The Alan Katz Health Care Reform Blog

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Posts Tagged ‘Hillary Clinton’

John Edwards’ Dangerous Rhetoric

Posted by Alan on January 2, 2008

Former Senator John Edwards talks often about two America’s: “The America of the privileged and the wealthy, and the America of those who live from paycheck to paycheck.” His populist message resonates well within the Democratic party and it has kept him among the top three candidates in most every survey taken. Usually, however, he’s in third place, and that makes everything from raising money to garnering endorsements to recruiting volunteers a bit harder. That’s why the Iowa caucuses are so critical for Senator Edwards. He needs to finish at least second to claim momentum. A third place finish merely confirms he’s behind Senators Hillary Clinton and Barack Obama. Fourth place or lower and it’s back to North Carolina.

Perhaps that explains why Senator Edwards has taken his populist message to a new and dangerous extreme. Senator Edwards is seizing on the recent tragedy of a teenage girl in California to demonize health insurance carriers and their executives. Late last month, Cigna denied Nataline Sarkisyan a liver transplant on the grounds it was experimental and, consequently, not covered. Without the assurance of being paid by the carrier, Ms. Sarkisyan’s doctors would not perform the transplant. After public pressure, including pickets at their office, Cigna relented. Unfortunately, Ms. Sarkisyan died before the procedure could begin.

The story is sad and complex. It’s easy, and lazy, to simplify what happened and ignore the subtleties. Should, for example, the doctors have performed the surgery and then worried about the money? Should they have recommended a treatment that only had a 65 percent chance of keeping the patient alive for six months? The Los Angeles Times, in its extensive coverage of the case, has done a good job of presenting these nuances. Senator Edwards has not.

Senator Edwards could have used the incident to define the difficulty of creating meaningful health care reform. Because as the Sacramento Bee’s Daniel has pointed out, Medicare and Medicaid might have made the same decision as Cigna — obtaining experimental treatment is always a judgement call whether the decision is made by a private company or a governmental agency.

Instead, Senator Edwards chose to use the tragedy as political fodder, employer language that would make the Association of Demagogues proud. According to the Des Moines Register, Senator Edwards is using the incident to ostracize the insurance industry from civil society. Here’s how the Register reports Senator Edwards as describing what happened:  “The doctors pleaded, the nurses pleaded, and finally, Americans started literally picketing and walking outside their offices…. And they finally gave in, and notified the family that they’d pay for it. But then a few hours later, she died. Because it was too late.”

This over-simplified description of what happened makes all insurance executives “Untouchables” in the mind Senator Edwards. Again from the Register: “The candidate paused for a second to let this sink in. Then his voice rose in indignation. ‘And people say to me that as president of the United States, they want me to sit at a table and negotiate with these people? Never. It will never happen.'”

I understand politics. I was Deputy Campaign Director for Tom Bradley in 1982 and worked alongside Joe Trippi, a Senior Adviser in Senator Edward’s campaign who has a significant impact on the Senator’s strategy and message (and who is someone for whom I have great respect). I understand the pressure to create an “us” versus “them” mentality in a tight election.

But Senator Edwards has stepped over a very important line. It’s one thing to debate the role of profits in America’s health care system. It’s fine to debate whether there should be private health insurance companies. Those are legitimate issues. But defining insurance executives — or anyone else — as unworthy to be in the presence of the president of the United States and, by implication, all right thinking people, that’s not legitimate. Once insurance executives are ostracized, who is next? Which executives or interest group is unworthy? Does the list continue to grow as the campaign heats up? Does the Senator’s enemies list include anyone who disagrees with him? This is a country built on tolerance of people and ideas. In descending into inappropriate rhetoric and a Nixonian mindset, Senator Edwards shows himself to be a politician who fails to grasp this vital aspect of America.

