Health Care Reform Is In, Charlie Brown

The Clinton health plan (CHP) was developed by a very small group headed by Hillary Clinton and Ira Magaziner. The usual groups involved in the health care debate (physicians, hospitals, and insurers) were effectively excluded, as this plan was developed in a political vacuum and was considered dead on arrival when it reached the Capitol. Perhaps the most effective campaign against the proposal was the Harry and Louise ads, which featured a middle-class couple discussing the CHP and its impact on them. While concerned about the overall health care system, they were afraid that they would no longer be able to see their own doctor.

The CHP defeat was one of the reasons for the Republican takeover of the House of Representatives in 1994. Perhaps the most significant outcome of the CHP was that no politician would touch large-scale health care reform at the national level because it had become the third rail. After CHP, any health care reform would be incremental; the only significant national health care reform to pass since CHP has been the State Children’s Health Insurance Program (SCHIP), which provided coverage for children. After CHP, the experiments in health care reform were carried out only at the state level.

Now What?

Yogi Berra, as usual, is right because health care reform is déjàávu all over again. Employers, with their money and political influence, are pushing the issue because their health care costs make them less competitive in the global marketplace. GM reportedly pays more per vehicle for health care than it does for steel. Doctors despise the paperwork and the extra, nonproductive steps they have to take to care for their patients. Patients don’t like the increasing share of health care expenses they are required to pay. However, it should not be forgotten that, like Harry and Louise, patients are generally very satisfied with their doctors, so they are concerned about what changes in this relationship health care reform would bring. And then there is the issue of the wide variation in quality of care that needs to be addressed. Actually, the only people I know of that are happy with the current system are the CEOs of health insurance companies.

Is now the time for major health care reform? There are many converging factors that make me think we are close. In addition to those mentioned in the preceding paragraph, perhaps the most powerful is, as is frequently the case, the middle class. As businesses try to reduce their overhead, fewer middle-class families have health coverage. Indigent patients who have limited coverage are not a group that has a great deal of political influence. However, when a sufficient number of the middle class lose their coverage, Congress will listen, and I think we may be getting close to that tipping point.