Richard Nixon: Health Reform Visionary

In 1974, President Richard Nixon addressed Congress on the issue of health care. Said Nixon “Without adequate health care, no one can make full use of his or her talents and opportunities. It is thus just as important that economic, racial and social barriers not stand in the way of good health care as it is to eliminate those barriers to a good education and a good job.”

Nixon went on to explain that the rising cost of health care placed too many American families in danger of being wiped out by a catastrophic illness. Our health insurance system was flawed according to Nixon because too many Americans were uninsured and unable to obtain insurance due to low pay, unemployment or pre-existing conditions and still millions more who had coverage lacked “balanced, comprehensive and fully protective” coverage.

To address the problems, Nixon proposed the Comprehensive Health Insurance Program (CHIP). Nixon pledged that CHIP would allow every American to obtain comprehensive insurance, that no American would pay more than he or she could afford, and patients will be free to choose their doctors. According to Nixon, CHIP would build on America’s existing private insurance market, promote effective use of health care resources, and use public funds only when necessary – all without requiring new taxes.

CHIP contained three key elements: Employee Health Insurance, Medicare, and Assisted Health Insurance.

• Employee Health Insurance – Employers would be required to provide health insurance to their employees, these benefits would need to meet minimum benefit requirements set by the federal government, and employers would be required to cover 75% of the cost of the insurance premium. There would also be a limit placed on annual out of pocket expenses.
•  Medicare – CHIP would reform Medicare to add coverage for outpatient prescription drugs and it would place an annual limit out-of-pocket expenses. Medicare would also be required to meet the same minimum benefit requirements established for employers.
•  Assisted Health Insurance – CHIP would have replaced the Medicaid program with a new federal/state program to provide health insurance to everyone not covered by Employee Health Insurance or Medicare. This program would also be available to those with pre-existing conditions who were unable to obtain care from private insurers. Premiums and out-of-pocket expenses would vary depending upon income with low income persons paying nothing. The program would have the same minimum benefit package as Employer Health Insurance.

Nixon argued that CHIP would require no new taxes and would save families money. To better control ever rising health care costs CHIP would rely on Health Maintenance Organizations that would end the days of fee-for-service medicine that incentivize the overuse of service and instead rely on prepaid arrangements with physicians and other providers. CHIP also would create Professional Standard Review Organizations (PRSOs), staffed by physician, an empowered to review best practices and find ways to reduce needless hospitalization.

Every person participating in CHIP would receive a Health-card. Modeled after a credit card, it would offer proof of insurance and provide information on blood type and any medical conditions or drug allergies that may be important to know in an emergency.

The Watergate scandal that ended the Nixon presidency also ended CHIP. Congress had no interest in considering comprehensive reform proposed by a President likely to be impeached.

But good ideas never die. Look to the legislation currently being considered in the House of Representatives or being debated in the Senate Finance Committee and you cannot help but see Nixon’s CHIP. Legislation in the House and Senate rely on employer mandates and establish minimum benefit requirements, the House legislation is likely to include a so called “public option” which is exactly what Assisted Health Insurance under CHIP was, both the House and Senate are proposing to create review bodies to promote efficient and effective resource use, both are likely to prohibit insurers from denying coverage based on pre-existing conditions, and both will rely almost exclusively on the existing private insurance industry to provide coverage.

There are some differences – Nixon wanted CHIP to be voluntary for individuals, no one was required to purchase insurance, but the House and Senate will likely include individual mandates. Neither the House nor the Senate will establish annual caps on out-of-pocket expenses for Medicare beneficiaries and prescription drug coverage was added in 2003 (30 years after CHIP proposed adding it). The House and Senate will also maintain the Medicaid program and in fact expand it. And HMOs have long since fallen out of favor – quite unfairly.

But these differences do nothing to diminish the fact that we are today engaged in a great debate over whether to at long last enact health reform first introduced by President Nixon in 1974. It’s not the first time, or even the second time, that we have considered CHIP – President Clinton’s Health Security Act, introduced in 1993, was essentially Nixon’s CHIP, right down to the health card and reliance on HMOs. Clinton dropped the public option and added an individual mandate, but otherwise it was very much CHIP.

