Decoding Health Care Reform

Healthcare - stethoscope over capital dome CBS/iStockphoto

Why aren't Americans in the streets, demanding reform of a health care system that is providing inadequate care for millions, wildly inefficient, and gradually bankrupting our country? A major reason: proponents of reform have lost control over the message because people think it's too complicated to understand. Confused about important details of the proposals, the public is susceptible to misrepresentations by opponents.

There's no better example than President Obama's assertion in last night's State of the Union address that "… according to the Congressional Budget Office - the independent organization that both parties have cited as the official scorekeeper for Congress - our approach would bring down the deficit by as much as $1 trillion over the next two decades." Yet a poll released this month by the Kaiser Family Foundation found that only fifteen percent of the public believe the current proposed health care reform legislation will reduce the deficit. So eighty five percent of the public is either unaware of the CBO report or doesn't believe it. Either way, it's bad news for the President.

Yesterday I spoke to Drew Altman, Ph. D., the President and CEO of the Kaiser Family Foundation, a non-partisan source of information for policymakers, the media, the health care community, and the public." He told me that the most recent tracking polls found "people actually like what's in the Senate legislation when they know what's in it." But most people don't know what's in it. For example, the majority of the public does not realize that the current legislation proposes to decrease administrative costs, help close the Medicare doughnut hole, limit charging higher rates to older people, extend coverage to dependents through age 25, levy taxes on insurers, drug companies, and device makers, and gives no federal money for illegal immigrants. The majority say that hearing about these provisions makes them more likely to support the legislation.

How did we go from health care reform passage being a no-brainer to it being threatened with collapse? A brief recap:

1) July, 2009: President Obama urges passage of health care reform by Congress before the August recess. The House releases a 1017 page version filled with the usual cryptic language of Congressional documents that invites misinterpretation. No further Congressional action occurs before the recess. Drew Altman tells me there's "all kinds of spin, mis-statement of fact and plain old mis-truths being bandied about and the debate is getting nastier and nastier." He adds that people are becoming confused and "it's beginning to make the public more anxious and antsier."

2) August, 2009: Let the message blurring begin. At town hall meetings across the nation, opponents of reform launch a campaign that includes gross distortions of fact. The most glaring example: the claim that a provision in the House bill for Medicare to fund doctor-patient consultations about end of life planning (such as drawing up a living will or planning hospice treatment) would lead to "death panels." Americans emerge more confused than ever, many fearful of a "government takeover" of health care.

3) September, 2009: President Obama addresses Congress about health care. Representative Joe Wilson from South Carolina shouts "You lie!" after the President denies that illegal immigrants will receive free coverage.

4) November, 2009: The House passes its version of health care reform by the narrow margin of 220 to 215.

5) December, 2009: On Christmas Eve, the Senate approves their version of the reform measure by 60 to 39 - the minimum needed to avoid a Republican filibuster.

6) January 19, 2009: Republican Scott Brown wins the Senate seat long held by the late Senator Edward Kennedy. The Democrats lose their filibuster-proof majority.


Now that both the House and Senate have passed versions of the bill, differences have to be ironed out. There are now four main scenarios for Congress:

1) Do nothing - a possibility because some rank and file Democrats may want to step away from such a controversial issue with elections less than a year away.

2) Cherry pick the most popular items in the reform bills (like cracking down on insurance companies and expanding coverage in more modest ways) and drop a comprehensive approach. But it will take time to assemble a smaller bill and a new proposal might not be supported by a Congress that has moved on to new issues.

3) Get the House to pass the Senate bill as is. House Speaker Nancy Pelosi has said this is not going to happen.

4) Pass the Senate bill along with "fixes" to satisfy the House through a process called "reconciliation," a complicated procedural path that cannot be filibustered and would allow the Democrats to ram it through with just 51 votes (instead of 60) in the Senate. This is the approach favored by Speaker Pelosi, who yesterday also raised the possibility of passing certain reforms separately while working towards more comprehensive legislation.


Comprehensive health care reform has eluded every President since Franklin Roosevelt. The odds of it finally happening will increase if proponents can muster public support by clearly and succinctly communicating the most important details of their plan. Otherwise, the reform that - yet again - they've arduously rolled up Capitol Hill may - yet again - roll back down like the boulder of Sisyphus.

For this week's CBS Doc Dot Com, CBSNews.com's Cali Carlin and I try to simplify health care reform, including the top four reasons why it's so desperately needed.
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