Maybe I’m being hypersensitive. But I’ve seen the “these people” used too often in the context of bigotry and stereotyping. (In addition to political work I’ve held leadership positions in organizations like the American Jewish Congress and the Westside Fair Housing Council). So I hope Mr. Trippi is not responsible for Senator Edward’s descent into this kind of de-humanizing rhetoric. I know him to be better than that. I don’t know Senator Edwards, but I hope he returns soon to the realm of civil discourse.

Senator Edwards is desperate to do well in Iowa. If this demagoguery is any indication, however, he’s doesn’t deserve to.

Posted in Politics, Presidential Election | Tagged: , , , , , , | 1 Comment »

Health Care Reform, Polls and Presidential Politics

Posted by Alan on December 26, 2007

Bill Robinson, a Palm Springs insurance agent and voracious researcher on health care reform issues, recently circulated a gem of an article concerning a seeming contradiction in how Americans view the health care system. The gist of the article,  posted in November by The Century Foundation and written by Maggie Mahar, is that Americans consistently denigrate the health care system while simultaneously claiming, by huge majorities, that it works just fine for them, thank you.

Comparing results from several polls, Ms. Mahar identifies this apparent discrepancy as resulting from Americans’ satisfaction with their own current health care coverage, but insecurity about how long they’ll be able to maintain it. With premiums rising, coverage contingent on sometimes precarious employment and, if I can add to Ms. Mahar’s list, politicians constantly claiming the system is broken beyond repair, widespread insecurity is not surprising.

At the same time, there are plenty of polls showing that people don’t have a lot of confidence in how Washington runs things, either. This creates an interesting quandary for presidential candidates. Most voters feel the system needs substantive changes, yet they don’t trust the government to make things better.

It’s no surprise then, that none of the major Democratic presidential candidates have called for a government-run single payer system. Instead they call for plans that expand the size and scope of public programs to varying degrees, but preserves the private system. There are differences between the plans: Senator Barack Obama focuses on affordability, Senator Hillary Clinton, former-Senator John Edwards and Governor Bill Richardson place more emphasis on universal coverage, with Governor Richardson distinguishing himself by avoiding the creation of any new bureaucracies.

What’s significant, however, is that the second most oft used phrase by the candidates is that “no one will have to give up their current insurance if they don’t want to.” (Still holding strong in first place is “The system is broken.”) The Democratic candidates, consequently, get to have it both ways, to a degree. They get to say they’re going to fix the current system with new regulations and public programs, but they’re going to preserve private sector involvement. This may play well in the general election, but it’s not likely to excite many of the more strident constituents of the Democratic party who will accept nothing less than a single-payer system (cue the California Nurses Association).

Republican candidates face a different challenge. They have an aversion to new taxes (or cutting back on existing tax cuts). And they don’t like turning private sector services over to the government. So they focus more on affordability with few, if any, new public programs. This addresses the “my coverage is fine” dynamic the polls identified, but it doesn’t face up to the demand for change. The result is the inverse of the Democrats’ dillema: the Republican candidates’ positions will get them through the primary season all right, but it’s going to look weak after the conventions.

As the Kaiser Family Foundation surveys and other polls have shown, health care is one of the most important issues voters expect presidential candidates to address. And as Ms. Mahar points out, the polls also indicate a nuanced understanding of the issue by voters. Since the candidate’s messages must be equally nuanced, their positions tend to clump together, with obvious differences between the parties. Consequently, the specifics of the candidates’ health care proposals are not likely to be decisive in garnering support, at least not early in the primary season. What will be more important than specifics is how their proposals reinforce their core messages.

Senator Edwards, for instance, needs to show that his plan will help the poor and middle class. Which is why he emphasizes universal coverage. Senator Clinton’s program needs to underscore her claim of competency and experience, which she does by highlighting the differences between this plan and the one she pushed in her husband’s administration. Senator Obama represents a break with the past, which means his opponents do him a favor by attacking his plan. And Governor Richardson brings to the campaign broad government experience at the state and federal level. His plan underscores this by redeploying and expanding existing public programs, not creating new ones.

