Health Care Reform: Now or Never?

By Andy Miller
WebMD Guest Blogger


Midnight, New Year's Eve, 2009.

Conventional wisdom says that if major health care reform hasn't passed Congress by then, it may not be revived for years, if at all.

Why is it now or (maybe) never?

This year offers an unusual alignment of stars that makes health reform's chances better than at any time since 1993, when Bill and Hillary Clinton launched an overhaul plan that later fizzled in Congress.

The confluence of favorable 2009 factors starts with political realities.

President Obama, a popular leader in his first year in office, has robust Democratic majorities in both houses of Congress. He clearly upped the stakes in recent days, and again in a televised news conference Wednesday night, on the importance of getting health reform done now.

But if major legislation isn't approved this year, Congress enters an election year in 2010, when it typically avoids the big-idea bills. The next year begins a presidential election cycle, notes Julius Hobson, senior adviser on health care for Bryan Cave, a law firm. "It's now or never -- that's why the president is pressing Congress,'' Hobson says.

Secondly, unlike during the Clintons' flameout, major medical stakeholders have stepped up to support reform efforts.

That includes the health insurance industry. Insurers have agreed to not reject applicants due to pre-existing medical conditions, as long as everyone is required to have coverage. The industry behind the potent anti-reform "Harry and Louise'' ads in the '90s is now on board, albeit with an asterisk: Health insurers fiercely oppose a public insurance option run by the government.

The American Medical Association has thrown its support to the House Democrats' plan, though not all physicians would agree. Hospitals have agreed to some concessions to help pay for health reform, as has the pharmaceutical industry.

And retail giant Wal-Mart, whose health benefits plans have drawn strong criticism in the past, has endorsed a requirement that employers provide insurance to workers.

"There is tremendous momentum,'' says Ken Thorpe, an Emory University health policy expert. "The stage is set.''

While this coalition has given reform a big boost, the interest groups also have objected to certain proposals. "Everybody wants reform,'' Hobson says. "Everybody has something they like, but everybody has something they dislike, too.''

Reform opponents, meanwhile, appear to be gathering strength. Bradley Blakeman, a Republican strategist, said in response to Obama's news conference, "The president is selling a product that no one wants. He is desperate and refuses to pull the plug on health care legislation that even Democrats concede is DOA.''

Conservative "Blue Dog" Democrats are balking at proposed new taxes and inadequate health cost containment in various reform plans.

And polls show that public confidence on health reform is slipping. CNN released a poll of polls Wednesday that found less than half the country approves of how Obama is handling the issue.

Obama targeted those public perceptions Wednesday night -- and the issue of how it affects the average taxpayer: the ''What's in this for me?'' question.

"This is not just about the 47 million Americans who don't have any health insurance at all,'' he said. "Reform is about every American who has ever feared that they may lose their coverage if they become too sick, or lose their job, or change their job. It's about every small business that has been forced to lay off employees or cut back on their coverage because it became too expensive … If we do not control these costs, we will not be able to control our deficit. If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket. If we don't act, 14,000 Americans will continue to lose their health insurance every single day.''

He returned later to that pocketbook problem. "Premiums for families that have health insurance have doubled over the last 10 years,'' he said. "They've gone up three times faster than wages … Employers are going to put more and more costs on employees or they're just going to stop providing health care altogether."

Other health care statistics are worsening, too. A Gallup poll released Wednesday found 16% of American adults -- one in six -- are uninsured. That's up from an average of 14.8% among those interviewed in 2008.

The U.S. spends much more on health care than other countries, yet the medical results are worse than many nations, Obama also noted.

His push on health reform undoubtedly will continue through the summer and into the fall, to get a bill this year. "Everyone recognizes that inaction will make all the problems infinitely worse,'' Hobson says.

Still, E. Richard Brown, director of the UCLA Center for Health Policy Research and an expert on health reform, says 2009 is not the last chance for reform.

It could come together again in 2011, if defeated this year, Brown says. "If we don't get it done now, the same pressures will be there in two years.''

Yet Brown also sees 2009 as a prime opportunity. "It's an opportunity we cannot afford to pass up. I do think this moment is a rare moment, an alignment of different interest groups. ''

SOURCES: Julius Hobson, senior policy adviser, Bryan Cave LLP; Ken Thorpe, professor, Rollins School of Public Health, Emory University; E. Richard Brown, director, UCLA Center for Health Policy Research; New York Times web site; CNN web site; Politico, The Arena; American Medical Association; California Healthline web site; Gallup Poll.