David. I am not sure the President can get everything he wants but he can get a lot more than this. These things would do nothing for the vast majority of the uninsured and interstate sale of insurance without national regulation would make the nongroup market much worse. I think a lot of americans are angry and fearful but the majority are still ready for real change. Tim

Timothy Stoltzfus Jost
Robert Willett Family Professor
Washington and Lee University
From my Blackberry

From: Anglo-American Health Policy Network <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Sent: Fri Sep 11 09:12:05 2009
Subject: Re: The Speech

Hi Ken and others
For the sake of the discussion, I want to register my disagreement with Ken’s analysis in point 2 below.  
    First, I do not think that the institutions or public opinion are particularly open to non-incremental health reform now AFTER having gone through non-incremental de facto nationalization of the banking industry, nationalization of the world’s largest insurance company, and nationalization of half the country’s automotive industry.
    In a flat diffuse structure, which is the American politial system, non-incremental is hard to come by under any circumstances.  The chance for something BIG in health care was blown away long ago when all the oxygen was sucked out of the room by the financial crisis, the bail-outs and the faux stimulus package.  
    I just do not think that one can overestimate the fatigue of the institutions, the fatigue of the players and the fatigue of public opinion at this point.
    In that regard, Joe Wilson’s outburst – calling the president a liar from the floor, an unbelievable breach -  is analytically interesting, even if socially and protocol-unacceptable:   
    I know Joe Wilson; he also represents the district where I grew up in South Carolina, whether I ever voted for him or not.   He is not an outburst kind of guy.  Never, ever has been.   He’s also not a drunk, so you can’t blame it on alcohol.    Why did he suddenly lose it?
    The depth and breadth in certain parts of the country of deep suspicion, even paranoia, about government in the US now suddenly becoming an uncontrollable behemoth, this has re-surged to the fore.   Remember, America was founded on a “keep the government out of our lives” moral philosophy.  You might argue that the original incubators of the Cato Institute were in fact the Founding Fathers.
    However the bumps of public opinion may read just after the Speech, over the longer term (weeks and months), there is no public opinion consensus on the specifics of anything that has to be done to reform health care, or even that there is any dire-ness to the problem.
    Recall that we all thought the situation equally dire in 1993/94.  Ted Kennedy himself thought the situation dire in 1971, when he nearly came to a bargain with President Nixon over the issue.
    Still, today:  Nothing.
    Alas, it doesn’t haunt Republicans at all that they “have no solution.”  It doesn’t haunt independents either.  It may haunt Democrats, but they, going it alone, cannot non-incremental reform achieve – reconcilation procedure or not.  
    More disturbing to me right now is that the focus of the president on big reform in this very thorny area, when no oxygen is left in the room, has distracted him and everyone else from the discrete do-able:   Pass a law making insurance portable from one employer to another and across state lines.   Pass one ensuring that employer-based insurance is kept for 12 months after the employer lets you go and you still haven’t found a new job.  Pass another law banning pre-existing condition exclusions.  
    Three “small” things right there would begin to the change the game for many individuals in the US now.  That’s the way you start stuff rolling in a flat diffuse porous political system that is structurally hostile to big change.
    Yours
    David
    


On 9/10/09 9:49 AM, "Thompson, Ken (SAMHSA/CMHS)" <[log in to unmask]">[log in to unmask]> wrote:

Tim et al..
 
I agree with your sentiments- with two other observations..
 
1)       I am hopeful that Obama made some headway in defining the American ethos- and moving it away from the rape and pillage individualism of the right.  What is to be the character of America?? This game is more then about health care…
 
2)       If he does not win health care reform, how does the game play out?  I strongly object to the notions that he will have lost the day- he is cooking the pot, and the pressure is building.  The argument that this is the only chance for reform only holds if the need for health care reform was not dire.  But it is dire- that is why we have any movement at all.  So if Congress does not move forward, all that happens is that the situation worsens- probably dramatically as the health care industry tries to maximize its gains before Congress is once again forced to act.  And we are right back here- except worse off.  And the republicans hold the whole blame. They cant really want this end game.  They have no solution to the problem- it  haunts them.  
 
Ken
 

From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On Behalf Of Jost, Timothy
Sent: Thursday, September 10, 2009 8:48 AM
To: [log in to unmask]">[log in to unmask]
Subject: Re: The Speech

I am more optimistic.  This is the first time that many Americans have actually heard what is contained in the legislation being considered by Congress.  A CNN flash poll showed that support for the plan jumped dramatically immediately after the speech. This is consisent, however, with what other polls have shown:  people say they oppose "Obamacare" but when told what the plan actually is, support grows considerably.



The media have done a terrible job of covering health care reform.  It is no wonder that the public is confused.  Americans have received virtually no real information from the media, which has been totally preoccupied with controversy and political machinations.  Again this morning, the only news is about Congressman Wilson having yelled "you lie" and about the President having effectively called ex-governor Palin a liar.  But last night, Obama went over the heads of the media and told the American people what he is in fact proposing.  They liked it.

More importantly, perhaps, Senator Baucus has finally said Senate Finance is moving forward, and once they are done, both the Senate and the House can vote on a bill. The bills will be rather different, but what comes out of conference will probably be better than the Senate bill.  I really believe we will get something by the end of the year.

Then comes the real problem.  If in fact, nothing happens until 2013, as in the House bill, two congressional elections and one presidential election from now, the odds of actual implementation are, to my mind, very low.  Opponents will have three years to snipe at the bill while Americans see nothing concrete coming from it, as their fears build.  I realize that the delay is necessary to make the budget numbers add up, but something needs to happen in the meantime, or we will never get health care reform, and Obama is likely a one-termer.  The President hinted last night at an interim program for the uninsurable.  We need more than this.  We at least need some Medicaid expansions, some kind of help for those who cannot afford insurance, and possibly opening up Medicare at cost to people over 55.  But we cannot expect the American people to hold their breath and trust the President for 3 years.

Tim Jost

Timothy Stoltzfus Jost

Robert L. Willett Professor

Washington and Lee University School of Law

(540) 458 8510

fax (540) 458 8488

[log in to unmask]">[log in to unmask]

From: Anglo-American Health Policy Network [[log in to unmask]">[log in to unmask]] On Behalf Of David Wilsford [[log in to unmask]">[log in to unmask]]
Sent: Thursday, September 10, 2009 8:16 AM
To: [log in to unmask]">[log in to unmask]
Subject: The Speech

At first blush of the morning after, a rhetorically strong speech (which we know to expect from him), which changed no minds within the Congress, although it temporarily has re-energized the Democratic liberal base.
    Did it change any minds in the country?  We won’t know until the weekend.  My guess is that within a couple weeks, public opinion will have settled back into its muddle.
    There is also still the irreconcilable difference between House Democrats who say they insist on the so-called public option and key Democratic senators from the center, like Baucus, who say the public plan will NOT be in any Senate bill.   Then, there is Jay Rockefeller who disdains the whole idea of coops.  (He’s right, too.)
    And there is still the matter  of clashing goals in the same reform effort, which end up sooner or later muddling the debate:  extend coverage ≠ controlling costs.  
    The president’s figures on this from the Speech are not at all convincing and lawmakers from the opposition are bound to return to these very large inconsistencies.
    Voilà, my first take on it.
    D


--
David Wilsford Ph D
Professor of Political Science, George Mason University (Fairfax Virginia USA) and
Visiting Fellow, London School of Economics (UK)

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French cell  +33.6.11.16.50.93
U.S. cell  +1.224.522.0111


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