As Bruce and Pete have pointed out, the dissimilarities between the current health care reform and past major tax reform are instructive. The analytical issues that distinguish one type of reform from another have not been studied in depth. The President is sorely in need of a blueprint (or even a few white papers) that would help him make the case to the so-called progressives that a government-run plan is not the best course of action or to those on his right flank that different government regulation of the health insurance market is essential. Ideally, this would have been done in a years-long process that involved not only Treasury and HHS reports, but Congressional testimony by the relevant Assistant Secretaries of those departments who produced the reports. Unfortunately for the President, the rhetoric over health care reform is very excited but not particularly informed.
That leaves him in a tough position this evening. The first thing to listen for is whether, despite the absence of a thoughtfully crafted blueprint for reform, the President is in a hurry to deliver something on health care reform during this session of Congress. If he signals that he has a deadline, then the quality of what we get for legislation is going to drop markedly. Medicare Part D in 2003 is your guide for what happens in these situations.
Regardless of his timetable, the President needs to be in coalition-building mode, whether that means getting so-called progressives to abandon their calls for Medicare-for-all, getting Republicans to go on record as willing to enact legislation to overcome the problem of pre-existing conditions in conventional health insurance markets, or getting the Blue Dog faction of the Democratic Party to agree to some deficit funding of expansions in coverage for those currently without formal health insurance. The second thing to listen for this evening is what types of coalitions the President is trying to form.
Finally, the third thing to listen for is any semblance of specificity about the reform proposals being discussed. For example, has there been any public discussion of the risk-adjustment mechanism? None so far as I can tell. Until I skimmed through HR 3200 myself, I had no idea that this was even part of the reform. It certainly didn’t come up in the news coverage of the townhall meetings. But as I have indicated, this is one of the most essential pieces of the reform. Again, the absence of a Treasury/HHS blueprint means that, if the reform is to happen based on its intellectual merits, the President has to explain it himself. He is a gifted orator, but this might be beyond what he is willing or able to do.