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Health-care Reform:
A Litmus Test for a President and his Proposed Epoch

Elvin Lim is Assistant Professor of Government at Wesleyan University and author of The Anti-intellectual Presidency, which draws on interviews with more than 40 presidential speechwriters to investigate this relentless qualitative decline, over the course of 200 years, in our presidents’ ability to communicate with the public. He also blogs at www.elvinlim.com. In the article below he looks at health care reform. Read his previous OUPblogs here.

Everything President Barack Obama has achieved legislatively up to this moment – even the much touted $800 billion economic stimulus bill – has been relatively easy; mostly expedited and achieved in the name of economic emergency. And the president has been upfront all along that these early accomplishments were but prologue to the health-care battle to come. Pundits have been saying for a long time that this president chooses his battles and knows well the importance of preserving his political capital. Well, the moment Obama has been saving up for is here, and the stakes are as high as the president is ambitious.

To put things more starkly – if President Obama’s proposed health-care reform fails, then his presidential honeymoon is decidedly over. For all the euphoric talk of the era of Obama, if he fails to deliver on health-care, then he would have proven himself to be just another Bill Clinton. Obama would not be a reconstructive leader in the mold of Franklin Roosevelt, and the era of big government will still be over.

Conversely, successful health-care reform will be legacy-making. Generations of Americans will remember Barack Obama for what he did for them, and they will remain as loyal Democratic party constituents for decades to come. Successful health-care reform will be tangible proof that the era of (“better”) government is back, and it would have been Obama (like FDR 80 years ago) who took us there.

The stakes then, could not be higher, and the task no more enormous. Overhauling our health-care system runs up against almost every institutional and structural pathology of American democracy: multifarious and over-zealous interest group politics, power struggles between Congress and the presidency, and the ideological chasm between the two major parties about the role of government. Health-care policy is one of those policies in which the public and indeed pundits know relatively little about. Very few people are going to peruse the hundreds of pages of bill(s) under consideration. So watch for it – this means reform will invariably be sold and criticized with generalizing slogans. The Obama administration will have to play a delicate balancing act of negotiating details with the experts on Capitol Hill and captains of the insurance and pharmaceutical industries (who are probably going to be the only groups who will be incentivized to keep track of the facts and figures), persuading lay persons with a clear and yet truthful account of what is at stake, while also deflecting the simplistic slogans dissenting organized interests will disseminate in media blitzkriegs.

Elections are just regularized signposts on the American calendar. The media focusses on it because viewers and voters like to keep up with a horse-race. But history is marked not by these regularly scheduled events, but by the passage of landmark legislation that durably alters the relationship (for better or for worse) between government and its wards. How historians will remember our era will turn on what happens in the next crucial months. As President Obama’s audacity is about to be tested, so is America at the precipice of an epochal test.

Recent Comments

  1. James Raider

    Obama has avoided the thorny details of assiduous analysis on the most critical problems facing America, and has used sweeping, but banal statements of obvious principals, while his appointees actually implement policies and programs inconsistent with the claims of the message. Now his methodology will be applied to Healthcare?

    Did America elect a monarch? … A President is still needed.


  2. Brittancus


    Healthcare in America is a privilege and a multi-trillion dollar industry, just benefiting the ultra wealthy insurance companies. Here is an very ominous example of our so called medical care. Professor and surgeon Dr. Richard Foster of Indiana University medical center operated on a cancerous kidney, that was partially successfully removed. After she was operated on my relative found herself in incessant chronic pain and has been on the strongest of pain killers since then. After many procedures nothing yet has eliminated the awful pain she endures every day. The surgeon in question severed the intercostial nerves under her rib cage.

    As with many states physicians are never held accountable for damage done to the human body. Its hard to prove medical malpractice even if you can afford the attorney fees. She is now appealing Federal disability, because two pain doctors say she can never work again. Since than she spends more time fighting with her California state-backed insurance company, for her pain medication to elevate the awful pain.

