10 lessons for national health care reform
Melissa A. Rodgers, San Francisco Chronicle
By Melissa A. Rodgers, San Francisco Chronicle
President Obama and a Democratic-controlled Congress have made health care reform a priority for the first time in 15 years. In the past two weeks, the House and Senate have released draft bills whose key features closely resemble the policies hotly debated previously in California. Although the economic situation in 2007-2008 derailed health care reform in California, it is today's economic crisis that may make national reform a reality.
The status quo is simply not a sustainable option. The increasing economic insecurity that Americans and their families face is mirrored in the worsening financial situation of employers, state governments, private insurers and health providers. The president and Congress must act now.
But if they are not careful, policymakers in Washington risk falling into the same pitfalls that brought down reform efforts in California. Last week's release of the surprising cost estimate from the Congressional Budget Office was an eerie reminder of the California challenges. In addressing the health care crisis quickly and boldly, national leaders would do well to heed the lessons that California's health care debate offers. Congress must:
1. Build in cost controls. Otherwise, as in California, the price tag for the health reform bill will be its downfall. Taxes alone cannot finance reform. We need measures that control costs over time, including a public health care plan that will compete with private insurance on a level playing field.
2. Keep a scorecard. How many people will get good health insurance? Will it be real insurance or just a high-deductible, bare-bones plan? What will happen to health care costs if reform stalls? Expose opponents who propose plans that would leave many Americans without good, affordable insurance.
3. Answer the public's questions. Keep the spotlight on making health care more secure and affordable for all American families. Be prepared to answer, "What's in it for me?" This is not just about the 47 million uninsured; almost half of the 84 percent of Americans who have insurance worry about their health care needs not being paid for. Middle-income voters want to know they will be able to get great medical care when they need it without facing unaffordable costs.
4. Focus on the big picture. The special interests will lobby on single issues. California provides a cautionary tale: Opponents joined to defeat health care reform while its supporters lobbied to change the bill - not pass it.
5. Reach out and educate. Leaders in Congress need to involve rank-and-file members or risk losing crucial votes. California's leadership learned this lesson the hard way - only one member of the state Senate Health Committee voted for the compromise bill and the Senate lacked the votes to pass the bill if it had come to the floor. Make sure that the complex elements of the plan are understood by all policymakers by putting a human face on the proposals.
6. Seize the moment. Pass a bill now, even if that means leaving some issues to be hammered out later on. Delay will only bring new priorities and more anxiety about the debt, and the political back-and-forth risks turning engaged voters into cynics and policymakers into defeatists.
7. Hold them accountable. Keep President Obama to his promise of delivering health care reform. But accountability is a two-way street: President Obama must also hold Congress accountable for passing a bill he can sign, and hold interest groups accountable for supporting the final compromise - not just single issues.
8. Unite allies, divide critics. Use incentives - like California did when it gained the support of some insurers by agreeing that every Californian would be required to carry health insurance - to win new allies and divide the opposition. Show voters that employers, doctors and insurers don't oppose the whole package even if they speak out against parts of it. Then use the grassroots organizing tools of the Obama presidential campaign to spread the word and win support for the bill.
9. Remember affordability. Be clear that everyone - families, employers, doctors and taxpayers - deserves a health care system that is affordable. But denounce health plan lobbyists and other critics who say they're worried about costs but are really concerned about their bottom line.
10. Avoid incremental change. Keep the focus on broad reforms that help all workers and families rather than more modest proposals covering only the most sympathetic or disadvantaged groups. Now is the time to remain ambitious and achieve much-needed long-term change.
Melissa A. Rodgers is the associate director of the Berkeley Center on Health, Economic & Family Security at UC Berkeley School of Law and the former director of the Health Consumer Center at the Legal Aid Society of San Mateo County.6/23/2009