I see the calculation but I don't see the votes. The basic problem is that
the "moderate" Senate or "Blue Dog" House Democrats for whom budget
responsibility is a key issue have preferences that don't add up. They sort
of think health insurance for everyone would be nice, but they don't like
big-government regulation, or government displacing the private sector;
object to most new taxes; and definitely don't want to increase the deficit.
Since the process in the U.S. requires that the Congressional Budget Office
estimate the effects on the deficit of any new legislation, and Republicans
will be screaming about those effects, the Blue Dogs can't just ignore the
costs. So "we'll fix the costs later" isn't really an option because the
Blue Dogs and their equivalent Senators won't vote for it. Unless and until
the Blue Dogs figure out that they have to endorse serious cost controls,
there is no solution. And the Blue Dogs came out against the public plan a
couple of weeks ago.
Not-especially-cheers,
Joe White
-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On
Behalf Of Calum Paton
Sent: Tuesday, June 23, 2009 7:37 AM
To: [log in to unmask]
Subject: Re: UK view of US health care (Times)
> Thanks, Mark.
I am recently back from visiting the US with a study group and discussing
health reform with some first-rate people.
My understanding is that (while any 'major' progressive reform will
always be difficult) Obama's team has overtly sought to learn from the
Clintons' failure in 1993. Then, cost-control - as well as 'managed
competition' - was built in to a greater extent than is (initially) the
case now, in the hope that fiscal conservatives as well as
'pro-competition' reformers would support. Thus the Clinton Plan became
1,00 pages of ingenious analytics which dies politically. Alain Enthoven
and others didn't return the complement of the genuflection to their
ideas; and fiscal conservatives on the Democrat side ( as well as being
'got at' by the insurance industry) were soon less significant than a
rising Republican tide at the Congressional level. The 'interests' were
offended.
Now, Obama seems to be saying (not explicitly!) something like.....at this
special moment (ie as Anatole Kaltesky rehearses), we will seek a big
tent, and try not to alienate (too much) the special, powerful interests
(providers and insurers)....get something passed a.s.a.p. and then
cost-control will be a necessity in any case, so it'll have to happen.
One hopes that, at this moment, the crass response of some Republicans
(like Karl Rove) is too much.....
Good luck to Obama, and Ted Kennedy et al (genuinely)
Calum
ttp://www.timesonline.co.uk/tol/comment/columnists/anatole_kaletsky/article6
523512.ece
>
> This article from The Times offers a UK view of recent events in the US
>
>
> Dr M. Exworthy
> Reader in Public Management and Policy
> & Director, Centre for Public Services Organisations (CPSO)
> & Deputy Director, Institute of Leadership & Management in Health (ILMH)
> School of Management
> Royal Holloway-University of London
> Tel: +44-1784-414186
> Email: [log in to unmask]
> CPSO webpage: http://www.rhul.ac.uk/Management/cpso/
> ILMH webpage: http://www.swlacademicnetwork.ac.uk/ilmh/
> Personal webpage:
> http://www.rhul.ac.uk/Management/About-Us/academics/exworthy.html
>
>
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