The importance of the health care reform issue, and of the candidates plans, will change over time. For now, however, they are mirrors of the candidates’ themes.  Which, given the seeming contradictions in the polls, is no doubt the wisest political strategy.

Posted in Health Care Reform, Healthcare Reform, Politics, Presidential Election, Single Payer | Tagged: , , , | 1 Comment »

On Drivers Licenses, National Health Care Reform and Clinton Inevitablility

Posted by Alan on December 2, 2007

It would be ironic if whether Senator Hillary Clinton leads the upcoming national health care reform debate is decided on the issue of driver licenses for illegal immigrants, but that may be what’s happening.

Here’s the (il)logic: Senator Hillary Clinton’s campaign is based, in large part, on convincing voters and contributors that her election is inevitable. (This is a page out of Governor George W. Bush’s playback back in 1999 and it worked for him). Yet in a debate last month, Senator Clinton stumbled on a question involving providing driver licenses to those in the country illegally. Her convoluted answer seemed to both support and oppose the measure — maybe.

This stumble, in turn, reminded voters, at least in Iowa, of Senator Clinton’s image as a First Lady who had trouble speaking frankly and forthrightly. Clearly some voters found this troubling. As a result, Senator Barack Obama moved up in Iowa polls. (For a list of poll results in Iowa and elsewhere, check out RealClearPolitics.com).

Losing ground in polls is not good for an inevitability strategy. Losing the first vote in the nomination process is even worse. Senator Clinton needs to win in Iowa. To regain momentum Senator Clinton’s campaign went on the offensive against Senator Obama and one of the major lines of her attack involves health care reform. (Admit it, you were wondering if I was ever going to get back to the topic of this blog). But the tact she took seems to have been counter-productive. She claims that Senator Obama’s proposal is inadequate because it doesn’t achieve universal coverage in the way she believes it should be achieved — through a mandate that all individuals obtain coverage. (The New York Times‘ coverage of the November 15th debate in Nevada captures the tone of the two Clinton-Obama tussle on health care reform).

Yet Senator Clinton’s attacks seem to have damaged her own campaign more than Senator Obama’s, perhaps by reminding voters of her “my way or the highway” approach to reform in the 1990’s. Bringing to mind her reputation for inflexibility, not to mention her greatest political and policy failure, is not a recipe for electoral success. Senator Clinton now trails Senator Obama in most Iowa polls.

This may not mean much as polls roughly 30 days prior to the Iowa caucuses sometimes fail to indicate much of anything. Four years ago, former Governor Howard Dean and former Representative Richard Gephardt were riding high in those polls; Senators John Kerry and John Edwards were in single digits. Yet it was the two Senators who wound up finishing one-two on election day.

That the Clinton campaign has let a poor answer to a debate question lead them into a fight over health care reform generates a long list of ironies. What’s interesting is that the debate between Senators Clinton and Obama is more about tenor than goals. Senator Clinton focuses on universal coverage through an individual mandate and making coverage affordable through subsidies. Senator Obama focuses on bringing down the cost of health care and health insurance, bolstered by employer mandates. (It’s interesting to note this chicken-and-egg debate over mandates and affordability is similar to what’s happening in California, as described in an earlier post).  

Whether President Hillary Clinton is as inevitable as President George W. Bush was eight years ago is yet to be determined. If it’s not to be, however, one reason will be because of the drivers license answer — and what it drove her to do on health care. And that must be driving her campaign nuts.

Posted in Arnold Schwarzenegger, Health Care Reform, Healthcare Reform, Politics, Presidential Election | Tagged: , , | Comments Off on On Drivers Licenses, National Health Care Reform and Clinton Inevitablility

Clinton Unveils Her Health Plan

Posted by Alan on September 17, 2007

That was then. This is now.

