Will Reform Happen?

Recess – when I was a kid it was the best part of school.  Recess was a period of task abandonment; a temporary reprieve from the classroom engagement and the pedagogy.  Unfortunately for Congress, recess means a time to confront constituents and to engage on the home front.  For members of the House facing early primaries in states like Illinois, this recess may be one of the most contentious in some recent time – especially for Democrats.  Let’s face it, 2010 is right around the corner and for all but a few fully secure members, Congressional job security (the seat and/or the leadership or committee positions in the House which are equally as prized) is front and center. 

This Congressional summer holiday will also be a time where policy is tested and political capital is gained or lost.   Front and center is the President’s health plan (let’s call it what it is) and perhaps, the legacy of the Democratic controlled Congress, swept into power via the 2008 elections.  I frankly can’t remember a political time where health policy was so much in the national spotlight and certainly, no time in my memory was there ever a greater prospect for a wholesale revision of the U.S. health system.  Even the Clinton years and Hillary’s dabbles with health reform pale in comparison to present day.  To be certain, we are much closer to the brink of health care revolution than at any time since the evolution of Title 18 and Title 19.

I have taken the time to actually read HR 3200 otherwise known as “America’s Affordable Health Choices Act of 2009” and the Tri-Committee mark-ups and proposed amendments (many of which still require action post the Congressional holiday).  I have also taken the time to read the Senate’s companion version (though far less detailed) known as the “Affordable Health Choices Act”.  I’ve even watched the workings of the Senate Finance Committee, the locus of payment discussions  for the Senate’s version of health care reform legislation.  I’m actually somewhat proud of myself for getting through both pieces of legislation (and a host of accompanying analyses) given that most Congressman and Senators have admitted that they haven’t read the legislation.  To say that the legislation is heady stuff would be an understatement.  It is quite honestly, some of the most broad based and confusing, cross-wired and special interest driven, undefined and bureaucratically laden stuff I have ever read.  It makes reading a Russian novel such as Crime and Punishment seem simple.

I am of the belief that any time one tries to do great things, the underlying premise must be clear and simple and the methodology by which the undertaking will get started, thoughtful and straightforward.  I realize that the “devil is in the details” and trial and error will undoubtedly occur.  I also realize that something as immense as reforming the largest private economy in the U.S. (and one of the largest economies in the world for that matter) and the delivery system of health care for every American citizen is a daunting task and as a result, will lead to legislation with pages numbering in the thousands.  What I don’t understand after reading the legislation is how this “reform” step can be so far from true reform and thus, so unlikely to actually happen.

As I have written before, I am a pro-health care reform “guy”.  I know the system is irrevocably broken as presently constituted and economically unsustainable in its present, entitlement and bureaucratic form.  What I have read to date doesn’t make the system anywhere close to better or more affordable; it makes it worse by a significant magnitude.  It seeks to transfer a system that is already over-regulated and bureaucratically inefficient to a government payer and a government overseer – neither of which are anywhere close to capable to achieve the desired result of “improving the cost and quality of health care in the U.S.”  Frankly, it is no wonder that one by one, the politicians who were at one time, part of designing this “grand experiment” are presently looking for ways to distance themselves from that which is now front and center.  Timing in politics is everything, and as the ability to pass this legislation under the cover of darkness waned and now has gone, the legislation is illuminated for what it is and sadly, isn’t.

As the news coverage broadens about what is going on at the various town hall meetings held to garner constituent reaction to the health reform proposals, we begin to see the disconnect between Washington and the American people. Of course the media coverage is skewed and the pictures and stories designed to parlay a particular group of opinions.  Even though distorted, the news portrays an accurate center; Washington has missed the mark in this venture.

It is true that President Obama was elected with a wide enough margin to create tacit endorsement of his political agenda, health care reform a major piece thereto.  The missing link however was the specificity that legislation requires in order to become law and election platforms are anything but specific.  Where the disconnect occurred was during the step that the Democratic majority took to craft a clearly different approach than what most people assumed as “health care reform”.  Alas, the Democratic  majority and President Obama clearly forgot that elections are played out in broad, sweeping rhetorical and promissory themes and policy is made in real time and even in past-time; the time zone that exists where people gauge what they want by what is happening now and what they might lose.

