Remembering The Uninsured

Tomorrow there will be a health care summit at the White House. Many stakeholders - though pointedly, no one from the single-payer community - will be getting together to lay out their take on the plans for sweeping health care reform. It is a direct opposite approach to the one took by the Clinton health care team in 1993-94.

Critics, including Democrats, lambasted Clinton and then-first lady Hillary Rodham Clinton for not adequately including Congress, interest groups and the public in their administration’s planning on healthcare. Clinton, these critics say, also waited too long to begin his push on reform, which started in the latter part of his first year in office.

Obama is trying to show he’s learned from those mistakes, and the summit is a part of that effort.

“The summit is an excellent way to really start this process in a participatory manner,” said Ron Pollack, executive director of the liberal healthcare advocacy group Families USA. “It’s obviously not the be-all and end-all,” however, he stressed. “It’s not the place where the important decisions will be made.”

That is an important last point. We don't yet know the final form that this will take. What we are learning is the sales pitch has changed, from one concerned with insuring everybody to one concerned with making health care better for even those who have insurance.

The "appeal" of this push, (Nancy Pelosi) said, will not be that 48 million people don't have health care insurance. "What is important to the bigger population," she explained, "is their own health care." She noted that with health care costs rising faster than any other costs, the key issues these days are the impact of these increasing costs on the economy, on the quality of the care delivered, and on federal entitlements (meaning the costs of Medicare and Medicaid).

Pelosi was signaling how congressional Democrats will be selling their drive for health care reform. She said that the package will focus on science and technology and include major investments in biomedical research, preventative health care, and electronic medical records. She noted that when technological improvements in maintaining medical records render it easy for health care providers to compare the medical treatment of a low-income person with a certain disease with a wealthy person with the same illness, both patients will benefit. That is, the more patients in the information pool, the better for all, including those who already have coverage.

So health care reform will be pitched not primarily as a benefit (or handout) for the uninsured, but as a way to deliver higher quality health care at a lower cost with fewer errors to those who posses some degree of coverage, especially those in the anxious middle class.

This is of course not going to be enough to hold off the pack of conservative dogs, who have been fighting for decades to block health care reform, because it would provide something tangible to the public and create a lasting social contract between Democrats and the electorate. So there will still be yipping about flawed polls "proving" that Americans don't want health care reform. There will still be misleading smear campaigns run by the same PR group that promoted the Swift Boat Veterans For Truth, and fronted by a sleazeball former hospital CEO who once defrauded the government for $1.7 billion dollars.

So we should assess the relative efficacy of this new Democratic health care message on how it will bring in voters, not back off conservatives. Focusing on the broader pool of insured instead of just the uninsured makes sense until you recognize that 87 million people were uninsured at some point in the past two years, which is nearly 1 in 3 Americans. I'm not sure the pool is all that bigger. The pool of LIKELY VOTERS is much bigger, and so you have to look at what those insured voters want. And clearly the main thing would be cost control. Private sector growth in health care spending is soaring, even faster than public spending (Medicare, Medicaid, the VA, etc.). This is a major strain on family budgets, and it's not just an entitlement issue, as much as the Beltway wants to pigeonhole it:

For all that people talk about unaccountable government bureaucrats, there are actually a lot of econ majors holed up in small offices deep within unknown agencies tasked with producing scary graphs showing how much money the taxpayer is spending. When the federal fiscal path is unsustainable, we know about it. That's less true in the private sector, where no particular body is charged with putting GDP on the Y axis and doom on the X axis. But what the country can't afford in taxes it also can't afford in premiums. You often hear it said that we can't fix Medicare and Medicaid without fixing the health system, and that's true. But even if we could, health costs would still bankrupt the country. They'd do it by collapsing businesses and households rather than the budget, but they'd do it.

How are we going to get these cost controls? One way is universality, because the uninsured cost both the government and individuals hundreds of billions in a "hidden tax" that shows up in public assistance and insurance premiums. Another way is increasing access to primary care facilities and community health centers so preventive steps can be taken before bigger and costlier problems arise. Another is health IT. And promoting generic drugs. And comparative effectiveness research that will hopefully get rid of wasteful, expensive and ineffective treatments. And guaranteed issue and community rating to keep insurers from pocketing too much excess. And a public option so that they have to compete on price and quality.

All of these things are a small part of the pie, but they add up. But quite a bit of them have to do with the uninsured. Not to mention the fact that it's a moral scandal to have 87 million Americans without access to health care at some point over a two-year period. So I wouldn't be so cavalier in rejecting the needs of the uninsured, even in the rhetorical setting of the policy. It's a talking point that still has the ability to resonate.