Then was when, as first lady, Hillary Clinton led the charge for health care reform. Her proposal was so unwieldy,  politically naive and arrogantly promoted that it helped Republicans take over control of Congress for the first time in over 40 years and set back the cause of health care reform by over a decade.

Now is when, as presidential candidate, Senator Hillary Clinton needs to put that history behind her and talk to the future. Which is what she did in Iowa today, unveiling the 2007 version of her health care reform plan.

Her approach this time is to be less original, less ambitious and less arrogant. Instead her new plan shares much in common with several other proposals making the rounds — including those of her rivals for the Democratic presidential nomination. This isn’t a bad thing; quite the contrary. It not only lends her plan credibility, but it provides political cover when it comes under attack.

So, for example, she shares with Governor Bill Richardson the concept that if people are satisfied with their existing coverage, they can keep it. She borrows from both Governor Richardson and Senator Barack Obama the idea of using refundable tax credits to help lower income Americans pay for their coverage. And, like Governor Richardson and former-Senator John Edwards she incorporates the idea of a requirement that all Americans obtain health care coverage and expanding MediCare eligibility.

Like many health care reform proposals — at least Democratic reform proposals — Senator Clinton would require insurers to accept all applicants without regard to their risk profile. As previously noted, she wisely balances this with a requirement that all Americans obtain coverage. What’s unclear is how she would enforce this requirement. Poor compliance by consumers would lead to the burden Senator Clinton’s state of New York bears: average insurance premiums roughly 350 percent higher than those in California.

Senator Clinton makes a major point out of avoiding the creation of new bureaucracies (another approach she shares with Governor Richardson). However, there’s something a bit disingenuous about this claim. True, instead of creating a new government health care program she would open up the Federal Employee Health Benefit Program to all Americans. However, the expansion required of the FEHBP to manage such growth would be the actuarial equivalent of creating a new bureaucracy. But with the added downside of probably disrupting the agency’s current mission.

As with all the health care reform plans put forward by presidential candidates, Senator Clinton’s proposal is more a window into her thinking than a blue print for reform. The new president will need to work with Congress to fashion a detailed reform structure. There will be plenty of debate and shaping of ideas in that process. The outcome may resemble what’s being described today, but then again, it may not.

Yet this glimpse into the approach of Senator Clinton is illuminating. By avoiding a single payer approach she demonstrates her willingness to take on the most liberal elements of her party. By imposing requirements on both corporations and individual she invites attacks from conservatives concerning a heavy-handed government approach to health care. In short, given the context of the health care reform debate as it exists today, Senator Clinton’s package is somewhere in the middle (ok, maybe a bit left of the middle, but close enough for government work). This positioning might be expected in the general election, but its a risky move in the primaries. However, it also demonstrates that Senator Clinton learned something then and she’s applying those lessons now.

Posted in Health Care Reform, Healthcare Reform, Politics, Presidential Election | Tagged: , , , | 2 Comments »

Senator Barack Obama’s Health Care Reform Plan

Posted by Alan on May 29, 2007

Illinois Senator Barack Obama revealed his plans for achieving universal health care coverage today in Iowa. Text of Senator Obama’s Health Care Reform Speech. In the context of the Democratic presidential primary it’s a centrist approach which reveals much about his political philosophy and approach to policy making.

Senator Obama has previously pledged to sign a bill assuring universal health insurance coverage for all Americans. His preferred approach is an interesting mix of public and private offerings.  Senator Obama’s plan would enable all Americans to buy into a government run purchasing pool offering coverage similar to that provided to federal employees. Senator Obama calls for subsidies to help low and middle income families afford this coverage, although his speech didn’t provide details as to the amount of the subsidy or who would qualify.

Coverage through the pool would be provided on an individual basis, meaning it would remain in force even if the insured changed jobs. To pay for the subsidies, Senator Obama would let President George W. Bush’s tax cuts for the wealthiest Americans expire. He’d also levy a tax on “all but the smallest employers” who fail to provide eligible coverage to their workers.

