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Report: Obama Should Act Quickly on Health Overhaul

By Derek Wallbank, CQ Staff

January 26, 2009 -- President Obama should act quickly if he hopes to pass wide-scale changes to the health care system, said two health care experts, whose suggestion is one of eight pieces of advice on enacting health overhaul published in a new edition of Health Affairs.

"Every day we wait we lose another opportunity," said Jim Cooper, D-Tenn., who co-authored along with Michael N. Castle, R-Del., one in a series of eight articles published in a new edition of Health Affairs.

Support for President Clinton's attempt at a large scale health overhaul started strong, at 59 percent in September 1993, before nose-diving to 43 percent in April 1994, according to Gallup polls taken at the time. Opposition rose over the same period from 33 percent to 47 percent.

Part of the problem, Castle said in an interview, is that the Clinton plan was hard to understand, publicly spearheaded by a relatively unpopular first lady and one that could never marshal the broad support necessary to pass, thanks in part to withering attacks from the health care industry.

In contrast, he said, any effort now must be led personally by Obama, whose initial approval rating was pegged by Gallup at 68 percent, the highest initial approval rating since President Kennedy's 72 percent in 1961. A health care overhaul plan also should be simple to explain and appeal to lawmakers on both sides of the aisle. The sour economy could help stem any potential backlash from industry, Castle added, as businesses may be more focused on shedding their own health care costs to save money.

Intel Corp. Chairman Craig Barrett and Peter Lee, executive director for national health policy at Pacific Business Group on Health, agreed the high cost of health care is "putting American business at a competitive disadvantage."

"President-elect Obama will find a willing partner in corporate America if he reaches out in ways that recognize that solutions must put the patient at the center of our health care system and also drive efficiencies to allow U.S. companies to compete globally," wrote Barrett and Lee in another article in the series.

A jumping-off point, wrote Cooper and Castle, could come in the form of legislation similar to a measure introduced in 2007 by Oregon Democratic Sen. Ron Wyden.

Under Wyden's legislation consumers would choose their health insurance coverage from a pool of plans. Employers could either continue to offer health coverage or transfer money they now spend on employee health insurance to workers' wages. While people would be required to hold some form of insurance coverage, the government would pay to cover the poorest Americans.

"This may not be a perfect bill, but it's a good start," Castle said.

Wyden spokeswoman Mary Conley said the legislation will be reintroduced in the 111th Congress.

In a third article, Stanford University Professor Victor Fuchs said other options with a chance of success include government-backed health care vouchers, the Massachusetts system of combining coverage mandates with subsidies or simply expanding Medicare eligibility to all—an option favored by liberal stalwart and filmmaker Michael Moore in his documentary "SiCKO."

Fuchs said Obama and his allies could succeed if they settle on and fully support one proposal, rather than try and construct the perfect policy through endless attempts at compromise—a tactic that helped kill Clinton's health care initiative.

"Anything that substantially changes 16 percent of U.S. gross domestic product will necessarily be complex," Fuchs wrote. "It is easy to disagree about the details of any plan. Failure because of such disagreements is always the easiest course, as the 90-year history of health reform has demonstrated."

Henry Aaron, senior fellow at the Brookings Institution, said trying to change everything all at once is a mistake.

"It's not typical of democracies to transform something the size of all of France through a single piece of legislation, or even through multiple laws during a single presidency," Aaron wrote in his article. "This is true particularly in the United States, because our political system is well calibrated to frustrate action on large matters that are not supported by overwhelming majorities."

Instead of what he called an "overreaching" attempt at policy change, Aaron said Obama should start by creating a national clearinghouse for health insurance, funding state efforts to expand coverage, improving health information technology and expanding cost-effectiveness analysis.

"It isn't completing the reform process that's the triumph, it's getting it underway," Aaron said in an interview.

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