Thursday, April 16, 2009

Will conventional wisdom kill health reform?

One of the biggest threats to achieving health care reform in our time is the growing chorus from Washington insiders urging Obama and Congress to go slow and set their sights low.

Former House Majority Leader and failed presidential candidate (D-MO) Dick Gephardt is the latest to counsel such. John Harwood writes in the New York Times Caucus blog that Gephardt is advising Democrats to focus first on costs of care, and put off universal coverage to another day. Gephardt believes that universal or near universal coverage cannot be enacted this year - that the best that might get done is to expand coverage to most children. Gephadt is quoted as saying that universal coverage "is absolutely imperative, and it needs to be dealt with. But the way to get to it is to show that we can deal with some of these [the cost of health care] problems first."

Let's see if I have this right. Universal coverage is absolutely imperative, but it would be a mistake to pursue now. But if not now, when? Will the political conditions for universal coverage be better a year, or two, or five, or ten years from now?

I understand Mr. Gephardt's caution. The safe bet, after all, is that this President and this Congress will unable to achieve universal coverage, since that has been the case with all who tried before them. We need to remember, though, that this is not a game of cards, but gambling with the tens of millions of Americans whose lives and economic security are placed at risk because they don't have health coverage.

From a pragmatic standpoint, I disagree with the idea that delivery system reform - controlling costs - is easier than expanding coverage. Delivery system reform will involve dishing out a lot of pain, but unless it is linked to universal coverage, it will be pain without the gain of providing all Americans with the security of health insurance that can't be taken away.

Today's question: What do you think of Mr. Gephardt's advice that Obama and Congress go slow and set their sights low?

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