The 5 Big Health-Care Dilemmas

The 5 Big Health-Care Dilemmas

Max Baucus, the Senate’s point man on health care, sounds supremely confident when he talks about the odds that Congress will pass its most sweeping piece of social legislation since the New Deal. “Meaningful, comprehensive health-care legislation passes this year. That’s a given,” he declares, sipping a bottle of water in his functionally furnished hideaway office just steps from the Senate chamber. “It’s gonna pass. It’s gonna happen. There’s no doubt about it.”

The rest of us might be forgiven if we view Baucus’ prediction with a little more skepticism. After all, universal health care is a cause that comes around every 15 or 20 years in Washington, and Presidents as far back as Woodrow Wilson have tried and failed to make it happen. The last big effort, in 1993 and 1994, was a political disaster that set Bill Clinton’s presidency back a year or more.

And yet there are signals coming from Capitol Hill back rooms and corporate boardrooms that suggest things could be different this time. In recent weeks, health-care-industry leaders have pledged to cut their own costs by $2 trillion over the next 10 years . The insurance industry now says it is willing to make concessions it never would have considered before — like agreeing to set prices on policies without regard to an individual’s health history — in exchange for the access to the vast new market that would come with universal coverage. “Nobody here in our industry is defending or wants the status quo,” says Karen Ignagni, who heads the leading insurance lobby group. Perhaps most important, there is more agreement than ever before that for any health-care system to work, everyone — or nearly everyone — has to be covered.

It is now possible to glimpse the outlines of a Grand Deal among insurers, providers, business, labor and patients that would put most of its focus on lowering costs and establish a foundation for expanding coverage in years to come. The two key Senate committees expect to begin writing legislation this month, with the House also moving forward in coming weeks with what is expected to be a more liberal version. The Democrats’ goal is for both chambers to pass their versions by the end of the summer, work out their differences in the fall and have a bill on Barack Obama’s desk by the end of the year. “This window between now and the August recess, I think, is going to be the make-or-break period,” the President said on June 2, before a meeting with Senate Democrats. “This is the time where we’ve got to get this running.”

Obama, having studied the mistakes that Bill and Hillary Clinton made, has set broad goals but left it up to Congress to figure out how to reach them. “One measure of success is, Do we make the health-care system function better, more rationally, in a way that produces better outcomes and is less expensive” says his chief political adviser, David Axelrod. “The point is the results.”

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