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The campaign for health care reform is making a lot of people nervous. Every day the media is reporting on a crippling blow President Barack Obama’s reform effort has suffered or on the inevitability of passage. It’s like watching an episode of 24 or Lost  – every episode (or news cycle, as the case may be) a new cliff hanger. The television shows are obviously fictional. The drama of the health care reform debate is, at times, equally manufactured. And even when the situation is real, the situation is neither definitive nor long lasting.

However you get your news, the situation is pretty much the same. Every news cycle there’s some make-or-break event that requires breathless analysis. The reality is not every meeting, vote or comment is of momentous importance. It may be interesting. It may be informative. But it momentous events are few and far between. Which poses a problem for the media because they live or die on excitement.

The reason is that the need of the media to capture attention of a large audience outweighs its sincere desire to educate and/or influence that audience. The news media is a business. Like all businesses (even non-profits) it must generate revenue. For the media this means selling advertisements.  Most reporters and pundits have a want to educate and inform. Some seek merely to entertain or inflame. All of them, however, have a need to bring an audience to their advertisers. This means the stories they put forward need to excite their audiences enough so they can be exposed to the advertising that creates the revenue the media owners expect. (In this admittedly cynical view, the reporters and pundits are the equivalent of the brokers – it all begins with a sale).

In-depth stories examining the subtleties of a complicated issue like health care reform are not very exciting to a broad audience. Further, most reporters and pundits lack the expertise to examine the subtleties of health care reform. That’s not a put down as it’s not their fault. They need to be generalists and understanding health care requires specialized knowledge. Even those who truly understand the intricacies of the issue face a serious problem, especially on television: the need to break for commercials every few minutes. It’s tough to maintain a narrative when your presentation is constantly being interrupted to sell cars, prescription drugs or cleansers.

What does excite people is conflict. Which is why the media loves a good fight. Conflict requires good guys and bad guys, winners and losers. So instead of exploring the nuances of how a health insurance exchange might work (or what challenges it may face) or how the governments Medicare and Medicaid reimbursement policies increases the cost of private health insurance, the press focuses on the political maneuvering of the day. Broad statements by lawmakers go unchallenged because there’s simply not enough time (or expertise ) to challenge them. Instead, the best sound bites of the day are played and discussed in an echo chamber designed to amplify any conflict – or to create conflict where none exists.

I don’t blame the press. They have a job to do and, as I mentioned, most have a sincere desire to inform their audience as much as is possible given the restraints of their business. I do feel sorry for their audience. They can’t help but perceive the health care reform debate as a pitched battle between the forces of Light and Darkness with ultimate victory or defeat at risk each day. In short, they are exposed on a regular basis to a heightened version of reality intended to cause enough fear, relief, frustration, and elation to keep them paying attention through the commercials.

So, for example, President Barack Obama wanted each chamber of Congress to pass a bill so the two versions of reforms could be reconciled into a single bill and voted upon in the Fall. The Senate will not meet this deadline (the House probably won’t either, but they may). For the media this is great. Everyone understands due dates. Congress missed theirs so health care reform is in deep trouble and the President lost a major political battle.

Well, not quite. There’s still plenty of time to complete health care reform this year. And while the President may have missed a deadline, at the end of the day he will be judged by whether the status quo endures or not. It’s like owning stock. The price of the stock you own may change every day, but the only thing that matters is the price on the day you sell it. But the media can’t let this be known so every day’s stock price is of paramount importance..

Another example: three Congressional Committees have moved health care reform bills forward (an important milestone). Two Congressional Committees are still refining their proposals. Which ones are the most important? Given the hyperbole and attention showered on the versions that have already made it through a committee you’d be forgiven for assuming it’s the former. The odds are, however, that what emerges from the Senate Finance Committee and the House Energy and Commerce Committee are going to more closely reflect the final legislative package than anything already voted upon. The reason is that these committees are seeking to gain the support of moderates (both Democrats and Republicans) and those moderates are critical for passage.

Consider: Democrats have 60 votes in the Senate, but 18 of those are moderates. Without the support of at least eight of those moderates nothing passes in the Senate. (And this assumes only 50 votes will be needed. If 60 votes are required to move health care reform legislation through the Senate, which is more likely, then every one of those moderates needs to be brought on board).

