100 Surprising Days of Health Care

I tend to not put much stock in evaluating a presidency on a hundred-day timeline.  Suffice to say, 1933 was a unique time in American history and comparing any president’s 100-day legislative accomplishments to FDR is about as relevant as comparing the number of books any president has written to Teddy Roosevelt’s record (35, by the way).  Still, this is a good time to reflect on the progress of getting real health care reform done in Washington – and on the top 5 surprises in our national debate so far!

5.)  Single-payer as persona non grata

To be clear, I did not expect good news for advocates of single-payer this year in general.  Obama had consistently said, “Love ya, but no thanks” during the campaign (or, more particularly, “If I was starting from scratch, maybe… but since I’m not…”).  He was always very clear on what was in his health care plan and what was not.  Sen. Baucus released his white paper on health reform, which largely agreed with the Obama plan.  We were told that Ted Kennedy was “working closely” with Baucus.  And the big pre-inauguration shake-up in Congress saw single-payer supporter John Dingell ousted as chair of the Energy and Commerce Committee by Obama-plan supporter Henry Waxman.  So the lay of the land was not good.  Plus, there was always going to be a strong chance that the support for single-payer in the House would erode as it actually became likely the legislators there could do something about it.  It’s easy to say you’re for something when it has no chance of being signed by President Bush, less so when Democrats are in charge.  Consistent support in the House has somewhat been a positive surprise all by itself.

But even I have been taken aback by how needlessly the White House shut out the single-payer perspective in their kickoff events.  To be clear, I’m not at all surprised at it being shut out of Senate hearings or Ted Kennedy’s closed-door sessions – the senators in charged signaled as much early and often.  But Obama specifically ran as the “I will meet with everyone” candidate.  The initial exclusion from the White House Health Summit of any single-payer advocate was unnecessarily insulting and the rush to include someone a rare misstep.

4.)  The “Freaky Friday” switch between House and Senate Republicans

You expect certain things.  The sun rises in the east.  It sets in the west.  And the worst opposition to reform comes from the Senate.  Not this time!  Although there are plenty in the Senate – Mitch McConnell for one – who are taking a more aggressive posture, the most important Republican senators are still being cooperative in working on a comprehensive reform bill.  Sen. Orrin Hatch has been decidedly low-key, which suggests he’s playing well with old friend and legislative partner Ted Kennedy on Health, Education, Labor and Pensions Committee.  Sen. Max Baucus and Sen. Chuck Grassley are practically having a bromance in the Senate Finance Committee.  Sen. Specter is being so accommodating that he switched parties!  The biggest pains in the butt to date haven’t been Republicans – they’ve been Democrats like Sen. Evan “I agree with health care reform but don’t agree we should pay for it, but do agree that we should cut the estate tax for those with over $7 million – that TV camera’s on, right?” Bayh and Sen. Ben Nelson, whose opposition to the public plan is bizarrely more stringent and less logical than most conservatives.

The House instead has been the stronghold of “No, Nay, Never,” forming its own feeble anti-reform group (with lame Web site), talking about how any attempt at better patient care is inevitably a government power grab, and generally being nutty.

This is a surprisingly good thing for reformers, by the way.  Because of the different rules for the House and the Senate, the House’s steadfast opposition is pretty marginalized – as both the stimulus bill and the budget showed, you can have over a dozen Democrats vote against a piece of legislation and still get it passed.  But you have to admit, it’s a big surprise.

3.)  Tom Daschle’s taxes

Coming into the administration, we thought this would be the year of “Tom Daschle, Health Care Superstar.”  As former leader in the Senate and author of an influential book on health reform, he had the perfect pedigree.  He had the West Wing office, he was making online videos and beginning the PR push.  He had a reception in the Senate Finance Committee confirmation hearing that was practically a homecoming.

And then he was out.

Weird.

Daschle was so essential to rolling out health care to the public and the Senate that they actually split his job into two, with Kathleen Sebelius as Secretary of Health and Human Services and Nancy-Ann DeParle as Executive Director of the White House Office of Health Reform.  DeParle has done a serviceable job on PR and, we presume, behind the scenes but isn’t a superstar.  Sebelius has star quality, but only recently got confirmed.  It’s been one of the weirder subplots.

2.)  No united front against health care reform… yet

Look, we were promised fireworks.  The “no to socialism” crowd that was whipped into a fury by Joe the Plumber and Sarah Palin was custom-made to be the street troops who would kill “socialized medicine.”  Somehow they got sidetracked into talking about the tax rates of millionaires, Sarbanes-Oxley, and tea.  What the hell happened?
PhRMA announced in November that they would spend $50 million of ads to defeat Obama’s health care plan, particularly if it went after prescription drug prices.  In short, I was led to believe there would be Montel Williams ads.  Nothing so far.

Granted, WellPoint has already begun moving against health reform, but the rest of America’s insurance industry, if AHIP is to be believed, are still at the negotiating table.  And the task of beating up on health care has fallen to ghosts from the past like Betsy McCaughey, who found previously undetected threats in the stimulus bill – undetected because they’re not there – and Rick Scott, a man who ran the hospital network HCA when it was piling up violations that would cause it to pay a $1.7 billion fraud settlement, whose latest attack ad is so risibly false that it inspired a refutation video by Media Matters.  Suffice to say, these aren’t the folks you want leading the charge if you want any measure of credibility.

It could still happen, and probably will.  All of these forces could come together to push back against part or all of the plan as it’s drafted in Congress.  But the fact that it happened yet, despite the passage of SCHIP, the billions spent on health care in the stimulus bill, and the clear support for health reform in the White House’s budget, is a surprise in and of itself.

1.)  Obama makes it clear he won’t back down

The biggest surprise is the most positive.

The conventional thinking was that there was no way Obama would try to do health care out of the box once the economy melted down in Fall 2008.  And there was no particular reason to think that Obama needed to do health care first.  After all, his campaign promise had only been to sign a universal health care bill into law by the end of his first term, not his beginning.  From what we’ve heard of the scuttlebutt, no less luminaries than Vice President Biden, Larry Summers, even David Axelrod though that Obama should shelve health care until the economy was in better shape.

Obama responded to this by doubling-down.  Not only would heath care get done, it would get done this year.  Not only was it not a distraction from the economy, it was fixing the economy.  Not only was it not pushing off entitlement reform, it was entitlement reform.  Signing SCHIP wasn’t enough.  Health care provisions in the stimulus bill weren’t enough.  Having an unprecedented health reform reserve fund in his budget wasn’t enough.  Having budget reconciliation as an option in case negotiations broke down with Republicans in the Senate – ok, that’s a good start.

As maddeningly vague to some as the president has been on details, he has been rock solid in perhaps the single biggest thing he can do given that Congress will actively be drafting the legislation:  making it clear through the bully pulpit that health care must be a priority and stay a priority until it’s fixed.

Given everything else on our country’s plate – the economy, two wars, now the possibility of a pandemic – health care didn't have to be at the top of our national political agenda.  It’s the welcomest surprise of all.

(Photo credit: uncgspecial on Flickr.)