Bridging the Gaps

I'm off to the Bridging the Gaps conference, where I'm speaking on a panel about state and federal solutions to the health care crisis. For those interested, here are my opening remarks:

I’m here, I think, to be the Grinch. We’ve got all these great universal bills passing at the state level, and I’m here to tell you that, well, they are pretty great, but they’re not going to work. It didn’t work in Washington State, when they tried it, and the insurers first jacked up the premiums, and then moved out of the state in order to kill the model. It didn’t work in Hawaii, which saw an economic downturn move more people onto their subsidies exactly as the state’s revenues dropped. It didn’t work in Tennessee, where the Democratic governor, Phil Bredesen, upon killing off Tenncare and leaving 300,000 people uninsured, told his state that, "I say to you with a clear heart that I've tried everything. There is no big lump of federal money that will make the problem go away." Similar plans failed in Oregon, in Massachusetts, and many other states.

The plans fall for a few small reasons, and one big one. The big one is that states don’t have the fiscal stability to run universal health care. 49 of 50 states cant deficit spend. That means that when the state goes into recession and more people need subsidies and the revenues to give them don’t exist the state can’t borrow the money. So they dismantle the program. It’s happened time and time again -- in some states, like Oregon, more than once.

Moreover, you don’t really want this being a state-run solution. As a stopgap, increasing coverage through state plans is worthwhile, but health care reform is more than access – it’s actual reform to bring down costs, which are, at the end of the day, the biggest problem in the system. And the states don’t have the regulatory authority, the money, or, save in a few cases, the size to do that. I simply don’t trust them to fundamentally reform the system.

Now, folks make a good point: Health care reform has failed at the federal level time and again. The filibuster knocks it out. You’ll never pass it. States are the only hope. To that I’d say two things: One, if you think these red states will never embrace health reform, then they’re not going to do it on the state level, either, and I’m not comfortable with a solution that means Texas and Arkansas and North Carolina are left out. So that’s point one. Point two is that I think you can have federal reform. More than that, you will. It’s true that federal efforts have failed before. But look closer.

Truman failed in the 40’s with a heavily Republican Congress. Nixon failed in the 70s – but he failed because congressional Democrats didn’t want to hand him a victory, and rejected his, by our standards, very liberal, very comprehensive proposal in favor of something much closer to single payer. In retrospect, that was a huge mistake, but reform could have passed. And as for 1994, well, I don’t need to tell folks in this room how poorly that process was run. Maybe nothing could have passed, even with a saner, smarter, process. But change a few variables here and there – leave Lloyd Bentsen on the Finance Committee, tackle health care before NAFTA, take an earlier compromise -- and maybe it all turns out different.

More to the point, with every passing year, the pressure for reform grows stronger, not weaker. We have more uninsured, more struggling small businesses, more flagging mega-businesses, more determined unions, more coming cost crunches, more public unrest, more anxiety, more necessity. You can look at the cost projections for Medicare – which are really projections for American health care, as the private system’s spending growth looks as bad or worse – and you can tell right there that we’ll need reform, if only to save the country’s finances.

Moreover, much has changed politically. The Democratic Party is no longer dominated by Dixiecrats in Congress. It’s more parliamentary, more ideological. We have progressive coalitions with a breadth and strength that we never imagined in 1994 – during the S-CHIP fight, a coalition formed that included – deep breath here -- the AFL-CIO, AFSCME, SEIU, MoveOn.org, Americans United for Change, USAction, and TrueMajority. That didn’t exist in 1994. Nor did the blogs, or Media Matters, or the Center for American Progress. So yeah, we’ll need to be better this time, with a smarter, more aggressive political strategy, one that’s willing to bring enormous pressure to bear on any and every congress member who balks. But I think it can be done. And once it’s done, I think it’ll work, which I can’t say for the state reforms.

You know, whenever you talk about the state reforms, you always hear the old Brandeis quote about the “laboratories of democracy.” But there’s another Brandeis saying that I think is more applicable: “If we would guide by the light of reason,” he said, “we must let our minds be bold.” And that’s what I’m asking: Be bold. Because nothing else will, in the long term, work.

Thanks.