Tuesday, July 21, 2009

Politics: Another Lesson from 1994?

TORONTO, ONTARIO - During the 1994 push for health care reform in the United States, Representative Jim Cooper, a then-relatively junior Democratic Congressman from Tennessee, impressed me by bringing forth an alternative to Clinton administration's reform plan. Cooper's bill, which some dubbed "Clinton Lite," more closely approximated the "managed competition" model that I thought at the time was most logical reform path. More importantly, Cooper's bill had at least limited bipartisan support. Some people believe that if President Clinton had shifted course and put his weight behind the Cooper bill instead of sticking with the plan his administration had proposed that the bill might actually have passed, and the United States would have a very different health care environment today.

Much has been made of the Obama administration's careful attention to past mistakes in health care reform initiatives in today's effort. His administration has tried to control the language, referring to a "public option" as the core of his vision, responding to the past attempts by opponents to talk about "governments" and "mandates," implying a government-run health care system that has never polled well in the United States. Rather than presenting his own plan to Congress as Clinton did, Obama has left it up to Congress to actually write the legislation. Finally, Obama has looked back to the Lyndon Johnson administration's fast passage of Medicare after an election as a model for the timing this time, which is why he is pushing so strongly right now for passage of a bill.

Oddly, Jim Cooper this time around has called on Obama to slow down, perhaps not heeding the lesson from 1965. However, Cooper may again be seeing through the practical politics of Congress. He does not support the bill that seems to be emerging from the House leadership, but instead that of Senator Ron Wyden of Oregon. In many ways, Wyden's proposal, called the "Healthy Americans Act," is reminiscent of the 1994 Cooper bill as it emphasizes health care plan portability in a private system without the "public option" that Obama has been touting. As described on Wyden's web site, the emphasis is on requiring private companies to accept people into their plans, and on cost containment, an element that does not seem to be emphasized in what is emerging from the Democratic party leadership. Most importantly, though, the Wyden bill has bi-partisan support. As pointed out by political blogger Nate Silver, the Healthy Americans Act not only has drawn support from centrist Republicans, but from all over the political spectrum.

The Healthy Americans Act of 2009 may be the Cooper bill of 1994--an alternate proposal that could pass if the president throws his weight behind it. It would require Obama to give up on the "public option" that he has been touted, but considering that the worst problem with the US health care system is cost containment and most analysts think the Wyden bill addresses that better than other proposals, there seems to be reason for him to change course. Has Obama learned this lesson from 1994? We'll have to see.

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