When it comes to achieving healthcare reform, President Obama has friends in all the right places, but the devil is still in the details.
No, this is not the title of a new country song; it is the assessment of Benjamin Heineman, a business ethics expert and senior fellow at Harvard’s schools of law and government. He is also former General Counsel for General Electric, and a former assistant secretary for policy at the U.S. Department of Health, Education and Welfare (now Health and Human Services.) So, he brings some amount of expertise to an article he wrote for the Washington Post.
Heineman asks the question that is on the mind of everyone following healthcare reform: “Can President Obama get from here to there and avoid the failures of two prior Democratic presidents (Carter and Clinton) who sought comprehensive reform following LBJ’s passage of Medicare and Medicaid in the 1960s?”
He goes on to write that the fundamental policy and political obstacles are little changed.
“From a policy perspective, how does one make the trade-offs between the fundamental goals of reform–increased access, consistent quality and meaningful cost control–in a sector of the economy that now accounts for 16 percent of GDP (up from eight percent 30 years ago)? How does one decide whether critical, substantive decisions should be made in legislation, in federal regulatory agencies, in states or in the private sector? And according to what standards?”
“From a political perspective, how do reformers find a “passable” compromise between the competing interests of virtually every individual and entity in the nation–from patients to payers, governments to corporations, and taxpayers to providers–that is strong enough to do more good than harm (and not leave the hardest questions to the future) and flexible enough to deal with the inevitable unintended consequences?”
So, these are the details that will still need to be sorted out. No small task, are they? But, what about the friends? Heineman says Obama has them in two key areas.
First, writes Heineman, “[Obama] is dealing with a Congress controlled by friendly, like-minded Democrats. the four major committee chairs (in Senate Finance, Senate Health, Education & Labor, House Ways and Means, House Energy and Commerce) are in broad agreement with the president on the direction for reform and can, presumably, work together closely to build workable majorities. Plus: the heads of the Office of Management and Budget (OMB) and the domestic policy staff are Hill veterans who can help compose Executive Branch differences and work in concerted fashion with the Hill.
Secondly, Heineman says, “there is broad if vague agreement among virtually all players–including corporations and providers–that the health system is too complex, too variable, too expensive and too ineffective for too many.”
However, Heineman warns the Obama administration that influential friends will not be enough to successfully bring about healthcare reform where so many before have failed. He acknowledges that “the contentious disputes about winners and losers–about who pays, whether system reforms will really work to save money–cannot be blinked away.”
“This administration also needs a detailed plan, Heineman writes, a bottom line, behind the principles if its vision of reform is to be realized, not lost, in the legislative process. The devil–and historic change–is still in the ferocious arguments to come about details.”
It will not take long to find out just how long the discussion will be able to avoid the “contentious disputes.” On Thursday, Mr. Obama will host a summit on health-care issues where a variety of stakeholders will come together with members of Congress. I will be in Washington on Thursday meeting with some Congressional delegations (unfortunately, not to attend the summit) and will hopefully be able to pick up a sense of the direction healthcare reform may be taking. Stay tuned.