Fascinating exchanges this time around
from all of you. But trying to predict right now is, as Joe says, hard. It is
right to say that big changes are always difficult in the
In this respect, thinking about where
Ted
From: Anglo-American
Health Policy Network [mailto:[log in to unmask]] On Behalf Of David Wilsford
Sent: Friday, September 11, 2009
9:12 AM
To: [log in to unmask]
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 ¨C
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
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 ¨C 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
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
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
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
(540) 458 8510
fax (540) 458 8488
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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 ¡Ù 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.
Voil¨¤, my first take on it.
D
--
David Wilsford Ph D
Professor of Political Science,
Visiting Fellow,
[log in to unmask]">[log in to unmask]
French cell +33.6.11.16.50.93