Prescription for Healthcare Reform

Elizabeth Roberts Health Guide
  • Call me a skeptic, or a cynic if you prefer, but when it comes to health care reform I'm not deciding who I'll give my vote to based on campaign promises. Promises come easy, especially to politicians who have no on-the-job experience trying to get 100 Senators and 435 Members of Congress to overcome the resistance from 50,000 registered lobbyists and billions of dollars in vested corporate interests to bring about real change. As a small business owner, I pay for 100% of my own health insurance. Since 2001, I've listened hopefully while the Republican majority in Congress and the White House pledged to make it easier for small business owners to pool together to buy health insurance, a much-needed reform that would put small business on a level playing field with large employers in purchasing affordable group plans. But in six years of GOP control of the House and Senate and White House, somehow it never got done. Why? Too low a priority? Lack of political will? Too difficult to get passed? Bush himself promised it in his State of the Union address, but still nothing happened.

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    Not that I doubt Senator Obama's or Senator McCain's sincerity when it comes to health care reform. They both mean well, I'm sure. But neither man really has a track record of getting big things done in Washington. Maybe that's not fair to McCain. He did get the McCain-Feingold campaign finance reform legislation passed, over the opposition of most of the Republican Party and many Democrats. But he just doesn't display the passion and drive that would convince me health care reform is really one of his presidential priorities. So he won't arrive in office with health care reform as part of his mandate, and without a mandate, it won't be part of the top-priority legislation he'll send to Congress in the honeymoon period, those magic first one hundred days in office when first-term presidents get done most of what they'll be able to get done before they have to gear up and run for reelection.


    So I ask myself, what about Obama? His website has a fairly comprehensive plan of health care reform, even if his campaign slogans and stump speeches rarely descend from the Olympian heights of overheated, somewhat hyperbolic rhetoric to get into the nitty-gritty details. But that's okay. Obama inspires, and we all need some inspiration to renew our faith that maybe there really are leaders who aren't ordinary politicians.


    It's going to take a politician to get health care reform passed by Congress. And not just an ordinary one, an extraordinary one. One who knows how to wheedle and deal and muscle and strong-arm and horse trade to get enough votes to clear all the legislative hurdles, from committee mark-up to floor passage to reconciliation to budget authorization to - the really nitty-gritty, budget appropriations. Pardon me for getting technical, but I worked in Washington for seven years, so I have an inside view of how the town works, and doesn't work.


    Doe-eyed newcomers get a quick education in D.C. It takes more than the ability to deliver an inspiring speech to accomplish anything. It takes real skills in coalition-building. The signature bill of Ronald Reagan's first one hundred days, his centerpiece tax and budget cuts, only passed the Senate because he was willing to horse-trade sugar subsidies for a few Southern senators' votes. Despite Reagan's clear ability to inspire, political victory came down to a willingness to swap subsidies of the kind he detested for passage of his legislation.


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    The German politician Otto Van Bismarck said that anyone who likes legislation or sausage shouldn't watch either being made. The process is messy and unappetizing. It isn't for starry-eyed idealists. It isn't for newbies. And it certainly isn't an on-the-job training kind of thing.


    That's why I favor Hillary when it comes to health care. Sure, I don't like every detail in her plan (or Obama's or McCain's either) but I'm not sweating that because in the give-and-take of legislative compromise, not one of their plans will be enacted 100% whole. There will be plenty of opportunities to grind away any rough edges. The reason I favor Hillary is that she has learned from her previous failure at getting health care reform, and she's actually thought through - in detail-how to get it done this time. Moreover, she means it when she says it's a priority.


    If she wins, her first 100 day honeymoon legislative package will have health care reform front and center. And she'll have a clear mandate from the voters because she's featured health care as the centerpiece of her candidacy. The same simply doesn't apply to Obama or McCain. Change is a slogan, not a legislative program, and McCain is just more of the status quo. If the Republicans were serious about health care reform, they'd have done more during the six years when they controlled the Congress and the presidency.


    As far as I can see, Hillary Clinton has the prescription for reform.
Published On: February 20, 2008