Interestingly, unlike former North Carolina Senator John Edwards, Senator Obama does not seem to require individuals to purchase coverage. If his voluntary approach doesn’t succeed, he’s prepared to revisit the plan until 100 percent of the population is insured.

Unlike many Democratic proposals, Senator Obama explicitly called for assuring choice in the marketplace, “If you want more choices, you will also have the option of purchasing a number of affordable private plans that have similar benefits and standards for quality and efficiency.”

Central to Senator Obama’s health care reform plan are five initiatives aimed at constraining health care costs:

1.  Shifting some expenses for catastrophic health care expenses to the federal government.

2. Requiring all plans to cover “evidence-based, preventive care services” and the promotion of healthier lifestyles.

3. Reduce the $100 billion a year he estimates is wasted on poor quality care by requiring hospitals and providers to “collect, track, and publicly report measures of health care quality.”

4. Reducing waste and inefficiency through adoption of electronic medical records and other technologies.

5. Reforming the pharmaceutical and health insurance industries.  These reforms include stopping drug company practices which drive generic drugs out of the market and, interestingly, taking on insurance industry consolidation.  Noting there were over 400 health plan mergers in the past 10 years, Senator Obama pledged to investigate and prosecute the monopolization of the insurance industry. And where we do find places where insurance companies aren’t competitive, we will make them pay a reasonable share of their profits on the patients they should be caring for in the first place.”

Taken together, Senator Obama claims his cost cutting measures are expected to reduce average health insurance premiums by $2,500.

There’s a lot of details still needed to fully flesh out the Senator Obama health care reform plan. But today’s speech goes a long way to adding substance to the broad rhetoric of the past. Significantly, Senator Obama rejects the single payer system solution promoted by the liberal wing of the Democratic party and many unions. While he doesn’t explicitly criticize this approach, he does throw an implicit elbow there way when he promises that his approach means, “If you need to see a doctor, you will not have to wait in long lines for one. If you want more choices, you will also have the option of purchasing a number of affordable private plans that have similar benefits and standards for quality and efficiency.”

While rejecting a single payer approach will cost him some votes in the Democratic primaries, it positions him well for the general election if he gains his party’s nomination.  And by focusing the bulk of his speech on the need for cost containment, Obama demonstrates a sophistication on the health care reform issue often lacking in the political debate. Further evidence of his nuanced approach is a recognition that even insurance and drug companies deserve a seat at the table, even if “they don’t get to buy every chair.” All of this is evidence of a realism too often missing from the debate.

There’s much to be concerned about in his approach. One example: government run purchasing pools rarely perform as promised and usually create an unlevel playing field in the market. Another: Requiring carriers to sell coverage to all applicants, regardless of pre-existing medical conditions, without a mandate for individuals to buy coverage is a recipe for disaster. Just ask folks in New York and New Jersey.

But I doubt if Senator Obama expects his plan to be enacted as is. While promising to sign a universal coverage bill by the end of his first term, Obama has long taken a reasonable approach to reform: stay focused on the goal, but to be “agnostic in terms of how to achieve those values.” And that’s the way politics should work.

Posted in Health Care Reform, Healthcare Reform, Politics, Presidential Election | Tagged: , , | 5 Comments »

Hillary Clinton on Health Care Reform: Part II

Posted by Alan on March 28, 2007

“We’re going to have universal health care when I’m president — there’s no doubt about that. We’re going to get it done,” said presidential candidate Senator Hillary Clinton in Iowa on March 26th.  Whether this prediction comes true depends on a lot of things, most important among them: will she ever be the president and will she have the political clout to get meaningful reform enacted? As discussed in my last post, her track record on this isn’t so good.

What would Clinton health care reforms look like in a Hillary Clinton administration? She hasn’t yet provided a lot of details, but in the past week she’s at least begun to provide their outline.