So the logical question at the moment is, “will reform happen?”  My simple read is, not likely.  Once the President and the leading Democrat authors and initial champions were put in the position of having to defend the basic tenets and provisions that they so hastily crafted in HR 3200, the momentum was lost.  Worse, once the various interest groups and Republicans got sufficient traction in the form of plausible arguments against the current reform proposals and those talking points gained reception among average Americans,  politicians became wary of their future “employment” prospects.  Nothing stalls momentum like politicians on both sides of the aisle worried about their political future in a looming election year cycle.

As we sit today, we begin to see a picture of where health reform will go and why.  As dangerous as prognostications are concerning policy and Washington, I have no immediate “skin in the game” so I’ll make a few.  It won’t take long, likely by late-fall, early-winter to see how close I came with my “EWAGS” (educated, wild-ass guesses).

  • The polls show, nearly universally, the majority of Americans to be satisfied with their current health care status.  The trend within these polls continues to show a widening divide between those who believe the Washington approach will make them “worse off” in terms of their current coverage status and those who claim to be “pro reform”.  Unless this trend changes or reverses, the present reform plan is more or less D.O.A.
  • Wall Street and the financial markets continue to trend positively, almost foretelling a belief that reform is unlikely to occur and certainly, not at a level matching that in HR 3200.  Wall Street tends to like government that is in “stalemate” believing that such stalemate creates a period of inactivity in terms of new budgetary and business/regulatory initiatives.  As the health reform legislation is forcasted to be another level of unfunded government spending (a widening deficit), it appears that Wall Street is forcasting it to be a “no go”.  In summary, it is unlikely that a rising Dow will do anything to election wary politicians other than to put up additional “stop” signs.
  • The economy is likely near the bottom of the recession and beginning to trend slowly and modestly upward.  The President’s message and that of the Democratic congress has been that “reform and recovery go hand-in-hand”; no reform essentially and continued economic stagnation.  If in fact, such is not the case or at least not to the magnitude the President has sold, the economic wind has left the sails on the urgency of health care reform.
  • The legislation itself is hopelessly flawed, economically and structurally.  As continued information (and misinformation) pours forth on the contents of the bills, the hoped for “good intent” becomes mired in the details that are not as pleasing.  Frankly, the legislation cannot be viewed for anything other than what it is; a government run, single-payer plan.  Viewed in this light, along with the other provisions that call for significant spending reductions in Medicare and Medicaid, the legislation is truly politically and socially unsavory.

Knowing the above, my prediction is that HR 3200 and the companion Senate bill are all but dead.  What will happen is a furious post-recess attempt to save political face on behalf of the President and the Democrats; a backpedaling and recapitulation period where pieces of the existing legislation are furiously re-drafted in an attempt to produce even a watered down bill.  What will likely be sold is a “multi-year”, “multi-phased” plan that does little in the first or so year but creates enough of an illusion that reform will eventually happen, to use as positioning for a President and Congress that need to have a win on this issue.  The legislation will address simple and tiny pieces already encapsulated within the enormity of HR 3200 such as the “donut hole” in Medicare D, perhaps health insurance portability, fraud, abuse and waste provisions, targeted savings in Medicare and Medicaid (still some cuts) and perhaps, the creation of various commissions and groups that will be tasked with forming coalitions, buying groups, new quality initiatives, etc.  These special commissions will be “cloaked” in glorious Washington clothing, sold as having enormous responsibility and power, directly tasked by the President and Congress to push ahead with the bold reform agenda.  In reality, these groups will, as is always the case, do very little but provide political cover to wary and wounded politicians and the President.

So, the question answered, “will reform happen?” – not this year and likely, not any time soon.  Unfortunately, despite the fact that the system needs reform badly, Washington has once again misconstrued the core issues and politicized the process so wretchedly that the basics that could be accomplished and form the foundation for meaningful reform will remain unaddressed.

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