If, like me, you’re used to a parliamentary system where the party with a majority in Parliament runs the government and, if it has a big enough majority, pushes through its manifesto commitments without too much difficulty, policy making in American can seem utterly chaotic.
Within three weeks of Obama’s election victory, a cast of powerful characters has emerged ready to drive through health reform and that’s not counting the President-elect himself.
Who is really in charge, the Senate or the Whitehouse, and whose ideas will prevail is all murky at present. But there does appear to be a consensus emerging that health reform is an important part of addressing America’s future prosperity rather than a distraction from it. Too many middle class Americans are losing health insurance coverage as the cost of premiums for employers and employees climbs annually. The price of getting this under control is one that must be swallowed.
Leading the charge for the Executive will be Tom Daschle, former Senate majority leader. The centre piece of Daschle’s recent book on health reform was the creation of a Federal Health Board, modelled on the Federal Reserve. The purpose of the Health Board is to provide some public governance and oversight for the private health care industry, setting standards around coverage and costs and, in doing so, increasing transparency and reducing administrative costs.
While the Federal Reserve may have lost some of its shine in recent weeks, it is clear that Obama’s health reform proposals would require some sort of independent regulator to oversee private plans that want to compete for the uninsured.
Daschle’s appointment indicates that Obama has learnt an important lesson from the Clintons’ attempt at healthcare reform. The Clintons ran healthcare reform largely from the Executive branch of government, setting up a series of work groups staffed by outside experts and civil servants. As the body that constitutionally writes and passes legislation, Congress was not impressed and the plan was dead on arrival on Capitol Hill.
Daschle’s former Senate role will guard against history repeating itself. Peter Orzsag, Obama’s Director of the Office of Management and Budget, will lend Daschle some muscle on the financing side of healthcare reform. Orzsag was until yesterday the director of the Congressional Budget Office. In this role, he’s travelled the country, on a mission to make America aware of the impending cost crisis in healthcare.
On the Congressional side, Senator Edward Kennedy made an emotional return to the Senate last week following his operation to remove a brain tumor. Kennedy has been involved in every major health reform effort since the 1970s and will exert considerable moral pressure on all parties to get something done while he is still around to see it happen. Kennedy has created three work groups to take forward a lot of the detailed work needed to underpin new legislation. Senator Harkin from Iowa will lead a work group on prevention and public health, an area on which he has been vocal in the past.
Senator Mikulski from Maryland will lead work on quality improvement and Hilary Clinton, if she resists the call to be Secretary of State, will lead a work group looking at insurance coverage.
Kennedy chairs the Senate Health, Education and Labor Committee which will be a major focus for any health reform effort in the Senate but any proposal will also have to go through the Senate Finance Committee.
Its Chair, Max Baucus, made his bid for a role in the proceedings last week with the publication of a white paper on health reform. Baucus’ proposals are very close to the ideas set out by Obama during the campaign, with the exception that Baucus, like Hilary Clinton, supports an individual mandate which compels everyone to purchase health insurance one way or another.
As the Democrats line up publicly to tackle health reform, business and industry forces will be planning their counterattack. But their traditional line of attack that that this is socialized medicine and a government take over of healthcare may be less persuasive today. If the government is bailing out Wall Street and the auto industry, shouldn’t it also bail out the average American with the costs of healthcare?
Vidhya Alakeson is a former Harkness fellow.