By Caitlin Webber, CQ Staff
January 22, 2008 -- An economic downturn in the United States could threaten access to medical care and serve as the catalyst for comprehensive health care overhaul, predicted an expert during a panel discussion on lessons learned from the 1990s failed health overhaul attempt.
A recession in the economically sensitive American health care system, with market-based treatment costs and employer-provided insurance, would raise the stakes for national overhaul, said Brian Biles, a George Washington University health policy professor and former assistant secretary of Health and Human Services under President Clinton. Biles spoke as part of the forum held Friday by the non-partisan Alliance for Health Reform and Robert Wood Johnson Foundation.
In contrast to the golden economy surrounding 1993–1994 overhaul efforts, Biles said "in the U.S., where health care is employment-based and when people lose jobs they lose health care, with a recession … could come the commitment to do something about it."
The cautious panelists also warned that comprehensive overhaul would also require robust public support and delicate political conditions.
"Health care reform is not done in a vacuum" said Chris Jennings, a senior health care advisor to President Clinton in 1993 and 1994. "It has a lot to do with timing, implementation, and people."
Panelists said health care advocates would face more acute challenges in 2009: costs are higher, partisanship is deeper, media scrutiny is more intense, and access to insurance will have deteriorated since the last comprehensive overhaul attempt failed in 1994. Proponents of changing the health care system would still have to vie with the many stakeholders and myriad interests invested in the health care debate, which plagued overhaul efforts nearly 15 years ago, they said.
"This issue is the one issue in our lives that touches every single thing: tax, spending, welfare…. It is life and death; you have to expect it'll be bloody," said Christine Ferguson, former chief of staff to the late Sen. John H. Chafee, R-R.I., who was a key player in the centrists' effort to create a bipartisan overhaul plan.
Experts said that the overhaul would have to top the congressional agenda and require a singular dedication from the president. Lawmakers should also aim to simplify proposals, allowing details to be resolved after enactment, and propel legislation in the beginning of the congressional session, ideally in the year after the presidential election, when political capital is highest.
"The [Clinton] administration took too long to send legislation to Congress; by January, the clocking was ticking," Biles said. He attributed the Clinton proposal's floundering to "not taking the momentum of the one-year congressional cycle … [and] the failure to use the budget reconciliation process."