Bringing all the healthcare pieces together

BRINGING ALL THE HEALTHCARE PIECES TOGETHER…. Following up on Hilzoy’s overnight item, momentum for major healthcare reform in the next Congress got a little stronger yesterday, when the health insurance industry said it would support extending coverage to everyone, in exchange for a healthcare mandate for all Americans. Given the insurance industry’s role in helping kill the Clinton plan 15 years ago, this is obviously an important development.

Hilzoy noted that the mandate is clearly the right policy, so the insurance industry’s demand is arguably a positive development. But then there’s the politics — while the Clinton/Edwards approach included a mandate, Obama’s campaign plan didn’t. Is this a problem? I doubt it. For one thing, I suspect Obama would be thrilled to have external forces force his hand on this. For another, as Jonathan Cohn noted, this isn’t entirely his call.

Congress, not Obama, will end up writing the actual plan. Senator Max Baucus, who will (along with Ted Kennedy) lead his chamber’s reform effort, has already indicated he supports an individual mandate. Senator Wyden’s bipartisan bill for universal coverage has an individual mandate, as well. The insurance industry’s positioning, therefore, is perfectly in line with these efforts. And it sets up a scenario under which Obama could, as a final compromise, “reluctantly” agree to an individual mandate in order to get a package passed.

If anything, this announcement is the latest sign that health care reform has serious political momentum heading into 2009. The insurance industry wouldn’t be taking this position if its representatives didn’t believe that the odds of universal health care passing are pretty good — and that they are better off trying to shape the plan from the inside than fight it, unsuccessfully, from the outside.

It’s also worth keeping the larger dynamic in mind. The Wall Street Journal has a good piece today, noting that an overhaul appears increasingly likely thanks to the multiple, divergent parties — some of which were intent on destroying the Clinton plan 15 years ago — that are finally on board with the same goal in mind.

Motivations vary depending on the interest group. Business groups want to reduce the cost and improve the quality of care. Consumer groups and labor unions want subsidies to help people afford insurance. Doctors and hospitals would benefit if more patients had insurance and could pay their bills.

“You see a range of diverse stakeholders trying to work together to achieve health-care reform,” said Karen Ignagni, president of America’s Health Insurance Plans. “You see it on [Capitol] Hill, off the Hill, in various coalitions. And that’s very different than what we saw in the early ’90s.”

This process will no doubt take some twists and turns, but there’s reason for genuine optimism, punctuated by the insurance industry’s apparent belief that Obama and congressional Dems are serious about this. Emanuel’s remarks this week, the Daschle news, the Baucus and Kennedy work, and word from America’s Health Insurance Plans and the Blue Cross and Blue Shield Association all point in a very encouraging direction.