Health Affairs, 27, no. 3 (2008): 688 doi: 10.1377/hlthaff.27.3.688 © 2008 by Project HOPE	New Online   McAllen, TX & Beyond: An Expert Roundtable   Geography & Reform   Medicaid or Insurance Exchange?   Siren Song of New GME   Public Plan Option: Pro & Con

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Politics

PROLOGUE

The Politics Of Health Reform: A Collection Of Perspectives

The following Perspectives on the politics of health care reform start with hope for the future in the form of the Healthy Americans Act, a bipartisan proposal by Sen. Ron Wyden (D-OR) and Sen. Bob Bennett (R-UT) that is gathering steam and cosponsors in the Senate. The senators posit that different, new, and fertile conditions for health care reform exist, marking this point in time as different from the 1990s.

The pollsters who follow, Celinda Lake and colleagues (Democratic pollsters) and William McInturff and Lori Weigel (Republican pollsters), render a somewhat more split verdict on whether we are witnessing a period of historic change. They both note the deep desire of the public for change, for an American solution that encompasses the view of health care as both a societal right and a personal responsibility, but it is unclear whether deep partisan divides in the electorate and a worsening economy will allow for anything other than incremental change.

The last group of Perspectives by Joseph Antos; Christine Ferguson, Elizabeth Fowler, and Len Nichols; and Jacob Hacker all use the Clinton reforms as a template for what went wrong and what is both possible and needed in 2009 to pass major reform legislation. The authors represent several political viewpoints, but they all suggest that the failure of the Clinton reforms was a failure of politics, not of policy. They all find the seeds of failure in the partisan nature of how the Clinton administration went about the reform business. As Hacker notes, instead of building a bridge to compromise, a transparent process with congressional input, the Clinton administration burned the bridges behind it. Health reform, major or minor, needs broad bipartisan support. It needs leadership from the executive branch and active participation from the legislative branch to muster the support to implement changes.

Senators Wyden and Bennett claim that their bill and their colleagues have learned these lessons. The bill has bipartisan support, and it is a model of clarity and brevity compared to the Health Security Act of the 1990s. Is this the moment? Will all of the political engagement of this year’s historic campaign translate into path-breaking legislation? Or are we headed back to the future?

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