Speaking at a Las Vegas candidates forum on March 25th, Clinton noted “fixing” health care would be an incremental process taking two terms of her presidency. “We all are going to try to start as soon as possible.  We can move quickly, but make no mistake, it’s going to be a series of steps.”

Clinton favors “guarantee issue” provisions, which requires insurers to accept all applicants regardless of their health conditions. At least that’s what she implied in Las Vegas. According to the Las Vegas Review Journal, Clinton claimed “Insurance companies make money by spending a lot of money and employing a lot of people to try to avoid insuring you ….” The Review Journal further reports her as calling for “an end to ‘insurance discrimination’ against people with pre-existing medical conditions.”

Let’s hope she’s not considering her home state of New York’s approach to guarantee issue, which is pretty much a disaster. As previously posted in this blog, the New York approach costs its citizens thousands of dollars each year. Consider: the average annual premium for a single New Yorker is $3,743 compared to $1,885 in California. For a family, the average annual premium in New York is $9,696 while a California family pays, on average, $3,972 per year. Given this, one hopes Clinton is considering a more nuanced approach to guarantee issue.

Unlike some of her challengers for the Democratic Party presidential nomination, Clinton seems to reject a single payer system. Here’s a portion of the transcript from the Iowa town hall meeting:  “I think we have to have a uniquely American solution to health care because we’re a different kind of country than anybody else.

“I think we will move toward requiring employers to participate the way Massachusetts does or the way California is considering. … And if you don’t insure your employees you’re going to have to pay some kind of per-employee amount so that everybody can be given insurance.” (Here’s the full transcript of the town hall meeting as posted by ABC News. The health care reform discussion begins on page 2 of the transcript).

While not supporting a single payer approach, Clinton does see the government as being an insurer of last resort for consumers who don’t get coverage from other sources such as their employers. And she would require individuals to buy coverage, presumably through this state program, with costs being borne by employers who don’t purchase coverage. As she notes, this mirrors the health care reform proposals enacted in Massachusetts by then Governor Mitt Romney and proposed in California by Governor Arnold Schwarzenegger.

Clinton is staking out a middle ground on health care reform. She’s going to get tough on insurance companies, but continue to rely on employer sponsored coverage. She’s supporting a government health plan for more Americans, but it won’t be completely government run. This may surprise some, and it should serve as fair warning for all. Remember: even if her presidential bid fails, Senator Clinton will be a powerful voice in the U.S. Senate on any health care reforms the new president has to offer.

Posted in Health Care Reform, Healthcare Reform, Politics, Presidential Election | Tagged: , | Comments Off on Hillary Clinton on Health Care Reform: Part II

Hillary Clinton on Health Care Reform: Part I

Posted by Alan on March 26, 2007

The botched attempt to pass comprehensive health care reform remains one of the seminal events of the Clinton Administration. It was the first time a First Lady was given responsibility for passage of such an immense public policy undertaking. Hillary Clinton undertook the responsibility with zeal, deploying a massive task force to thoroughly examine the issues and deliver a solution to the American people.

What they came up with went down in flames.

In part, this stems from the political deafness displayed by now Senator Hillary Clinton and members of her task force. There was the brilliant way they demeaned and ignored members of Congress, the rightousness in which they cloaked their arguments and the arrogance. Oh, the arrogance.

In one memorable instance for insurance agents, Hillary Clinton told Lori Proctor, a broker from Ohio, that there being no role in her plan for agents was OK, because, “… someone as bright as you could find something else to do.” An arrogant response to a legitimate question, made more foolish by making it in front of a Wall Street Journal reporter.

My favorite example of the Clinton Task Force arrogance came from Walter Zelman, formerly a deputy California Insurance Commission under (now Lieutenant Governor) John Garamendi. He explain that when Garamendi tried to remake California’s health care system it required a document of only a couple dozen pages. Now, as a member of the the Clinton Administration, he was pleased they had hundreds of pages worth of reform because that’s what it took to cover all the possible consequences of the Clinton plan. The audacity of believing a group of people could impact one-fifth of the nation’s economy and not come afoul of the law of unintended consequences, struck me as monumental folly — and unmatched arrogance.

