The early headlines have been all about the President's efforts to repair the financial system and jump-start the economy. If he succeeds, he probably will be re-elected. But Barack Obama's place in history will be determined by the long-term structural changes he initiates, and his most important legacy battle is just beginning as Congress tackles the holy grail of modern liberalism, a universal health-care system.
---"The Fire This Time: Is This Health Care's Moment?" Joe Klein, Time (5.07.09)
Time columnist Joe Klein focuses the political spotlight on the backstage Obama initiative that will likely be the measure of his social policy legacy. And, along with his management of the economic crisis, foreign policy and foreign conflicts, too, it will be a determinant of his place in history. That initiative for national healthcare reform and universal access is now moving forward. And Obama, understanding full well the opportunity and the stakes, the previous failures, and the political minefield he must negotiate, has employed a patient, careful, and pragmatic approach to the legislative challenge. Klein, on where we are:
In the 2008 campaign, Obama and Clinton worked overtime to assure voters that if they liked their current health-care coverage, they could keep it — that is, the system would remain a private one, presided over by a more strictly regulated insurance industry. And in the months since the election, the insurers have indicated that they will play ball: they've said they will cover everyone, at the same rate, regardless of pre-existing condition. (There are caveats: the details of health insurance are devilish, and pitched battles are fought over arcana too obscure to cover in this space.) But more-liberal Democrats have decided to press the issue. They have proposed a "public" health-insurance option, similar to Medicare. They argue, correctly, that the profits made by insurance companies are a good part of what makes health care so expensive in the U.S. and that a public option is needed to keep the insurers honest. Needless to say, the insurers are vehemently opposed to this and will unleash a torrent of negative advertising and lobbying power if the final bill includes it.
So, now there must be fashioned practical, cost effective program priciples and decision making citeria. The critical economic and societal trade-offs must be wisely, bravely settled upon in setting rules governing what is covered under what conditions. The devil, as they say, is in the details, and the program rules, as well as the principles, must assure a fair, cost-effective health services program. Klein, on next steps:
But the question of whether the government can decide which health-care treatments are appropriate is central to whether an affordable universal system can be devised. Part of the answer is implicit in the electronic medical-records system that Obama has proposed: it will be easier to determine which treatments are cheaper and more effective. The other part of the answer involves an essential change in Medicare, from fee-for-service to a managed-care system that decides whether a hip replacement is necessary for a terminal cancer patient.
But in the end, it is about how well the issue is set up politically, how much negotiating room is created and preserved, and how pragmatically, effectively, a workable program can then be moved to "yes." Klein, on a likely end-game:
My guess is that the public option is a bargaining chip that will be cashed in to gain support from moderate Republicans and Democrats as crunch time approaches. The real battle, and the fate of this liberal dream, will be fought over what gets covered and who decides.
http://www.time.com/time/politics/article/0,8599,1896574,00.html
No comments:
Post a Comment