Wednesday, February 4, 2009

Health Reform: Where Now

With Tom Daschle's withdrawal, the President has lost a strong advocate for his "hybrid" approach to health reform, which would leave private sector employment-based health insurance in place, while also aiming to expand the role of public sector insurance plans; and a person with the chops to approach Congress, if not necessarily to move it.

Health advocates are wondering: Will there be leadership on health reform this year? In choosing a successor nominee, will the Administration look to a friend of the industry? of consumers? An advocate for the status quo, or a change-maker? What will be the policy space to build on Congress' early support for strong public sector health insurance/social insurance programs, and to advocate for alternatives to the hybrid proposal?

Daschle's approach was middle-of-the-road. Clearly, that's not where opponents of reform are heading. If we're really going to move on health reform this time we need a strong, seasoned advocate for reform, who understands and is familiar with: 1. The importance of a strong government payer/purchaser to control costs and assure universal coverage. The lack of this feature is the great weakness of the "hybrid" plans proposed by Daschle and others, and why they always struggle and fail at the state level; and 2. The institutional players.

Two great candidates:

1. Theodore Marmor is a Yale University Professor Emeritus in the Schools of Management and Law and the Department of Political Science and an Adjunct Professor in Public Policy at Harvard’s Kennedy School of Government. The former Director—from 1992 to 2003-- of the Robert Wood Johnson Foundation’s post-doctoral program in health policy. The second edition of The Politics of Medicare appeared in 2000); the first edition of this book became something of a political science classic and launched his career in health politics, policy and law. His best known other works include Understanding Health Care Reform (Yale Press, 1994), Why Are Some People Healthy and Others Not? (Aldine de Gruyter, 1994), and America’s Misunderstood Welfare State (Basic Books, 1992) co-authored with Yale colleagues Jerry Mashaw and Philip Harvey.

Marmor began his public career as a special assistant to Wilbur Cohen (Secretary of HEW) in the mid-1960s. He was a member of President Carter’s Commission on the agenda for the 1980s, and a senior social policy advisor to Walter Mondale in the Presidential campaign of 1984. He is an active member of
the Institute of Medicine of the National Academy of Sciences and the National Academy of Social Insurance.

2. Sheila James Kuehl is best known to Californians as the state Senator from the L.A. area who twice spearheaded passage of the state single payer bill, SB 840. She served as Speaker pro tempore during the 1997–98 legislative session, becoming the first woman in California history to hold the position. She was elected to the California State Senate in 2000, and has repeatedly been voted the "smartest" member of the California Legislature. She was also a founding member of the California Legislative LGBT Caucus. A child actor, many of us remember her role as Zelda in "Dobie Gillis."

Throughout her career as a legislator, Kuehl has taken a leadership role on health care policy. Her foremost objective has been securing passage of legislation to establish a single-payer health care system in California. SB 840 passed both houses of the legislature in 2006, but was vetoed by Governor Arnold Schwarzenegger; it was reintroduced in 2007 and again passed in both the Assembly and Senate, to face another veto by the Governator.

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