So here we are in 2009 considering a reform first proposed in 1974… at what point does a proposal become too old to be deemed dangerous or radical? Nixon’s Comprehensive Health Insurance Program was a good idea in 1974 and it is a good idea today. We may never see single payer in the US, but we could move closer to the German model via the reforms currently on the table.

Is the Senate Really in Play?

Charlie Cook has some eye opening news over at National Journal - the Democrats may not have long to enjoy their 60 vote super-majority.  Cook counts Harry Reid (NV), Blanche Lincoln (AR), Christopher Dodd (CT), and Michael Bennett (CO) as endangered and sees a real chance for Republicans in DE and NY, not to mention the open seat in IL that has been tainted by scandal. That's 7 seats. Now add Arlen Specter (PA) and Barbara Boxer (CA) as each may face serious challenges as well - that totals 9 seats. If Republicans ran the board then Democrats would have a bare majority of 51 to 49 - and one of those seats would belong to Joe Lieberman - so let's say 50 to 49 to 1 - and Lieberman recently hinted that he may join the GOP... Now, this of course assumes that current trends hold and that the GOP does run the board (both are unlikely) - but the fact that such an outcome is even possible just speaks to how far the Democrats have fallen since their high in November of last year... the truth is, if the GOP gains as few as 4 seats President Obama's agenda will need to be drastically altered. Current polling already shows the Republicans within striking distance of recapturing the House.

Public Option's Big Day

See my post at the FreeStater Blog for an update and analysis.

Today will be a decisive day in the health reform battle. Today, the Senate Finance committee will decide whether or not to amend the Baucus bill to add a public option. The Committees 13 Democrats and 10 Republicans will consider no fewer than 4 "public option" options and at this point, no one knows what will happen. Most counts find 9 Democrats in favor of a public option and no Republicans. Max Baucus, not one of the 9, has said he supports a public option but does not believe that it can pass in the Senate (assuming a 60 vote threshold). Blanche Lincoln, Blue Dog Democrat from Arkansas, is an unknown quantity. She is slowly inching toward the endangered senator list - like several Democrats up for re-election in 2010 her seat was once deemed to be safe, until the health care debate changed the 2010 electoral calculus. There is also the issue of Olympia Snowe and her support of a state-based public option trigger - a trigger that would only be pulled if private insurance reforms fail. At least 2 Democrats support Snowe's alternative. If the Senate Finance Committee adds the public option, in form other than Snowe's trigger, then all bets are off with regard to Democrats using reconciliation to pass the bill - they will use reconciliation. Then the battle will shift to the House where leaders will put heavy pressure on select Blue Dogs just to get the simple majority needed there. Today is one of those rare, high drama days in American politics and a day worth closely following.

The Finance committee meeting will begin at 10 AM and will likely be broadcast on C-SPAN.

Hyper-Partisanship and the Weakening of Democracy

Charlie Cook at National Journal offers some great reasons for redistricting reform. From Cook: "When I first came to Washington in September 1972, Congress abounded with conservative and moderate Democrats, as well as liberal and moderate Republicans. These lawmakers provided the ballast that prevented their parties from going to extremes. They kept the Democrats from driving into the ditch on the left and steered Republicans away from the one on the right."

The lost center in American politics is poisoning our system and weakening our democracy. It turns legislating into a winner take all war rather than the exercise in compromise that our framers intended. When our representatives engage in this brand of politics it discourages moderate voters and emboldens partisan voters - the result being an even more partisan Congress. As Congress becomes so hyper partisan normal rules of procedures are ignored and bypassed. Sarah Binder and Michael Mann at Brookings have a great review of the 110 Congress and show that the use of restrictive rules of debate and amendment in the House, bypassing the normal committee process in the House and Senate, and simply ignoring the Conference process have become the norm. The practices were begun by the Republicans in 1995 and have only gotten worse.

These abuses of process reduce the minority party to a non-entity with little recourse but to serve as an obstructive force. The result is a zero sum game politics where each legislative battle is treated like an all out war. These legislative battles then influence the politics of the voting public. Republican and Democratic voters each view the other as a threat, one that cannot be tolerated, can never be accepted as legitimate. Anger and hate naturally follow. Ends justify the means politics ensue as each side views its policies as superior and noble.

