Obligatory health care post

When I worked in the Clinton correspondence office, one of my issue areas was health reform. This was back in 1994, the really ugly year. I spent a lot of time trying to learn the details of the Clinton plan and to understand congressional committee procedures. I dealt with a lot of very critical letters. Some were from insurers and medical practitioners, worried that certain procedures wouldn't be covered or that their businesses were going to suffer. Some were from conservative ideologues who were convinced that, should Clinton's plan pass, visiting an American doctor was going to become like obtaining toilet paper under Brezhnev or living in a gulag under Stalin or playing dreidel under Hitler. Just about every day, of course, we had C-SPAN on in the office, and I heard congressional statements morph from "We will have health reform this year" to "The President's health care bill is deader than Elvis."

All this is to say that I've seen this movie before, and I didn't like the ending.

If you haven't read it, Ezra Klein's piece comparing the Obama and Clinton health reform efforts is really fascinating. He notes that Clinton was criticized for crafting the whole reform himself and not letting Congress figure it out, while Obama is being criticized for leaving it all up to Congress and not giving supporters something specific to rally around. He also notes that the Clinton plan was probably a lot more ambitious than anything Obama's pushing for today. It actually saw the way health care was going in this country and sought to create some workable rules:

The managed-care revolution of the mid-90s was, by the early years of that decade, clearly inevitable; the financing and delivery of health care could not remain separate forever. But this was a dangerous change. Insurers make money by denying claims. Money they spend on health care is money they lose (they even have a name for it: the "medical-loss ratio"). Private insurance is a bit like a fire department that turns a profit by letting buildings burn down.

So Clinton sought to cage managed care inside managed competition, which would regulate the behavior of insurers and force them to compete for patients. This would give consumers more power against their insurance companies, drive the bad actors from the market and generally protect against the excesses of managed care. Clinton's plan also included a handful of other safeguards, like out-of-pocket caps and an independent appeals process, designed to protect consumers from deficient insurance.

But Clinton's opponents sought to defeat the plan, raising fears that care would be rationed and costs would go up and that consumers would have less choice. This, of course, is exactly what happened, except that Clinton's plan didn't pass.

Now the same fears are being raised today. I have to say that the hostility makes me a bit sick. Of course, I have no problem with heated, polarized debate, but this is nothing of the sort. This is trying to whip people into a frenzy by scaring them to death without actually informing them of anything substantive. Here's the text of an e-mail I received from the Colorado GOP the other day:

Republican Call to Action – Help defeat Obamacare!

Four important things you can do to help:

1.) Call and email your member of Congress and let them know you oppose this legislation
2.) Write a letter to the editor
3.) Forward this email to your friends and family
4.) Participate in one of the “Hands off my Healthcare” rallies taking place throughout the state Thursday, August 6th – Friday, August 8th. Please see schedule below:

The Patients First bus “Hands off my Healthcare” tour will be coming to Colorado this Thursday, August 6th , Friday, August 7th and Saturday August 8th for a rally against a government takeover of your healthcare. Nearly 2,000 Coloradans have already rallied in Denver and Colorado Springs against Washington’s plans to dictate our health care choices. Now the rest of Colorado gets their chance for their voices to be heard.

What exactly are they protesting? There are several plans being considered by Congress right now. What does the Colorado GOP object to? Expanding health insurance? Creating more competition among insurers? We don't know.

At this point, only two factors give me any confidence that some version of health reform will pass this year:

1. The Democrats have (at least nominally) 60 votes in the Senate, which they did not have in 1993-94.
2. The Democrats remember how the failure of health care contributed to their loss of control of both chambers of Congress in 1994, and they do not want to repeat that.

Sorry for the rant.