The New Health Dialogue

As we were thinking about what might happen at the nationally-televised bipartisan health summit President Obama offered, we clicked over to Nate Silvers www.fivethirtyeight.com blog for some insight. He, alas, is still analyzing the Saints coaching and that gutsy onside kick... But maybe there's a parallel after all. Nontraditional, but aggressive, calls from the coach can change the momentum.

We aren't going to write anything more about football, because we would definitely get something wrong, but the summit, possibly the political version of an onside kick, does bring us back to the whole question of bipartisanship. We've written so frequently about bipartisanship, that it would take us until all this snow melts if we were to link to every post we've done on it. Suffice to say that as Meredith pointed out in a recent post, a lot of this -- not all of it, but a lot of it -- has been done out in the open, way more than critics allege. As Len Nichols has pointed out, (and Ezra Klein makes some similar points today) both the House and Senate health reform bills build on ideas that have long been endorsed by members of both parties, including the mandate. And during the storm and this snowed-in weekend, we've been reading "The Heart of Power: Health and Politics in the Oval Office" by David Blumenthal and James Morone. 

Blumenthal and Morone basically trace a lot of the current dialogue not just back to John Chafee and the Senate centrists in 1993-94, but even further, back to the Nixon years. It was a time, as the two authors see it, when a hybrid approach to expanding health coverage emerged, a hybrid that has dominated to this day. They call it "public policies operating through private institutions."  Nixon fought bitterly against the Social Security approach -- what we now call single payer. But he was also "the first Republican president too accept the premise that all Americans should have health insurance." He opposed radically changing the whole insurance system (part of it worked quite well back in the early 1970s!), but did focus on solutions for "the minority of Americans who lived without insurance."  No president -- indeed no major party nominee -- since then has proposed national health insurance provided by the government. Instead, the hybrid -- public policy (including policy embedded in the tax code) executed partly through private markets and institutions -- has been the dominant model.  They write, "the failed Nixon plan would become nothing less than the official Democratic policy wish."  Every subsequent Democratic nominee would offer variations of Nixon's plan --  filling in the gaps around employer provided health insurance.  The last few years have seen a change in that consensus -- and it's the conservative Republicans, with their calls for deregulation, "consumer-directed"  health care, cuts and vouchers, that have often offered the most notable breaks with the past.