Wednesday, November 5, 2008

The 2008 election and health care reform

There is one word in my mind that best describes the 2008 election: extraordinary.

And, I say this from a purely non-partisan standpoint. Whether one voted for Senator Obama or Senator McCain, it is undeniable that the outcome of this election is extraordinary.

That the voters elected the first African American to the Presidency of the United States is in itself an extraordinary occurrence. I will leave it to others more eloquent than me to describe what this means for the country.

Instead, I will focus on the extraordinary re-alignment of political power in Washington created by this election, and what it may mean for health care.

President-elect Barack Obama is the first Democrat to get more than 50% of the vote since Jimmy Carter. He scored the biggest Electoral College victory since Bill Clinton in 1996. He won in parts of the country - the South, the Midwest, and the Mountain states - that in the past two presidential elections were out of reach for Democratic candidates. He is the first Senator to be elected President since John F. Kennedy.

He has the political fortune of being able to work with a Congress where both chambers are controlled by his own political party. When all the votes are counted, it looks like the Democrats will gain another 20 or so seats in the House of Representatives, and another 5 to 7 seats in the Senate, leaving them just a few votes short of the 60 votes needed to overcome Senate filibusters. President Bill Clinton had similar congressional majorities in his first two years, but came to office with the decided disadvantage of having won only a plurality (43%) of the total votes cast in the election.

Few presidents have had as great an opportunity to shape the nation's politics, priorities, and policies at a time when the country is facing so many crises, both domestically and abroad.

One priority will be health care reform. Health care reform is the holy grail of the Democrats. From Harry Truman to Bill Clinton, Democratic presidents have sought to achieve universal coverage, only to find the politics and policies too difficult.

Will an Obama administration be any different? Some observers speculate that an Obama administration will back away from health care reform, because it costs too much, the deficit is too high, and there are too many competing priorities.

I disagree: President Obama and the congressional leadership will not allow the best chance in a generation to achieve lasting health care reform to pass them by.

I expect the new president and the leadership of Congress to make a push early in 2009 for comprehensive reforms to expand coverage - starting with reauthorization and expansion of the State Children's Health Insurance Program (SCHIP), which expires on March 31 - and then moving beyond that to try to enact income-based subsidies and insurance market reforms to close gaps in employer-based coverage. They will also take on Medicare physician payment reform.

Will they succeed? That depends largely on whether President-elect Obama and his congressional allies have learned the lessons from the last time the country had a serious debate over health care reform. Over the next few days I will post and invite commentary on some of those lessons, and the extraordinary opportunities and challenges health care reform poses for the American College of Physicians.

Today's question: What do you believe the 2008 election means for health care?

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