The defining symbol of Obama's campaign was thousands of people joining together to chant "Yes we can! Yes we can!"
The defining symbol of health care reform, at this critical juncture, could be the growing chorus of "No we can't!" to health care reform - or, at least to the parts of reform not to a particular group's liking.
Hospitals are saying "No we can't!" to Medicare pay cuts to fund health care reform.
Labor unions are saying "No we can't" to taxing health benefits (above a certain premium cost) to pay for health coverage for the uninsured. They also are saying "No we can't!" to health reform that doesn't include a public plan option like Medicare - and some unions are even attacking Democrats who disagree.
Insurance companies are saying "No we can't!" to health reform that includes a public plan option like Medicare.
Employers, for the most part, are saying "No we can't" to mandates that they provide coverage to employers or pay into an insurance pool. Today's announcement that Walmart supports an employer mandate is one welcome, and highly notable, exception.
To be fair to the groups mentioned above, most of them say they want health care reform to happen this year. Some have shown a great deal of leadership in promoting positive reforms in the health care system. They would tell you that their objections to specific elements are in the spirit of getting a "good" bill passed.
What about physicians? My sense is that there is a broad range of opinions on issues like the public plan. Most physicians still believe reform is necessary, but some are focusing on the things they don't like (like expanded roles for nurses), and there is a vocal minority of doctors who are hoping that the whole thing "tanks" (as one physician commented yesterday in response to my blog post on Obama's views on primary care).
For its part, ACP believes that health care reform is imperative, and we support the broad outlines of the draft proposal being considered in the House of Representatives: sliding scale subsidies for people to buy affordable coverage through a health exchange, insurance market reforms, and payment reforms and funding for primary care.
It is one thing to express concern about particular elements of reform, but it is another thing to issue non-negotiable, take-it-or-leave it, line-in-the-sand, my-way-or-the highway statements that leave no room for consensus or compromise. There will come a point where the chorus of "No we can't" on particular elements will begin to drown out the more compelling reasons why we need health care reform, and undermine public support in the process.
Health care reform is about making sure that each and every American has access to coverage at a price they can afford, that no one is turned down because they have a pre-existing condition, and that they have access to a personal primary care doctor. It is also about creating a health care system that won't bankrupt American families, businesses, and taxpayers. In my mind, we can't afford not to achieve those goals.
Today's question: Do you think that those who are laying down firm markers on what they can't support will ultimately derail health care reform?