The Political Feasibility of Health Care Reform

The problem of health care has surfaced again this year as a political issue against a backdrop of rising unemployment, increasing health costs, and a growing number of Americans without health insurance.

I examined the political climate for expanding coverage and looked at some current proposals to achieve this goal this spring. You can find my analysis here.

Some political observers have questioned whether the political system in the United States allows for significant health care reform that would cover most Americans.

Health care is on the political agenda, substantive plans that address the problem abound, and yet the same could be said in 1973 and 1993, when major reform efforts failed.

This raises an important policy question: What is politically feasible?

Two recent papers by respected policy analysts in the journal Health Affairs address this question; one by Uwe Reinhardt; and one by Jonathan Oberlander.

The two papers point out several obstacles to reform, including:

• The institutional structure of the U.S. government, and particularly congress, favors the status quo over change.
• The moral imperative to provide health coverage to all has not been persuasive even in times of budget surplus, and is unlikely to prevail in a time of deficits, when action would involve increased taxes or the loss of other programs.
• The 15% of Americans without health care coverage are diverse and do not speak with a unified political voice.
• The 85% of Americans who are covered are wary of change that could increase their costs or decrease their benefits.
• The health care industry (sometimes dubbed the "Medical Industrial Complex") commands a large and growing share of society's resources and is defensive towards any perceived threat to this economic power.

Neither author is very optimistic about the chances for achieving anything more than incremental improvement in the near future.

However, both Uwe Reinhardt and Jonathan Oberlander feel that the continuing policy discussion is worthwhile, because every so often the political stars align and significant reform is possible, as evidenced by Medicare in 1965.