Sunday, December 28, 2008

Health Reform a Joint Mission


by: Lisa Wangsness, The Boston Globe

Instead of creating a separate White House bill to overhaul the health care system, President-elect Barack Obama plans to work jointly with Congress from the start. (Photo: Charlie Neibergall / AP)

Obama to solicit Congress at start; looks to heed lessons from '90s.

Washington - President-elect Barack Obama and his team have signaled that they plan to work jointly with Congress to overhaul the healthcare system, rather than produce a separate White House bill that would be sent to Capitol Hill, according to people involved in healthcare strategy discussions.

The Obama team is determined to avoid the mistakes of the early 1990s, when the Clinton White House created a healthcare policy team that had more than 500 members and spent months secretly developing a 1,342-page proposal with minimal input from Congress. A lack of investment among congressional leaders helped doom the bill, which never even went to a vote.

Obama and his team - headed by former Senate majority leader Tom Daschle, who will serve as a bridge to Congress - have already begun privately engaging with congressional leaders and have emphasized that they intend to work more collaboratively on healthcare than the Clintons did, said the two leading Democratic senators on healthcare reform.

"Congress did not want to be told what to do," said Max Baucus, the Senate Finance Committee chairman, whose committee will determine whether a healthcare overhaul is fiscally feasible. "They're very cognizant of that and they don't want to make the same mistake."

"The only way for this to work is to have both ends of Pennsylvania Avenue working hand-in-glove," Senator Edward M. Kennedy, chairman of the Health, Education, Labor and Pensions Committee, said in a statement. "And all signs are that's how it will proceed. It's not Congress or the White House, it's both together."

Len Nichols, a health economist at the New America Foundation and the senior manager of health policy at the White House budget office in 1993 and 1994, said he believed the Obama team would probably set broad parameters but let Congress work through the details and write the legislation, giving guidance both privately and publicly on what would or would not be acceptable to the president.

"That is the right strategy," he said. "Clinton tried the alternative, which is to go write it yourself in a hotel room and drive it up there and plop it down" before Congress, he said. "It didn't work too well. Daschle was here and he paid attention - he knows you can't do that."

Daschle's low-key style and legislative background contrast sharply with his counterparts in the Clinton administration - Ira Magaziner, a consultant charged with running the healthcare reform effort, and Donna Shalala, an academic who served as Clinton's secretary of health and human services - had little political experience and few relationships on Capitol Hill upon which to draw.

Daschle "has an excellent working relationship with the people who used to be his colleagues, and I think that there is going to be a balance that involves give and take, so that the administration and the congressional leaders on the various committees develop a joint direction for their proposal," said Ron Pollack, president of Families USA, a left-leaning healthcare advocacy group who has spoken with the transition team and has been working closely with staff on Capitol Hill.

Obama and his team have said little publicly about their working relationship with Congress on healthcare. The transition team is encouraging people to hold local discussions on healthcare across the country before the first of the year and to contribute ideas through its website,

Asked how Obama planned to work with lawmakers on healthcare, Tommy Vietor, a spokesman for Obama, said in an e-mailed statement that Obama would fix healthcare by "engaging the American people, asking for their input, and conducting an open, transparent, and collaborative process."

When Obama announced his selection of Daschle, though, he cited Daschle's political skills: "He brings the respect he earned during his years of leadership in Congress," Obama said. "He knows how to reach across the aisle and bridge bipartisan divides."

Obama has also been dealt a more promising set of congressional leaders to work with than the Clinton White House had. In 1993, Senator Daniel Patrick Moynihan of New York, the powerful Democratic chairman of the Senate Finance Committee, in particular emerged as an early antagonist, dismissing the Clintons' numbers as "fantasy" and questioning the need for a healthcare overhaul in the first place.

This year, Kennedy and Baucus have taken the lead, relieving the president-elect of the political burden of having to present legislation to Congress and making it clear that overhauling the healthcare system should be a top bipartisan priority.

Both Kennedy and Baucus also seem to be keenly aware that delay contributed to the failure of Clinton's healthcare plan, which was not announced until September of Clinton's first term, long after fights over gays in the military, the budget, and trade had sapped the new president's political momentum.

With speed in mind, aides to Kennedy, a top supporter of Obama's, have been meeting informally with various interest groups on policy matters for months in hopes of getting a bill out early in the new administration, and both Kennedy's and Baucus's committees have already been holding hearings on the subject. Days after the election, Baucus released an 89-page policy paper that many see as a blueprint for what a Democratic approach to overhauling the healthcare system might look like, and its contours were very similar to those Obama outlined in his campaign.

Some compare Obama's approach to the strategy President Lyndon Johnson used to help push Medicare through Congress in 1964 and 1965.

In a recent New England Journal of Medicine article, David Blumenthal, a Harvard Medical School professor and unpaid Obama adviser in the campaign, and James Morone, a political scientist at Brown University, suggest Johnson offers a valuable model for Obama. In an interview, Blumenthal said Clinton knew speed was important but simply couldn't move any faster; he did not, however, recognize as Johnson did how important it was to let Congress handle the bill writing and get the early credit.


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