POLITICS: "Doing Nothing" is No Longer Everybody's Second Choice

If you were Chris Jennings, a top healthy policy adviser for Hillary Clinton's campaign, this probably wouldn't be the best month of your life. So we were delighted to hear Jennings sounding pretty optimistic about the prospects for health reform next year—not necessarily exactly the way Chris would have done it, but optimistic nevertheless about a national climate that can lead to progress in fixing health care.

Jennings as well as representatives from the McCain and Obama campaigns met with a small group of health writers at the Kaiser Family Foundation on Monday. They outlined the differences between the two parties, which are of course significant in terms of the respective role of governments and the market in shaping health care. But they also discussed the commonalities, which are mounting, particularly in such areas as trying to encourage more primary care, do a better job of managing chronic diseases, creating a higher quality system with more coordination of care.

Jennings listed six ways that the dynamics for change are different than the 1993-94 Clinton health care battles:

• The very experiences of 1993-94 inform the current debate
• The burden health care costs place on business has mounted and is recognized
• Health care costs are the root of our fiscal challenges at the federal and state levels
• We are talking not just about coverage but about quality and value—how to get more bang for our health care buck (or our 2-trillion health care bucks)
• A "center-out" coalition of stakeholders is helping to push the message that the current system is simply unsustainable
• A new and widespread recognition that "doing nothing" is not the second best option

Jennings, when he's not working with one Clinton or another, also wears a bipartisan hat; he's one of the advisers to the Bipartisan Policy Center, where four former Senate majority leaders have made health reform their signature issue.

Doug Holtz-Eakin, McCain's policy adviser, said the debate itself is reason for hope (although Holtz-Eakin has to have the only Washington resume we've ever seen that declares in big letters at the top "I am an eternal optimist.") The fact that health reform was an issue even in the Republican primaries, he noted, says a lot. He predicted that the next president, from either party, would be working on health care steadily. "Health Care on Day 1. Day 2. Day 3. Day 4.... Every day for their entire term." There's no choice, he added. "It arises every place you turn."

Obama adviser Gregg Bloche focused less on the common ground between Democrats and Republicans than on minimizing rifts between Democrats and Democrats. He made the case that the disagreements about an individual mandate were not as great as political accounts would have it, and argued that there were several effective policy tools to achieve the goal of covering all Americans.

The session wrapped up with words from Washington Post columnist David Broder, who wrote The System a book on the Clinton health plan failure. The downside of the current political panorama, Broder said, was that neither the public nor the political classes had consensus on health coverage. The upside, though, is that John McCain and Barack Obama—whom Broder identified as the likely Democratic nominee—are both more likely than many politicians to seek a deal. "These are the two most likely to negotiate and reach out." Our troubled health care system needs all the reaching out we can get.