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HEALTH REFORM: Putting it In Perspective... It Looked Different A Year Ago

I ran into an old friend the other night at an overpriced grocery store (slowing down the checkout out of anyone unfortunate to be in either of our lines), and as we chatted in the parking lot trying to catch up before our frozen food started to drip, he asked me whether he, a progressive, should be disappointed about health reform.

It depends on your perspective, I said, voicing some of the thoughts that had been clattering around in my brain recently. What's your starting point?

If you start from your most optimistic, sky's the limit moment, say last November 4 or January 20, expecting to get a $1.5 trillion deficit-oblivious bill that covered absolutely everyone immediately and had a robust public plan and completely rebuilt our health care system ... you know, all the things that some hoped for in the "happy talk" stage of reform when the stars were all aligned for change but none of the hard decisions had been made and the Republicans hadn't opted for the "try to beat'em, don't join'em Waterloo strategy.." well, then disappointment is understandable.

But think back a year, I told my friend. One year ago, last October, I wrote an overview chapter for a book on health reform, and I just took it off my shelf to remind myself just how much has changed. (Here's a link but the online version has been updated.) 

A year ago, we still didn't know whether McCain or Obama would be the next president. Nor did we know how much of a priority health reform would be, particularly given the then-new stresses on the country because of the economic crisis and tumbling markets and mortgage abyss. Not to mention all the foreign policy challenges facing the next president. And the legitimate pent-up need to address other problems, like clean energy and global warming.

Would a new administration in a post-crash economy see health care as unaffordable given the gaping and growing deficit? Or would they see it (as we do) as part of a solution to the long-term economic problems?

Would reform be comprehensive? Or incremental? Or sequential (the Washington buzzword for serious and significant but not quite comprehensive reform)? Given the political risks and the memories of 1994, would any president dare to seek consensus about an incredibly complicated big sprawling bill or would it be easier for Congress to swallow one policy pill at a time. (We at New America have always called for a comprehensive approach, because of all the interlocking pieces and interactions in health care, but it wasn't a given that Congress and the new president would see it that way.)

Would we do costs, then coverage? Or coverage, then costs? Or both? Would we do a kid first approach and leave millions of their parents and neighbors uncovered? Would we tinker with payment rates and "low hanging" fruits, or would we try to make transformative changes in how we deliver care, what we offer the chronically ill, how we improve and expand primary care, how we get rid of the billions of dollars we spend on tests and treatments that don't make us healthier? 

Would we deregulate, as Republicans were calling for, scrapping mandates and promising that the free market (and tort reform) would cure what ails American health care? Or would we regulate, so insurers have to cover everyone, fair and square?

A year ago, would we have really expected to invest nearly a trillion dollars in creating a fairer and more equitable system, that asked all of us to contribute what we could and gave all Americans the promise that we'd have the care we need when we need it?

We didn't know those answers twelve months ago. And we don't know all the answers now -- the legislation is still a work in progress and will be for another month or two, and we too very much hope that some of the things that we're not crazy about in current versions of the legislation get fixed.

But if you feel discouraged, think back to last October. You'll feel better. My friend in the parking lot did.

Putting it in Perspective

I think Joanne's perspective is very valuable.  I wrote a very similar blog a few days ago after listening to Daniel Schorr on NPR sigh about what was "left out" of the health reform bills.  You can read it (along with some provocative comments) at


just read your post... and yes we did have some similar reactions to the events of the past year. I covered the health reform efforts on the Hill in 94, and as it heated up again this time around, and I talked to others who had been around in 93-94, by far the most common regret I heard voiced was that there wasn't enough willingness to compromise.. not to accept something awful or meaningless, but to accept something decent and helpful and then work to build on it in the future.. 

I also think that even a lot of smart well informed thoughtful people have not always been able to really digest all that's in these very large and complicated bills -- i do this fulltime and I certainly couldn't accurately reel off every provision in all three bills without a Google equivalent of a cheat sheet. A bit of misunderstanding therefore may be inevitable but then maybe some of the opining should be a bit less emphatic.