Saturday, December 27, 2008

Obama team gets serious about healthcare legislation

The Obama team is setting the stage to revamp America's health care system and avoid the mistakes the Clinton administration committed in 1993.
WASHINGTON - President-elect Barack Obama and his team have signaled that they plan to work jointly with Congress to overhaul the healthcare system, rather than produce a separate White House bill that would be sent to Capitol Hill, according to people involved in healthcare strategy discussions.

The Obama team is determined to avoid the mistakes of the early 1990s, when the Clinton White House created a healthcare policy team that had more than 500 members and spent months secretly developing a 1,342-page proposal with minimal input from Congress. A lack of investment among congressional leaders helped doom the bill, which never even went to a vote.

Obama and his team - headed by former Senate majority leader Tom Daschle, who will serve as a bridge to Congress - have already begun privately engaging with congressional leaders and have emphasized that they intend to work more collaboratively on healthcare than the Clintons did, said the two leading Democratic senators on healthcare reform.

"Congress did not want to be told what to do," said Max Baucus, the Senate Finance Committee chairman, whose committee will determine whether a healthcare overhaul is fiscally feasible. "They're very cognizant of that and they don't want to make the same mistake."

"The only way for this to work is to have both ends of Pennsylvania Avenue working hand-in-glove," Senator Edward M. Kennedy, chairman of the Health, Education, Labor and Pensions Committee, said in a statement. "And all signs are that's how it will proceed. It's not Congress or the White House, it's both together."

Len Nichols, a health economist at the New America Foundation and the senior manager of health policy at the White House budget office in 1993 and 1994, said he believed the Obama team would probably set broad parameters but let Congress work through the details and write the legislation, giving guidance both privately and publicly on what would or would not be acceptable to the president.

"That is the right strategy," he said. "Clinton tried the alternative, which is to go write it yourself in a hotel room and drive it up there and plop it down" before Congress, he said. "It didn't work too well. Daschle was here and he paid attention - he knows you can't do that."

Daschle's low-key style and legislative background contrast sharply with his counterparts in the Clinton administration - Ira Magaziner, a consultant charged with running the healthcare reform effort, and Donna Shalala, an academic who served as Clinton's secretary of health and human services - had little political experience and few relationships on Capitol Hill upon which to draw.
The reason that Clinton's effort failed is that Congress did not buy into the program, which allowed an opening for the insurance companies to persuade the public to barrage their Congressional representatives and Senators to simply not act. The Clinton plan never got a vote.

The Obama team needs to avoid that fate, and they know it.

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