Uplifting as it was to see insurance executives, pharmaceutical manufacturers, hospital officials and doctors gather at the White House on May 11, pledging cooperation toward health care reform, nothing they said or did was inconsistent with precisely the opposite objective. According to the famed pollster who is helping Republicans in Congress to block reform, in fact, the first critical step toward stopping real change is pretending to support it.
“You simply MUST be vocally and passionately on the side of REFORM,” urges a recent strategy memo authored by Frank Luntz, the opinion research expert who has counseled Republicans since the heyday of Newt Gingrich. “The status quo is no longer acceptable. If the dynamic becomes ‘President Obama is on the side of reform and Republicans are against it,’ then the battle is lost. …”
The same advice that Mr. Luntz provided to the Republican Party leadership applies with equal force to the corporate opponents of reform, who appear to have grasped the political realities of the moment. So when the lobbyists who have long protected the profits and privileges of Medicine Inc. stand beside President Obama and declare their determination to help, they are simply following the script. Whether those organizations are actually willing to accept government action that will bring lower costs and universal care remains very much in doubt.
Taken at their word, the voices of the lobbyists sounded promising—especially in contrast to the multimillion-dollar propaganda war they launched against the Clinton administration’s attempt to reform the health system in 1993. In a letter to the president, they agreed to implement new measures that would reduce costs, presumably including some of the ideas that have been endorsed by the Obama administration. Without offering any details, the lobbyists estimated that their proposed changes would reduce the growth in health care costs by 1.5 per cent annually—or about one-fifth of the current, unsustainable rate of 7 percent. In terms of the national budget, that would amount to approximately $2 trillion over the next 10 years.
Administration officials and many supporters of health care reform regard those promises as a sign of real progress. Of course, it is to be hoped that they are right. But it is equally likely that the times have changed more than the lobbyists—and that the real motive for the industry’s newly friendly posture is to foreclose the kinds of reform that would cut costs, expand coverage and outlaw the financial and medical abuses that demand reform.
How will we know if the lobbyists have truly reformed themselves? They would have to agree to implement the kinds of successful changes that transformed the Veterans Administration, including computerized health records and comparative effectiveness regimes. They would have to stop fighting government efforts to reduce the cost of drugs and medical devices. And perhaps they will even withdraw their ferocious opposition to a public insurance option—which would serve as what the old New Dealers used to call a “yardstick” to measure the performance of the private sector.
Serious reformers, including Andy Stern, the leader of the nation’s largest health care union, say they believe that the industry coalition is committed to real cost control. But for the moment, at least, the most prudent course is to assume that their goal is to preserve profits—and to achieve the goal laid out by Mr. Luntz in his memo to the Republicans.
“You’re not going to get what you want,” he warned, “but you can kill what they’re trying to do.”