    These insurers have denied her over and over again, and forced her into federally mandated emergency room. This is an outrageous travesty of what we have a nerve to call health care. Health care in most European civilized countries has been exceptional, but since the advent of unparalleled immigration, a once Universal health care, single payer system has rapidly gone downhill. Yet If I had a chance at being a member of Canada’s, France, United Kingdom method of delivery, I would grab it happily with both hands any day.

    In America it’s run for profit, that is monopolized by giant wealthy insurance companies, who deceives the American people with copays, premiums and and almost impossible referrals, once the doctor has seen you. Of course the–BIG ONE–is pre-existing condition clauses, and small print in documents that you need a magnifying glass to read, if at all. Time this superpower called the United States accommodated it’s citizens with a single payer system for all and not just the high income families.

  3. Jake

    The lesson is clear: when government and other third parties get involved, health care costs spiral. The answer is not a system of outright socialized medicine, but rather a system that encourages everyone – doctors, hospitals, patients, and drug companies – to keep costs down. As long as “somebody else” is paying the bill, the bill will be too high.

    The following are bills Congress should pass to reduce health care costs and leave more money in the pockets of families:

    HR 3075 provides truly comprehensive health care reform by allowing families to claim a tax credit for the rising cost of health insurance premiums. With many families now spending close to $1000 or even more for their monthly premiums, they need real tax relief – including a dollar-for-dollar credit for every cent they spend on health care premiums – to make medical care more affordable.

    HR 3076 is specifically designed to address the medical malpractice crisis that threatens to drive thousands of American doctors – especially obstetricians – out of business. The bill provides a dollar-for-dollar tax credit that permits consumers to purchase “negative outcomes” insurance prior to undergoing surgery or other serious medical treatments. Negative outcomes insurance is a novel approach that guarantees those harmed receive fair compensation, while reducing the burden of costly malpractice litigation on the health care system. Patients receive this insurance payout without having to endure lengthy lawsuits, and without having to give away a large portion of their award to a trial lawyer. This also drastically reduces the costs imposed on physicians and hospitals by malpractice litigation. Under HR 3076, individuals can purchase negative outcomes insurance at essentially no cost.

    HR 3077 makes it more affordable for parents to provide health care for their children. It creates a $500 per child tax credit for medical expenses and prescription drugs that are not reimbursed by insurance. It also creates a $3,000 tax credit for dependent children with terminal illnesses, cancer, or disabilities. Parents who are struggling to pay for their children’s medical care, especially when those children have serious health problems or special needs, need every extra dollar.

    HR 3078 is commonsense, compassionate legislation for those suffering from cancer or other terminal illnesses. The sad reality is that many patients battling serious illnesses will never collect Social Security benefits – yet they continue to pay into the Social Security system. When facing a medical crisis, those patients need every extra dollar to pay for medical care, travel, and family matters. HR 3078 waives the employee portion of Social Security payroll taxes (or self-employment taxes) for individuals with documented serious illnesses or cancer. It also suspends Social Security taxes for primary caregivers with a sick spouse or child. There is no justification or excuse for collecting Social Security taxes from sick individuals who literally are fighting for their lives.

  4. Karen

    Unfortunately, most proposals for health care “reform” either make marginal changes or worsen the problem. This is because they don’t address the root of the problem with health care, which is that government polices prompt excessive reliance on third-party payers. The excessive reliance on third-party payers takes away all incentive from individual patients to concern themselves with health care costs. Laws and policies promoting Health Maintenance Organizations resulted from a desperate attempt to control spiraling costs. However, instead of promoting an efficient health care system, HMOs further took control over health care away from the individual patient and physician.

    Moreover, the prevalence of third-party payers means there is effectively no market for individual health insurance polices, thus those whose employers cannot offer them health benefits must either pay exorbitant fees for health insurance or do without health insurance. Since most health care providers cater to those with health insurance, it is very difficult for the uninsured to find health care that meets their needs at an affordable price. The result is many of the uninsured turn to government-funded health care systems, or use their local emergency room as their primary care physician. The result of this is declining health for the uninsured and increased burden on taxpayer-financed health care system.

    Returning power over health care to the individual is the key to true health care reform.

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