Shelter from the storm
The health care industry, inside the tent
Shelter from the storm
Dick Polman, Inquirer National Political Columnist
Lyndon Johnson famously observed during his presidency that the best way to tame one's antagonists, or at least to mute their mischief, is to keep them close. In LBJ's characteristically inelegant words, it's always better to have the mischief-makers "inside the tent pissing out," rather than "outside the tent pissing in."
The LBJ aphorism came to mind yesterday as President Obama stood at the White House with the major players of the health care industry - all of whom, under different political circumstances, might ideally be tempted to urinate on health care reform from a great height... just as the major players did back in 1994, when they hooked up with the ascendant congressional Republicans to bury the Clinton reform plan.
But it's not 1994 anymore; the congressional Republicans have been driven to the margins of governance, and the polls show strong public support for government-driven reform. In February, for instance, a CNN-ORC poll asked, "In general, would you favor or oppose a program that would increase the federal government's influence over the country's health care system in an attempt to lower costs and provide coverage to more Americans?" The response: 72 percent favored, 27 percent opposed. Meanwhile, in early April, the CBS-New York Times poll reported that 57 percent of Americans are "willing to pay higher taxes so that Americans have health insurance they can't lose, no matter what." Granted, the devil is always in the details, but the general mood is unmistakable; as a subsequent the CBS-NYT poll reported, 87 percent of Americans support either "fundamental changes" in the health care system, or prefer to "completely rebuild" the system.
All of which is why the medical, pharmaceutical, and private insurance players have decided (with goading from the Obama administration) that it would be far wiser to position themselves inside the tent. Which is why they showed up at the White House yesterday with a good-faith pledge to lower their own costs by $2 trillion over the next 10 years ($2500 per typical family), clearly hoping (to borrow a Dylan phrase) that this gesture will give them shelter from the storm.
And at the White House event, Obama took full rhetorical advantage. He was in bipartisan mode: "This is a historic day, a watershed event in the long and elusive quest for health care reform...(which will) require all of us coming together, as we are today, around a common purpose - workers, executives, hospitals, nurses, doctors, drug companies, insurance companies, members of Congress. It's the kind of broad coalition, everybody with a seat at the table that I talked about during the campaign." (Obama is following up today with a business roundtable on ways to cut employer health-care costs.)
Obviously, the health care industry is entering the Obama tent with its own best interests in mind. It's a bit vague on how it plans to achieve those voluntary, unenforceable savings (which, after all, could wind up shaving their own profits), and clearly the industry figures that it can best achieve one of its most self-interested goals by working from the inside, as opposed to lobbying from the outside.
That goal, of course, is to topple one of the pillars of health care reform: the creation of a "public option," whereby Americans would have the choice of buying into a public health insurance plan, as an alternative to the plans offered by private insurers. More specifically, those Americans who can't get coverage at work or who can't qualify for Medicaid would be able, under the public option, to buy some health coverage.
All the details of a public option plan would have to be hashed out in the congressional sphere during the summer, but here's the bottom line: Such a plan would create competition for the private health insurance industry. And the industry doesn't want competition.
So the industry will fight that reform as it always has. But it's hard to see how the lobbyists can obstruct as effectively from the inside, with Obama hugging them close. Yes, they're pledging voluntary savings merely to slow the reform momentum. But they're going to look particularly craven a few months from now if they suddenly leave the tent. And it's questionable whether, as outsiders, they would get any traction from crafting a new version of the "Harry and Louise" TV ads that worked so well 15 years ago, in a different political era.
Granted, there was much talk back in the early '90s that the political moment for national health care reform had arrived; in 1991, the editor of the American Medical Association's Journal wrote that such reform had the air of "inevitability." But the health care industry's top players never stood shoulder to shoulder with Bill Clinton at a White House event; they never gave Clinton a golden opportunity to drive a wedge between themselves and their traditional Republican friends. They have done so with Obama. The political optics today contrast sharply with those of 15 years ago.
This hardly means, of course, that substantive reform ultimately will be enacted to everyone's satisfaction; it does mean, however, that the political prospects are brighter than before. And health care industry aside, if you really want an accurate barometer, just check out Arlen Specter.
On TV nine days ago, the new Democratic senator from Pennsylvania said he opposed a public health insurance option that would compete with private insurers. But now, in a letter to a progressive health care group, he says he is open to a public health insurance option, that he looks forward to "discussing and considering" such an option.
Forgive me for rewriting Dylan:
You only need an Arlen to know which way the wind blows.
Comment removed.
I'm comfortable turning far more than 20% over to a liberal government.— HandNik- Comment removed.
