
little involvement from congressional Democrats. In the Senate, then-New York
Democrat Daniel Patrick Moynihan, who was chairman of the finance committee at
the time, actively resisted the idea of sweeping change in
healthcare.
There are no signs of a similar rift today, said Jacob
Hacker, a political scientist at UC Berkeley who has written a book about the
failed Clinton effort.
"Possibly more important than policy agreements,"
Hacker said, "is the fact that the political forces now are in
alignment."
Levey is a writer in our Washington bureau.
noam.levey@latimes.com