November 18, 2008
By Stuart M. Butler, Ph.D.
In this installment of Health Care Watch, Stuart M. Butler
and Ezekiel Emanuel talk about what President-elect Barack Obama
should and shouldn't do on health care reform.
My fellow Campaign Stops contributor, Ezekiel Emanuel, is right
that Barack Obama's election could be transformative for health
care as well as other areas of policy. Let's hope Mr. Obama doesn't
blow it, as others have on health care -- most notably Bill
Clinton. Getting it done right will require Mr. Obama to keep four
things strongly in mind or his honeymoon on health care will end
First, he has to make a strong commitment to bipartisanship,
which was distinctly lacking in President Clinton's health strategy
and helped assure its demise. Not often obvious during the heat of
the election season, there has been a good, honest conversation
about health reform across the reasonable political spectrum in
recent years. We saw it in Massachusetts. We see it in the
bipartisan proposal introduced by Senators Robert Bennett of Utah
and Ron Wyden of Oregon. We see it, too, in Massachusetts' senator
Ted Kennedy's wide outreach in the last several weeks, and in
bipartisan conversations about health tax reform and health
exchanges. Mr. Obama needs to tell the more triumphalist liberal
supporters on Capitol Hill to chill, and that he's looking for
Second, these very difficult economic and budget times
underscore the need to find better ways to use the money we are
currently spending on health rather than throwing tens of billions
in new money at the health industry in an effort to expand
coverage. That's why reallocating the $200 billion tax expenditure
on the tax exclusion is so critical. Ezekiel Emanuel and virtually
every other health expert agrees with me on that. Mr. Obama must
not adopt a "not invented here" attitude just because John McCain
proposed reforming the exclusion. It's a real opportunity for him
to reach out to his former opponent and craft a workable bipartisan
solution. Fortunately the Democratic chairman of the Senate Finance
Committee, Senator Max Baucus of Montana, may have opened the door
to that in his own just-released health plan by raising the idea of
reforming the tax exclusion.
Third, and in the same vein, Mr. Obama should put meat on the
bones of his campaign proposal to allow states flexibility to
redesign existing health programs and use money more efficiently to
reach the goal of maximizing affordable coverage. I wrote about
this in my last post. Again, he can go bipartisan. Various bills in
the Senate and the House have been introduced to enable states to
receive waivers from existing federal programs and laws to try out
bold ways to use funds to expand coverage. Mr. Obama should embrace
these approaches. Allowing states to try out major changes first
means skeptical Americans can see a model of reform before they are
asked to accept it. That strategy was essential in building public
support for major welfare reform, and it is needed even more for
significant change in the especially sensitive area of health
And finally, he needs to remember that Americans are very
conservative about their health care. Those with coverage are
extremely nervous about changing what they already have. John
McCain was hurt by claims that his approach to health care was too
radical and might result in people losing their employer-based
coverage. Mr. Obama's plan actually masks what would be big
changes. As I've pointed out, for instance, millions of workers
will discover that they will be put into a public plan by their
employers. Once workers with coverage know this, they are going to
feel tricked and angry if he pushes ahead with changes that are
more substantial than they thought they were voting for.
All the more reason, then, for President-elect Obama to tread
carefully, to set up models at the state level so Americans can
kick the tires of major reforms first, and to reach across the
aisle to build trust and broad support for a workable way of
reaching the goal we all share.
M. Butler, Ph.D., is Vice President for Domestic and
Economic Policy Studies at The Heritage Foundation.
First Appeared in NYTimes "Campaign Stop" blog
In this installment of Health Care Watch, Stuart M. Butler and Ezekiel Emanuel talk about what President-elect Barack Obama should and shouldn't do on health care reform.
Stuart M. Butler, Ph.D.
Distinguished Fellow and Director, Center for Policy Innovation
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