The Health Care Troubles

Having been in the Clinton Health Care War Room, I knew that moments like this would come, times I would describe as "the troubles." Health care is such a massive issue, with so many land mines and pit falls, that the monumental effort to reform it will always run into panic inducing barriers. You just cannot transform 17% of the American economy without goring a lot of people's oxes, and generally ticking off lots of powerful people.

We are officially in that phase. Hospitals, doctors, insurers, powerful Congresspeople and Senators, and all manner of other special interests are screaming bloody murder at one thing or another. Nobody wants to change what matters the most to them, or pay anything more to get health care reform, or have their sacred dollars in the federal budget cut. And the media treats every complaint as an apocalypse, another sure sign that health care reform is doomed.

Well, to steal my favorite line from Desperately Seeking Susan, everyone "should take a Valium like a normal person." What, you thought this would be easy? Based on Clinton experience, this has all been highly predictable kabuki theater:

Step 1: Everyone comes together and professes support of common goals and a commitment to working together and staying at the table. (In the Clinton fight, we launched our health care issue campaign with a media event where about 1500 groups endorsed our goals and outline of our plan. After President Clinton congratulated me on the success of the event, I told him how few of those groups would actually help us when the tough times came.)

Step 2: Proposals and compromises get floated, some push back happens, but the special interests mostly hold their fire because they want to stay at the table.

Step 3: CBO announces that health care reform is going to cost money. Everybody panics, because this had apparently not occurred to them before.

Step 4: The policy teams start firming up decisions, and the cries of anguish and outrage begin.

All of this happened in the Clinton health care fight, and all of it was completely predictable. But there are a lot of differences between this time and that time, including the fact that we are doing this in the 17 months from the next election rather than in the summer and fall of an election year; the fact that Obama has a 67% approval rating instead of Clinton's 40ish% at the time of the 1994 fight; the fact that the head of the Senate Finance Committee is totally engaged and determined to get something passed as opposed to irritated and disinterested as Moynihan was; and most importantly of all, the fact that we only need 50 votes in the Senate this time rather than 60.

I think it's really important in all this to keep some perspective. There are five committee fights and two floor fights before this is all said and done. With President Obama making this his top priority, they are going to be able to negotiate a lot of things out and roll over the road blocks that remain. No single issue complaint, no single special interest has the power to single-handedly stop this thing. The interest groups today who are screaming NIMBY ("health care reform is great, but not in my backyard") will have their 15 minutes of fame in the process, but they can't stop health care reform unless the Democrats themselves lose their nerve. So to my friends on Capitol Hill and in the media: just chill baby, we're in the period of "The Troubles," but we will come through it if everyone keeps their head together and hangs tough.


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http://www.huffingtonpost.com/mike-lux/the-health-care-troubles_b_217311.html