The threat by the Democrats to use reconciliation to pass health care reform is just one more example of our poisoned politics. I have taken serious flak for my support of Max Baucus and his efforts to forge compromise health reform. To be sure, the Baucus plan is flawed and would not bring the fundamental reform we need. So why do I support it? Because Baucus has demonstrated a clear respect for the process of legislating. He has sought compromise and he is seeking a bill that can pass without bypassing the normal procedures of legislating. Baucus represents a Congress of a bygone age... and the best hope of bringing that Congress back. In the process, he may just save our politics. In the end, that is far more important than any one single piece of legislation.

About that New CBS News/NY Times Poll

As all other polls show the president hovering around 50% approval, with little improvement regarding his handling of health care along comes a new poll from CBS News and the NY Times suggesting that the president has a 56% approval rating. It also suggests that he now has a plurality 47% to 45% supporting his handling of health care reform...


So what's the problem? Look to the last page of the poll release and you see that the original sample was 28% Republican, 34% Democrat, and 38% Independent - no too far off from recent surveys of party ID. But then the polling firm weighted the sample such that it was 22% Republican, 37% Democrat, and 41% Independent - from a6% Democrat advantage to a 15% advantage.

What effect did that have? If the pollsters had relied on the original sample (no weighting) the president's approval rating would be 53% and his approval/disapproval on health care would be 44%/48%. That would mean that he gained no ground on health care after his media blitz and that his approval rating fell since August. I guess that neither CBS nor the New York Times felt like reporting that story...

Is Health Reform Really that Close?

Jay Cost at RealClearPolitics offers an interesting take on where things stand on health care reform - like me, he's trying to figure out just what Nancy Pelosi is trying to accomplish by dissing the Blue Dogs. What I have to ask as well is - how far are Democrats willing to go to pass what is essentially pretty basic reform.

From Cost:
"Some commentators have suggested that the Democrats are pretty close to finalizing a comprehensive bill on health care. But like Mickey Kaus, I am not as certain. Last week, I listed several questions I had about the bill's progress. Here's an update on that post, plus a few extra considerations."

"In other words, the conditions of uncertainty are severe, to say the least. That's why I still have nothing but questions. And as for my prediction for a comprehensive bill passing...how about this: I'll put it at 50% with a standard deviation of 25%, for a practical range of 25% to 75%. "

The Democratic party is deeply divided over health reform, it will be difficult to find common ground. Democrats know that they can use reconciliation to pass "Liberal" reform with only 51 votes in the Senate - but can they really get to 218 votes in the House without the Blue Dogs? And, would the Democrats be willing to use reconciliation knowing that it would embolden Republicans and boost GOP chances in the 2010 midterms? The simple fact is, neither the House or Senate have proposed reform so fundamental that it would be worth risking the Democrat's majority status just to pass it. If Democrats really think that they have the votes - they should just swing for the fence and push for single-payer...

St. Mary's College to Host Forum on Health Care Reform

The debate over health care reform in the last few months has featured plenty of yelling, a lot of finger-pointing and a shortage of dialogue.

Todd Eberly, an assistant political science professor and coordinator of Public Policy Studies at St. Mary's College of Maryland, hopes to bring some civility to the rancorous issue on Monday, Sept. 28, when three health policy experts offer diverse viewpoints at the school.

The forum, called "Beyond the Shouts: A Discussion of Health Reform in America," came about after Eberly, who spent 10 years as a health policy analyst before coming to St. Mary's, grew frustrated about the lack of conversation at congressional town hall meetings nationwide this summer.

No politicians will be on the college's panel in an effort to foster a productive flow of information and exchange of ideas. The three panelists each have different perspectives on health care reform:

• Greg Scandlen, founder and director of Consumers for Health Care Choices, opposes President Obama's health care proposal and advocates for individual freedom and a consumer-driven health system.
• Margaret Flowers, a pediatrician-turned-health activist who is a Congressional Fellow of Physicians for a National Health Care Program, which supports a single-payer national health system that would eliminate private insurers.
• Karen Davenport, director of health policy for the Center for American Progress, a left-leaning think tank that supports Obama's quest for health care reform.

Each presenter will have 10 minutes to talk about health reform before a question-and-answer session.

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