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Is Slower Better in Health Overhaul Debate?

By John Reichard, CQ HealthBeat Editor

JANUARY 29, 2009 --The conventional wisdom is that Congress must move quickly while President Obama still has political capital if lawmakers are to pass legislation extensively overhauling the nation's health care system. But could the reverse be true—that Congress must move through a very deliberate and necessarily very time-consuming process of sorting through ideas from both sides of the political aisle and from the various stakeholders in the system if legislation is to have any chance whatsoever?

With the notable exception of Rep. Henry A. Waxman, D-Calif., key figures in the debate are increasingly acting as though they believe the latter to be true while giving lip service to the former. Obama's talk-to-both-sides approach to economic stimulus legislation may be laying down a precedent of bipartisan consultation that will be relied upon fully when lawmakers turn to overhauling health care. His administration in effect has already thrown in its lot with that approach in deciding not to rely on "budget reconciliation" as a vehicle for health systems changes, an approach that would have allowed passage of legislation in the Senate with a simple majority rather than requiring 60 votes to break a filibuster.

On Thursday morning, House Majority Leader Steny Hoyer, D-Md., sounded a similar note, saying he is committed to bringing overhaul legislation to the House floor in the 111th Congress while all but saying that would be unlikely to happen before 2010. The buzz preceding his remarks to a Families USA conference was that Hoyer would announce action on health care as soon as Congress is finished with economic stimulus legislation, but he offered little detail on his timetable. Instead, he emphasized the need to take time to build consensus, both in his speech and in comments afterward.

The answer to what an overhaul will look like "is still taking shape, of course," Hoyer told the conference of liberal community activists. "But as House majority leader I promise that I will help members with a wide variety of proposals sort out their differences and settle on a common course," Hoyer said. "Whatever issues arise, the process must take in ideas from both sides of the aisle. All of the interest groups. Patients. Doctors. Hospitals. Insurance companies. All of the stakeholders. We want to take their ideas into consideration."

But Hoyer stressed that "we want to synthesize those and create a consensus so we can have action. As history has demonstrated there's no surer way to lose public support than going through this process in the dark," Hoyer said, referring to the 1993 task force run by then First Lady Hillary Rodham Clinton to develop a health overhaul plan. The task force operated in secret and Clinton was widely blamed for failing to adequately consult lawmakers on the plan. "We want this process to be transparent," Hoyer said. "We want people to know what's going on. Who's suggesting what. And what interests are involved."

Hoyer added that the process must cast a very wide net to include Medicare and Medicaid. "We can no longer afford to think of health reform and entitlement reform as two separate issues," he said.

Asked after his remarks whether in effect health overhaul legislation wouldn't come to the floor before 2010, Hoyer gave a long-winded answer that suggested that might be the case. "Well, we've been dealing with the economic program right now so we've been focused on that. We'll have to get through that, and then we're going to have obviously extensive meetings with the president, with all the members of the committees, the leaders of the committees, to determine how quickly we can move on this."

"But I've talked to the president. The president's conviction is, and mine as well, that it's more important to do this right than to do it quickly. This is a complicated effort that ... is critically important and we want to move in a timely fashion. A timely fashion means that we can create the consensus that gets it done. We saw in '93 and '94 we couldn't do that," Hoyer said, referring to the failed attempt by the Clinton administration to get universal coverage legislation through Congress.

Asked about the views of a number of analysts then that it was a mistake to let the overhaul debate spill over from 1993 into 1994, an election year, Hoyer said, "we want to move as quickly as we can to get it done right."

In his remarks to the conference Iowa Sen. Charles E. Grassley, the top Republican on the Senate Finance Committee, emphasized the need for a deliberate approach. Bipartisanship, he said, doesn't mean getting all Democrats on board and then picking up a couple of Republicans, it means sitting down at the start and building a plan from the ground up with both Republicans and Democrats involved. He said he's begun such a process with Finance Committee Chairman Max Baucus, D-Mont., with meetings that began last November. Grassley said that he and Baucus want an approach that tackles the health system as a whole, an approach that will help bring down the growth rate of Medicare spending, he suggested.

Grassley indicated an openness to overhaul elements such as creating a structure in which consumers are given a menu of plans to pick from and in which those of modest means are given assistance in purchasing coverage. "Anything that helps people understand what they are getting into I think is very, very important," he said. He spoke favorably of some kind of cap on the exclusion of health insurance premiums from taxable income, saying that setting that cap even at as much as $15,000 per year would generate considerable tax revenues while helping to break down health costs fueled by "gold-plated coverage." Grassley indicated that a cap might help knock a few percentage points off annual health spending growth rates of seven percent or so. Hoyer in his remarks also indicated he was receptive to considering tax code changes.

In his remarks to the conference later in the day, Waxman said a bill overhauling the health care system can become law this year. Informed of Hoyer's stated commitment to floor action in this session of Congress rather than this year specifically, Waxman said, "I think he doesn't realize that we can move quickly."

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