In the House, Democrats will soon hold a 257-178 member majority (there’s one vacancy, so there are only 256 Democrats in the House today). It takes 218 votes to pass anything through the House. Without Republican support, the House Leadership can only afford to lose 39 members of their caucus. The moderate Blue Dog Coalition has at least 52 members. Do the math.

What all this means is that we have yet to see the two most meaningful health care reform bills yet. Which makes much of what’s being reported lately exciting, but ultimately, not as important as the media would have us believe. The day-to-day tumult is not what matters. Health care reform will be determined by the forces and dynamics that are not easy to explain. And they certainly don’t fit within commercials.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics Tagged: Blue Dog Coalition, House Energy and Commerce Committee, media, Senate Finance Committee

The reality is that Congress will miss President Barack Obama’s August deadline for health care reform. The Administration had wanted each Chamber to pass a bill before Congress recesses in early-August. Members of a Conference Committee would then spend the recess working through differences between the bills and Congress would be in a position to send legislation to the President’s desk in October. That was the plan.

Now there is a strong likelihood Congress will be unable to pass out a bill before the summer recess. Part of the reason is that moderate and conservative Democrats are balking at the price tag for reform and some of the provisions being pushed by their more liberal colleagues. At the same time, the Senate Finance Committee and its Chair, Senator Max Baucus, has not given up on fashioning a bi-partisan bill, no mean feat on legislation as complicated as health care reform.

What this means is that lawmakers will return home in August with numerous questions concerning health care reform unanswered. They will hold town hall meetings, listen to constituents, and return in September to make the final effort to reform America’s health care system. While this will push the work of the Conference Committee back by a few weeks, it does not mean the President’s real deadline – signing a bill into law this year — will be missed. It just means the Conference Committee will have a bit less time to do their work.  (A short civics lesson: a Conference Committee is an ad hoc working group comprised of both Senators and Representatives from both parties whose job it is to reconcile bills on the same topic passed by the Senate and House. Their compromise bill, if approved by both Chambers, is then sent to the President for his signature or veto).

The summer recess will hardly be relaxing for most members of Congress. While home they will be confronted on a daily basis passionate advocates on all sides of all the many issues tied to health care reform. Cost containment, universal coverage, preventive care, taxes, mandates and more will be part of their daily diet. Whether the cumulative effect of this stew of meetings, confrontations and discussions will be to encourage a more progressive or a more moderate approach to reform is an open question. Certainly millions of dollars will be spent by interest groups of all political persuasions, especially in the districts and states of moderate Democrats. The 24-hour cable news networks will be so inundated with health care reform advertising next month they may have no room for their regular fare of prescription drug, debt relief and Vonage commercials.

While the deadline is being missed, what elements are likely to be included in the reform package is becoming clearer. It is all but certain, for example, that an exchange will be created with the intention of helping consumers shop for health insurance will be created (although the nature of this exchange is still to be determined). There is also, surprisingly, a growing consensus on requiring every American to have health insurance. As reported by the Washington Post, the idea of an individual mandate “Is one of the few common threads running through all three bills being considered in Congress, greatly increasing the likelihood it will survive the legislative process.” Given that another virtual certainty is that carriers will be obliged to accept all applications for coverage without regard to pre-existing conditions, this is a good thing. States in which there is a mandate to sell coverage, but not one to buy it, premiums sky rocket. In New York and New Jersey, where this imbalance exists, average premiums for individual coverage are more than twice as high as they are in California which has neither mandate.

Not everyone supports a balanced approach to guaranteed issue. Many Republicans oppose the concept of requiring individuals to buy health insurance. One Republican proposal, The Patients’ Choice Act, introduced by two Senators and two Representatives, all self-proclaimed conservatives, emulates the New York and New Jersey model. Meanwhile some Democrats are concerned subsidies to help low income Americans afford the premiums they’d be required to pay will be inadequate. Nonetheless, as the Washington Post article explains, support for the concept is widespread.

Even President Obama, who opposed the mandate to purchase idea during the campaign has come around as long as there are exemptions for those who simply cannot afford the premiums: “I was opposed to this idea because my general attitude was, the reason people don’t have health insurance is not because they don’t want it, but because they can’t afford it. And if you make it affordable, then they will come,” he said in a recent interview with CBS. “I’ve been persuaded that there are enough young, uninsured people who are cheap to cover, but are opting out. To make sure that those folks are part of the overall pool is the best way to make sure that all of our premiums go down.”