I led the National Association of Health Underwriters’ legislative efforts during the Clinton health care debate. At one point I had the priviledge of testifying before four Congressional sub-committees in a single week. What the Clinton forces did manage to do is raise health care reform to the dominate political issue of its time. What they failed to do was accomplish anything, a squandering of an opportunity that impacts the country — and the health care reform debate — to this day.

So now Hillary Clinton is running for president. What would be in store for the country if she were to win? That’s the topic of my next post.

Posted in Health Care Reform, Healthcare Reform, Politics, Presidential Election | Tagged: , | Comments Off on Hillary Clinton on Health Care Reform: Part I

Proof of the Govenor’s Clout

Posted by Alan on March 19, 2007

My last post commented on Governor Arnold Schwarzenegger’s political clout and how it will shape the health care reform debate. A recent article provides some proof.

In addition to gloating over the Governor’s seeming inability to get his reform package introduced as legislation (see my previous post), many took glee in the hurdles the Administration faced in obtaining the federal funding he needs to finance his proposal.

No more glee for thee! Mike Leavitt, U.S. Department of Health and Human Services Secretary recently committed the Bush administration to supporting nearly all of the govenor’s $3.7 million request to increase Medi-Cal funding. According to the Sacramento Bee, in an article written by Judy Lin and published on March 15th, the remaining shortfall will be forthcoming once the state submits the proper paperwork. Pretty impressive considering the White House has proposed Medicaid cuts (Medi-Cal is the state’s version of Medicaid).

Maybe any California Governor could have pulled this off. We’ll never know as we only get one governor at a time. At the very least, this breakthrough reinforces the message of my earlier post: it’s not the bills you introduce, it’s the the clout you wield. There’s a long way to go before the end of the health care reform debate in California. With or without legislation embodying his overall plan, the Governor is showing he’s going to shape it.

Posted in Arnold Schwarzenegger, California Health Care Reform, Health Care Reform, Health Insurance, Healthcare Reform, Politics | Tagged: , | Comments Off on Proof of the Govenor’s Clout

On Schadenfreude and The Timing of Political Power

Posted by Alan on March 18, 2007

There’s a lot of quiet sniping about Governor Arnold Schwarzenegger’s failure to have his administration’s health care reform package introduced as legislation. The smell of schadenfreude is in the air and you almost hear them say, “He may be a movie-star-gazillionaire-governor, but we have a bill and he doesn’t!”

Big deal. What the Governor does have going for him is, well, he’s a movie-star-many-multi-millionaire-governor. Cripes, he even appears on The Apprentice. He has what’s known as clout. The ability to shape debates and influence legislation. He’s above needing a particular bill. He has the power to hijack most any of them.

The fact is, no bill becomes law as introduced. They are shaped by amendements, compromises and, sometimes, the force of powerful individuals. Look at what happened with AB 1672, the small group health insurance reform bill of the 90’s. You can trace it’s genesis back to AB 350, introduced by then Speaker of the Assembly Willie Brown. It would have created a “pay-or-play” system in California. It sparked the reform debate, but never became law. Instead, a conference committee was convened for AB 1672, which as originally introduced dealt with auto insurance, if I’m not mistaken. Stakeholders negotiated for months and the result was a very good piece of legislation.

The moral of the AB 1672 story is, the health care reforms being introduced now are merely the starting point. Eventually real negotiations will start. The political sausage making process will kick in and the political clout the governor enjoys will come into play. It would be fun to watch if the outcome wasn’t so darn important.

Posted in Arnold Schwarzenegger, California Health Care Reform, Health Care Reform, Healthcare Reform, Politics | Tagged: , , | Comments Off on On Schadenfreude and The Timing of Political Power