Blog | Wednesday, December 3, 2008

Obama should read the NEJM


There's no shortage of advice available to President-elect Obama on how to reform health care. If there's a health policy analyst out there who hasn't thrown her 2 cents in yet, I'd be surprised. But the experts writing in this week's New England Journal have an extra argument on their side: history. They analyze the last successful piece of federal health reform--the creation of Medicare.

In their account, the passage of the plan was in large part due to LBJ's political skills. We know Obama is talented in that department, but a couple of the authors' key suggestions may prove difficult for him to follow.

First, they say that to be successful, health care reform must be tackled immediately (if not sooner). Yet, it seems likely that dealing with the disaster that is the economy will take most of Obama's attention after inauguration. Can he really launch a huge, new spending plan when pleas for money are coming from every direction? (See governors' meeting taking place today.)

The authors also recommend letting Congress manage the specifics of reform. But Obama's already got problems with Congressional Democrats straying way off the health care reservation. (e.g., Sen. Baucus is now proposing to mess with employer-sponsored coverage--an idea that Obama campaigned hard against during the election.) Also, can what has come to be known as our do-nothing branch be trusted to get something effective passed on this issue?

There is one recommendation that it seems like it shouldn't be too hard for Obama to follow. LBJ got Medicare enacted because he didn't worry too much about the future costs, the authors say. (Explains a lot about the mess it is now.) And as AIG, Citi and the rest of the bunch can attest, if there were ever a time when it was publicly acceptable for the government to spend money it doesn't have, that time is now.