So yes, Congress will miss the August deadline for passing health care reform. At the same time, critical elements of what will eventually emerge in the reforms are becoming increasingly clear. The only deadline that really matters is passing legislation before the silly season of mid-term elections arrives. And that’s a target date Congress is likely to meet.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics Tagged: Max Baucus, Patients' Choice Act, Senate Finance Committee

Health care in America is complicated, pervasive and critical. There’s a lot that works well in the current system. There is much that needs to be fixed. Getting health care reform right will take patience, determination and constructive debate. That’s why it makes sense to worry less about deadlines and more about getting reform right.

Moderate Democrats and others have been driving this point home and President Barack Obama statement’s were beginning to recognize Congress was unlikely to meet his August deadline for passing health care reform legislation. (He continued to push for enactment this year, but seemed more open to a vote in the Fall).

Enter South Carolina Senator Jim DeMint. Speaking on a conference call organized by Conservatives for Patients Rights, Ben Smith on Politico.com reports Senator DeMint as saying if Republicans can “hold [health care reform] back until we go home for a month’s break in August … Senators and Congressman will come back in September afraid to vote against the American people.” This may or may not be true, but it’s certainly a reasonable political analysis. However, the Senator then went on to say,  “If we’re able to stop Obama on this it will be his Waterloo. It will break him.”

And thus Senator DeMint undermines the efforts of responsible lawmakers to pass thoughtful health care reform legislation. Senator DeMint did not offer public policy differences with President Obama. He cast the issue as purely political. It was the essence of the “just say no” “I hope Obama fails” foolishness that Republicans spout from time-to-time. It’s the my ideology right or wrong philosophy that has made the GOP party a distinct minority in Congress. It makes the health care reform issue all about President Obama.

Regardless of whether you agree with Senator DeMint’s opposition to President Obama or not, this is inept politics. It undermines substantive reasons for taking more time to refine the health care reform package. Worse, it gives the Administration an opportunity for changing the topic and potent ammunition for calling for fast passage. Which is exactly what’s happened. Newsweek describes the scene: President Obama is speaking at a Children’s hospital. After quoting Senator DeMint’s remarks, he proclaims, “Think about that. This isn’t about me. this isn’t about politics. This is about a health care system that is breaking America’s families, breaking America’s businesses and breaking America’s economy. And we can’t afford the politics of delay and defeat when it comes to health care, not this time, not now.” In other words, on “their” side is the party of “no,” on your side, my fellow Americans, is me.

The Administration wants nothing more than to cast his health care reform effort as a battle against obstructionist conservatives. You may have noted that conservatives got pounded in the last election. They make ideal targets. Making Senator DeMint the face of the GOP anti-health care reform efforts is a gift to the White House. Even Senator DeMint realizes this. “Let’s be clear, there is no one in this debate advocating that we do nothing despite the president’s constant straw man arguments,” the Senator said yesterday. And he’s right, the Administration is using his remarks to create a straw man, an easy target to knock down. The reality is what Senator DeMint says to a group of conservatives who already agrees with him doesn’t really mean much. He was preaching to the choir. But when his language was given a wider audience, it was easily exploited.

Senator DeMint said today that “Republican have offered comprehensive health care reform solutions ….” Technically that’s true, but what the GOP has put forward is as misguided in their own way as any element of the Democrat’s proposals.

What’s needed, but won’t happen, is for everyone to take a deep breath and calm down. It will take 60 votes in the Senate to pass health care reform – President Obama knows this, the Congressional Leadership knows this and so do the pundits. There are not 60 liberals in the U.S. Senate. Nor are there 40 conservatives. The political reality is the reforms that emerge will reflect the views of the moderates that can provide the necessary votes. This doesn’t mean the reforms will be wise, but it probably means they will be less than extreme.

The Senate Finance Committee’s proposal will come the closest to reflecting this moderate approach to reform. They need more time to get their bill together and we should give it to them. In the meantime, let’s recognize that health care reform is too important an issue to play with solely to embarrass a political opponent. Doing so only makes the job harder.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics Tagged: Jim DeMint, Senate Finance Committee