"Hearts, minds and health care"

E.J. Dionne Jr. (WaPo):

The next health-care fight has already started. It's the battle to define the bill that President Obama will eventually sign as a victory for consumers, taxpayers and the common good.

You might say this view is premature. Legislation has yet to pass the House or the Senate, there are differences between the two bodies, and some moderates still have doubts.

But barring astoundingly self-defeating behavior by Democrats, a decent bill will get to Obama's desk. He and his party will then own the most sweeping reform of the American social safety net since the passage of Medicare in the 1960s and, arguably, Social Security in the 1930s.

Both parties know this. That's why much of the rhetoric you'll hear in the coming weeks will not really be about whether to pass a bill. It will be designed to shape how the voters who will decide the 2010 elections -- and, ultimately, the fate of health-care reform itself -- come to view the new system.

Republicans will try hard to minimize the benefits that will flow from the reform and set themselves up to claim that anything bad that happens to anyone's health care in the next few years is Obama's fault. It will be a bit like those New York City taxi drivers during the late 1960s and early '70s who despised Mayor John V. Lindsay so much that they were prepared to blame him for bad weather.

And since most of the changes don't become effective until 2013, the next few years will be a time of uncertainties and unknowns. Citizens typically want to know what's in this for them, and what they'll get right now.

That's why the most important document House Democrats released when they unveiled their bill last week was a list of 14 benefits that would be created immediately.

These include insurance reforms to ban lifetime limits on coverage and an end to "rescissions," under which insurers abruptly nullify patients' policies after they file claims. One of the most popular reforms in the bill -- barring insurers from denying coverage to those with pre-existing conditions -- wouldn't take effect until later. So the House bill creates an interim high-risk pool to help those who need coverage in the meantime.

There are also particular benefits for Medicare recipients, including an immediate reduction in drug costs, and a very popular provision that would allow parents to keep their children on the family health plan through age 26.

Especially important are new investments in community health centers and in efforts to increase the number of primary care doctors. As millions more people get access to decent care, the system will have to provide more doctors, nurses and facilities to treat them.

"People will be excited about 2013," said Rep. George Miller, chairman of the House Education and Labor Committee, which shares jurisdiction on the health-care bill. "But there are enough benefits between now and then to keep them engaged and to keep them favorably disposed."

The key word here is "excited," and the central task of supporters of health-care reform is to elevate the discussion to the central question at stake: Will the United States join all the other wealthy democracies in providing nearly everyone with health insurance? Or will we kick away the opportunity?

Miller focuses on how much a guarantee of health insurance will lift needless anxiety from the average family. "Right now, when you lose your job, you also lose your health care, your ability to send your kid to college and sometimes your home," he says. Knowing that health coverage will always be there doesn't solve all those problems, but it removes a burden.

While negotiations between the two houses will be difficult, my hunch is that they could be less challenging than many are predicting.

For example, the two houses could split their differences on financing by including a scaled-back version of the Senate's tax on high-end health plans while reducing the House's tax on millionaires. Some of the Senate's cost controls could be added while preserving the House's more generous approach to coverage. And a public plan will survive because it's an option most Americans understand and want.

Above all, the negotiators need to know that if they make the process look like a bad day at the sausage factory, they will undermine public confidence in the outcome. From now on, they are not simply enacting a bill. They are rolling out a product.

Howie P.S.: Howard Dean has his own point of view:

Dean stressed, first, that Congress was not going to reform health care; "We're" going to reform health care, he declared, explaining that it would be public demand that eventually would change the system. He reiterated a concept he's fond of saying, namely that "change is never made until the pain of staying the same exceeds the fear of change."

Dean was positive about the current (as of this weekend) health care reform bill; although stating that he thought the early strategic abandonment of single-payer was a mistake, and that he thought "the public option should be Medicare," he felt that the inclusion of a public option would create the ability for Americans to choose something other than the existing insurance plans. That said, he was not overwhelmingly an endorser, saying that while the current public option in the House and Senate bills -- and he singled out Harry Reid as not having been given enough credit for including same when no one thought it would happen -- was a "good public option," that if it gets any weaker, it would be a bad bill. Dean felt that opt-out was OK, but that an opt-in provision would render the bill "worthless," and that if it included a trigger it would be a "farce." Dean urged the attendees to, at this stage, call the White House and express the need for the bills to move forward and get signed, without further dilution.

"It is not real reform," said Dean, "if all we do is put $60 billion into the pockets of the insurance industry."