Hitting the Road and Hitting the Fan

Earlier this week, former Labor Secretary Robert Reich described the moment we’re in this way:  “This is it, folks. The concrete is being mixed and about to be poured. And after it's poured and hardens, universal health care will be with us for years to come in whatever form it now takes.”  If the legislative calendar that the Senate and House are publicly calling for is at all accurate, he’s right.  At the end of the next four weeks, give or take, we’ll know what the consensus is in the House and Senate, and what’s still left to be decided.  Gradually, the central question will shift towards whether to support the bill or not, and away from what’s in it.  No wonder both sides are ramping up their outreach to influence what's in it while they still can.

The prime movers today are President Obama and the American Medical Association.  If the AMA represents “the voice of physicians” in the minds of the general public, that’s only because of historical memory.  The physician’s voice is hardly monolithic these days.  Physicians for a National Health Program is one of the strongest groups advocating for a single-payer health care system, and the Health Care for America Now! coalition contains five different national progressive doctors organizations.  Up until now, the AMA has largely kept quiet.  They were part of the group that met with the president promising to find fat to trim in our health care system, but have been a far cry from the organization that single-handedly defeated Roosevelt and Truman’s health care aspirations, JFK’s national push for Medicare, and helped drown the Clinton effort of the 1990s.
It’s been disorienting to say the least.  Today, we’re starting to see the AMA we all know and love.

In an article in the NY Times, they’ve made clear they find the public health insurance option to be a non-starter.  Of course, they’re couching it in the popular “crowd out” argument:  “The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans… [and] the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.”  So few words, and yet so many leaps of logic.  Whether the public plan can dip into taxpayer funds at all is an open question (some, like Sen. Rockefeller in his new proposal, say it should be financed by premiums and subsidies from the Exchange alone - a viewpoint shared by Sen. Schumer and the drafters of the House Tri-Committee principles).  There will be subsidies for those who can’t afford it, but customers who choose private insurance in a National Health Exchange will have access to the exact same subsidies.  Moreover, the argument as always is that private insurance can’t adapt, and that they’re so inefficient that they’ll go out of business.  This is a reason to keep them around?

But of course, the story behind the story, as revealed by Forbes, is that “Doctors and hospitals, which already get paid less by government programs like Medicaid and Medicare than they do by private insurance, do not want a bigger public payer in the market either. That's why the American Medical Association this week came out strongly against it.” Ah yes, those pesky Medicare rates – something the AMA has been complaining about since before Medicare existed.  Cut our compensation, they warn, and you’ll have inferior care.  But the truth is many doctors are making a killing off of Medicare, no matter the complaints.  More to the point, “Two decades of research suggests that the higher spending does not produce better results for patients but may be evidence of inefficiency.”  We’ve seen health care costs explode at double the rate of inflation.  The result hasn’t been that we’re all a lot healthier – it’s that millions more of our fellow citizens are uninsured or underinsured.

But today is also the first of President Obama’s many public appearances on the road in support of passing a real health care reform bill this year, with a town hall event in Wisconsin.  Yesterday, Organizing for America, the heirs to the Obama presidential campaign, launched their health care Web hub, with content and tools very familiar from the general election.  For weeks, Obama has kept health care in the headlines even as Congress worked on the details.  Now he takes the show on the road.

These two forces are set to collide Monday – when Obama addresses the AMA directly.  On the campaign trail, candidate Obama took a number of opportunities to prove that he had the character to tell people what they needed to know, not what they wanted to here.  Telling Detroit executives that they needed to stop blocking progress on improving car emission standards wasn’t popular; neither was talking about a more equitable economy in front of Wall Street executives.  Will he have any trouble once again reiterating a strong belief in the public health insurance option?

So to sum up a wild week, there’s a bill in the Senate HELP Committee, hearings and debate in the House, and furious Twittering in Senate Finance.  Conservatives are in lock-step with Frank Luntz, decrying the influence of a “Washington takeover” of health care – a takeover, incidentally, that would keep all of the delivery system and the majority of the financing private.  Big Insurance, Big Pharma, and the AMA are all taking solid aim against the public health insurance option and, more particularly, the threat of a shrinking profit margin.  And finally, a popular president is taking to the road to drum up a popular movement to get health care legislation across the finish line.

Health care doesn’t look like “Kumbaya” anymore.  It looks like war.

(Disclaimer:  I have no relationship with the AMA whatsoever, and views expressed are entirely my own.  They do not reflect the views of any employer, past or present.)