Hearts, Minds and Health Care (Guest Voice)

WASHINGTON — The next health care fight has already started. It’s the
battle to define the bill that President Obama will eventually sign as a
victory for consumers, taxpayers and the common good.

You might say this view is premature. Legislation has yet to pass the
House or the Senate, there are differences between the two bodies, and some
moderates still have doubts.

But barring astoundingly self-defeating behavior by Democrats, a
decent bill will get to Obama’s desk. He and his party will then own the
most sweeping reform of the American social safety net since the passage of
Medicare in the 1960s and, arguably, Social Security in the 1930s.

Both parties know this. That’s why much of the rhetoric you’ll hear in
the coming weeks will not really be about whether to pass a bill. It will
be designed to shape how the voters who will decide the 2010 elections –
and, ultimately, the fate of health care reform itself — come to view the
new system.

Republicans will try hard to minimize the benefits that will flow from
the reform and set themselves up to claim that anything bad that happens to
anyone’s health care in the next few years is Obama’s fault. It will be a
bit like those New York City taxi drivers during the late 1960s and early
’70s who despised Mayor John V. Lindsay so much that they were prepared to
blame him for bad weather.

And since most of the changes don’t become effective until 2013, the
next few years will be a time of uncertainties and unknowns. Citizens
typically want to know what’s in this for them, and what they’ll get right now.

That’s why the most important document House Democrats released last
week when they unveiled their bill was a list of 14 benefits that will be
created immediately.

These include insurance reforms to ban lifetime limits on coverage and
an end to “rescissions” under which insurers abruptly nullify patients’
policies after they file claims. One of the most popular reforms in the
bill — barring insurers from denying coverage to those with pre-existing
conditions — doesn’t take effect until later. So the House bill creates an
interim high-risk pool to help those who need coverage in the meantime.

There are also particular benefits for Medicare recipients, including
an immediate reduction in drug costs, and a very popular provision that
would allow parents to keep their children on the family health plan
through age 26.

Especially important are new investments in community health centers
and in efforts to increase the number of primary care doctors. As millions
more people get access to decent care, the system will have to provide more
doctors, nurses and facilities to treat them.

“People will be excited about 2013,” said Rep. George Miller, chairman
of the House Education and Labor Committee, which shares jurisdiction on
the health care bill. “But there are enough benefits between now and then
to keep them engaged and to keep them favorably disposed.”

The key word here is “excited,” and the central task of supporters of
health care reform is to elevate the discussion to the central question at
stake: Will the United States join all the other wealthy democracies in
providing nearly everyone with health insurance? Or will we kick away the
opportunity?

Miller focuses on how much needless anxiety a guarantee of health
insurance will lift from the average family. “Right now, when you lose your
job, you also lose your health care, your ability to send your kid to
college, and sometimes your home,” he says. Knowing that health coverage
will always be there doesn’t solve all those problems but it removes a
heavy burden.

While negotiations between the two houses will be difficult, my hunch
is that they could be less challenging than many are predicting.

For example, the two houses could split their differences on financing
by including a scaled-back version of the Senate’s tax on high-end health
plans while reducing the House’s tax on millionaires. Some of the Senate’s
cost controls could be added while preserving the House’s more generous
approach to coverage. And a public plan will survive because it’s an option
most Americans understand and want.

Above all, the negotiators need to know that if they make the process
look like a very bad day at the sausage factory, they will undermine public
confidence in the outcome. From now on, they are not simply enacting a
bill. They are rolling out a product.

This column is copyrighted and licensed to run on TMV in full. (c) 2009, Washington Post Writers Group