Health Care Reform: Postelection Possibilities

Abstract

Previously we examined health care system reform proposals of major candidates in 2008 Presidential Primaries (Flint & Gorin, 2008). Whatever outcome of 2008 election, pressure for reform is not likely dissipate. In this article we assess current climate for and possibility of reform. We also identify and discuss four current approaches--conservative reform, a single-payer system; private--public models; and state reform. BACKGROUND Readers of this journal are well aware of problems facing our health care system, particularly in areas of access and cost. More than 47 million Americans are completely uninsured, and number of underinsured people (that is, individuals with inadequate coverage) has reached 25 million, having grown 60 percent between 2003 and 2007 (Schoen, Collins, & Kriss, & Doty, 2008). According Urban Institute, 22,000 adults (ages 25 64) a year die because of a lack of health insurance (Dorn, 2008). Although health care inflation has slowed in recent years, this modest respite is likely temporary (Ginsburg, 2008). Despite recent moderation in medical care inflation, nearly a fifth of population went without or delayed receiving needed care (Cunningham & Felland, 2008). Although problems with access were particularly intense for individuals without coverage and those in poorer health, insured people also faced large increases in unmet need (Cunningham & Felland, 2008, p. 1). The central reason cited for problems with access was concern about cost. Health care costs are spreading beyond impeded access care. The Government Accountability Office recently warned that health care inflation poses a serious threat long-term fiscal stability of nation (Long-Term Fiscal Outlook, 2008). Given these circumstances, pressure for health reform is not likely any time soon. Prospects for Reform Prognosticating is fraught with risk, particularly because at time of this writing we do not know which party will win White House or control Congress. Nonetheless, basis of information we have, this is our best estimate of current climate and prospects for reform. Wyden and Bennett (2008) argued that we have entered a period during which it may be possible break 60 years of gridlock and enact meaningful health care reform. They point bipartisan support for Senate Bill 334, Healthy Americans Act (2007), which guarantees universal coverage though market-driven health care choices like those that members of Congress have (Wyden & Bennett, 2008, p. 690). They cite ideological truce between Republicans and Democrats, and recognition by business and labor groups that they must work together modernize our employer-based system meet needs of both workers and employers (Wyden & Bennett, 2008, p. 690). Democratic pollsters assert that fundamental reform may be possible, but warn that the opportunity could easily dissipate (Lake, Crittenden, & Mermin, 2008).Voters believe that health care should be a right and recognize reform as an investment in future. They also want security and peace of mind universal coverage would bring. Despite this, opponents will actively work to sow confusion, doubt, and fear about major change (Lake et al., 2008, p. 698). Immigration is a particular wild card. Opponents of reform are likely attack any universal proposal as benefiting illegal immigrants, a charge that is potentially a greater liability than any of usual attacks taxes, government control, and so on (Lake et al., 2008, p. 697). Although reform is a real possibility, advocates cannot take it for granted but must work strategically as well as passionately for changes they seek (Lake et al., 2008, p. 698). McInturff and Weigel (2008), prominent Republican pollsters, argue that situation we face today is similar that in early 1990s. …