Health Reform: The Way Forward

Henry J. Aaron
Henry J. Aaron The Bruce and Virginia MacLaury Chair, Senior Fellow Emeritus - Economic Studies

January 28, 2010

The State of the Union address contained no health reform surprises. But it did display resolve. The message was straightforward: “We will press ahead. We will try to pass reform along the lines of the House and Senate bills. We will support constructive additional ideas. But we will not quit.”

In the aftermath of the Massachusetts political trembler, the White House and many Congressional Democrats seemed almost as shattered psychologically as the Haitians were physically after their catastrophic earthquake. In the State of the Union address, the president needed to communicate resolve and a realistic appraisal of political resources available to effect health reform. And he did. The speech followed statements from Speaker Pelosi and other elected officials indicating that Congressional Democrats are regaining their wits and determination.

The way forward is clear. The Senate should agree to modifications in the plan it passed late last year that would convert that bill into one that would pass the House of Representatives. The House should pass the Senate bill. The Senate and House should both approve the agreed modifications under reconciliation procedures that require a simple majority vote.

This strategy will not be wholly to the liking of members of either house of Congress. Not all provisions of the Senate bill that are objectionable to the health reform supporters in the House can be fixed through reconciliation. Not all of the changes on which House members will insist are to the liking of some Senators who supported initial passage. But no other option for moving ahead offers any plausible chance for success.

This course is risky. Republicans will doubtless complain about use of these procedures and argue that the public is opposed to health reform along lines of the House and Senate bills. The procedural objection is substantively without merit. Coming from Republicans, it is disingenuous. Reconciliation exists to deal with Congressional failure to implement elements of the budget resolution. The 2009 budget resolution called for action on health reform. Effecting those instructions is no abuse. It is just what reconciliation is intended to do. Furthermore, these objections are ridiculous coming from members of the very party that in 2001 abused reconciliation by misrepresenting as temporary tax cuts that were intended to be permanent so that those cuts could be enacted with fewer than 60 votes.

The more serious risk comes from the prevailing public mood of distrust and skepticism about health reform. Public querulousness is real. But the right response is to confront it. For the past year Democrats have argued with each other about provisions of reform legislation. Meanwhile, Republicans have been talking to the public, framing the proposed health reforms through a distorting lens. They have told people that a plan based on providing tens of millions of people with private insurance coverage was a ‘government takeover.’ They have told people that a plan scored as reducing deficits was a budget-buster. They listened passively or actively abetted the mendacious mischaracterization of end-of-life counseling as ‘death panels’ (labeled ‘the lie of the year’ by Politifact). They have told the majority of Americans whose insurance arrangements would not be touched by the proposed legislation that reform threatened their coverage.

Meanwhile Democrats spent the past year arguing with each other. They spent endless hours and passion on whether to include a public option. They fought over whether to have a national or state exchanges. They hashed out various other technical provisions, some of which were important, but all of which were dull and utterly bewildering to all but a few specialists.

Now is the time for Democrats to resume talking to the American voter. They should explain the many genuinely appealing features of health reform legislation. They should make sure that every American understand that reform will prevent insurance companies from cancelling coverage or jacking up premiums for the sick. They should make vivid the millions who will be newly insured. They should make understandable to all the legitimate promise of cost control and the tangible steps to improve quality of care that will result from health reform.

They have taken the hard votes, but failed to explain why those votes are in the interest of their constituents. Democrats have ten months before the mid-term elections to do the job. An effective campaign to sell health reform will take patience, money, and energy. The reasons why health reform is in the national interest will not explain themselves. Republicans will certainly not do the job for them. If Democrats cower before current public opinion polls, they will surely lose heavily come November – and, arguably, they will deserve to lose. If they stand up for the genuinely constructive legislation they have crafted, they will deserve to win and they can prevail.