- Show me how to pay for it first, then, I am open to universal healthcare. By the way, Obamachev is borrowing 50 cents for every dollar it also spends. That is not a way to run a country. How can the USA afford universal healthcare? By the way, social security is running out of money faster than predicted.— CD75
- If you promise people stuff without telling them the cost of the stuff, of course they want the stuff. Thus, Polman's cherry-picked polls mean nothing.— CD75
- Dick, you say "Such a plan would create competition for the private health insurance industry. And the industry doesn't want competition." But you are being glib with your explanation here. Its not just competition. The industry wouldn't mind fair competition. This is an organization (the government) with an endless supply of borrowed capital (i.e. our tax money). The industry cannot, I repeat, CANNOT compete with that. No public organization can compete with a government controlled entity. They will all fail as the government can undercut all of them, and many people will go for the cheaper healthcare option, unaware of the lack of quality that they will get, and this will essentially destroy any semblance of a competitive capitalistic system, and healthcare will end up 100% controlled by the govt (i.e. socialism, bordering on communism). Why are liberals like yourself either too stupid to realize this, or evil enough to lie about it to the less liberal who would be against this to bulldoze this through without a bit of real legitimate popular support.— pete317
- pete--can't compete with the government? UPS is doing OK last I heard. And the feds have been privatizing every government program in sight for the last 20 years or so--funny how that story is off the media's radar screen. Also--although health insurance companies are "private" entities, they pay very little in the way of taxes for the most part. But the bottom line is, I can't understand a conservative, free-market guy essentially admitting that the government can provide something cheaper than the market. And that's the essence of your argument, casting the insurance companies as victims of "unfair" competition.— liberal
- CD 10:56 post: the text reading software must be on the fritz, since one of Polman's polls did in fact pose higher taxes in return for healthcare. Another sign of serious breakdown; I'd suggest uninstalling and then reinstalling--might help.— liberal
- pete, right you are! Same thing happened when Fannie/Freddie competed with private company's, the GSE's led the whole financial sector over a cliff! Why not have all the private insurance companies compete for all of the govt. business? The govt. could give out percentages of the new business to each of the private companies! That would achieve the desired result of universal healthcare (if that is the desired result & not taking over healthcare entirely), but keep the business in private company hands not in competition with the govt.! Now this is a much better topic Mr. Polman, and you can still get in your partisan shots while we can discuss the topics of the day, a win/win :)— NEPhilly
- This is reminiscent of the first SCHIP bill passed. It was supposed to enroll only children in poverty, but soon escalated to 300% (and in some states 400%) of the poverty level, and many children left the private insurance plans to be enrolled in SCHIP. Therefore, it ended up costing billions more than first envisioned. Polman is also telling a half truth about the public option. Many Democrats (including Obama) want EVERYONE eligible to the public option. The Lewin Group, a health care consulting firm, estimates enrollment in a public option will reach 131 million people if it is open to everyone. Also, Medicare pays about 30% less to providers than private plans...so who would want to be a doctor making that much less money. Lastly, as stated by Jan Schakowsky (D-Calif) the ultimate goal of Obamacare is to put the private health insurers out of business. In other polls, Gallup December 4, 2008, Americans by 49-41% wanted to maintain the current system over a government run system. In the same poll, by 58-39% most people were satisfied with the cost of their health care. As for the polls Polman cited, talk about "framed questions". Of course people are going to favor lowering costs. However, in that same CBS-NYT poll, only 14% said healthcare costs was a top priority for them, only 3% said healthcare costs was the most important ECONOMIC problem facing the country, and in the April 9 CBS-NYT poll, I could not find the quesion mentioned in this post. Perhapd it was in another poll in early April.— tom - wilmington, de
- How can the US afford universal healthcare? This is surely a joke since we're the richest country in the world. And, we already pay more for healthcare per capita than anywhere else. So obviously the problem is a faulty structure of the system, not a need for more money. Just think what you're already paying for health insurance, and realize that you are picking up the cost for a couple of uninsured people either on that tab or on your federal, state and local taxes.— liberal
- Private insurers spend .30 of every dollar on administrative costs, Medicare spends .03 of every dollar on administrative costs. CMS is a well run entity and I would much rather have a government paid beaurocrat make health care decisions for me than a employee of a insurance company whose sole goal is to make money.— chasing history
- It seems to me the best hope large companies like GM, Lockheed, Boeing, Ford etc have is to have a public option that takes the healthcare costs off their books. Imagine how much more capital all the companies above have if they're not locked into paying for retirees' medical care let alone those on the payroll currently. It seems to me that those on the right who continuously say we can't afford universal healthcare are disingenuous at best and outright dissemblers at worst. Imagine the money that can be poured back into R&D and imagine the people who are locked into jobs they hate because of golden handcuffs. There really is a lack of imagination on the right.
- Comment removed.
- Liberal some facts so you realize we are not the wealthist nation in the world nor have we been since Carter. 1. We are the 8th wealthiest country in the world. 2. property values are lowering . 3. We import more than export. 4. We run a federal deficit twice our revenue base (first time in US history this high). 5. We do not make the products people in the world desire. 6. our taxes are increasing taking dollars out of the loop, which decreases the money multiplier and potential income for people. These facts and factors all lead to a poorer America than egos believe. http://www.aneki.com/richest.html— Fisher
Cited by the Columbia Journalism Review as one of the nation's top political reporters, and lauded by the ABC News political website as "one of the finest political journalists of his generation," Dick Polman is a national political columnist at the Philadelphia Inquirer. He is on the full-time faculty at the University of Pennsylvania, as "writer in residence." Dick has been a frequent guest on C-Span, MSNBC, CNN, NPR and the BBC. He covered the 1992, 1996, 2000, and 2004 presidential campaigns.
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