June 1st, 2009

Reports Kaiser Health News:

“It will be hard,” President Barack Obama acknowledged in a speech earlier this year to Congress. But he added, “Let there be no doubt: Health-care reform cannot wait, it must not wait, and it will not wait another year.”

Action is about to accelerate. Democratic Sens. Edward Kennedy of Massachusetts and Max Baucus of Montana are close to introducing separate bills to expand coverage to the uninsured and remake the health care system. House Democrats are working on their own versions.

The biggest challenge: The price tag. The Democratic proposals could cost $1 trillion to $1.5 trillion over 10 years, and lawmakers are a long way from coming up with the money.

The biggest unknown: How forcefully will Obama engage, and what’s his bottom line? Will he go for broke, insisting on a big expansion of health coverage and sweeping changes to the health care system? Or will he be more pragmatic, quicker to compromise than, say, the Clintons were–so as not to lose everything?

Here are three scenarios on how the health care battles of 2009 might turn out:

DEMOCRATS WIN BIG

Defying skeptics, Congress passes comprehensive health care legislation in late fall. Shortly before Christmas, Obama holds a signing ceremony at the White House. Flanking the president, Democratic leaders beam at the prospect of heading into the 2010 elections with a major domestic triumph. Selected Republicans are on hand as well.

CRASH AND BURN

As the summer gets hotter, the Champagne stays in the White House fridge. Legislation that started out in June looking like a 21st Century New Deal for health care gets bogged down as some moderate Democrats, Republican critics and industry officials get more insistent: The plan is too expensive. It depends too heavily on taxing the middle class. It does too little to control spiraling costs.
Attempts at compromise flag as President Obama and Democratic leaders cling to the goal of universal coverage. Republicans, smelling blood, move to exploit the fissures among the Democrats. Conservative groups roll out ads focusing on the high cost of the overhaul, the new taxes needed to pay for it, and the specter of a government takeover of the health system.

HALF-A-LOAF, or LESS

Fall is in the air and next year’s congressional elections suddenly seem a lot closer as the Democrats and Republicans each declare victory in the battle over remaking the health care system. Sure, the Democrats didn’t get universal coverage or a public plan. But the legislation Obama signs extends coverage to several million Americans who lack it, takes a stab at making the system more efficient and creates a framework for future changes – if and when Congress and the president are ready for them. Republicans, meanwhile, boast that they stopped government-run health care in its tracks while providing modest tax credits for small businesses.

Visit Kaiser to read how they say each scenario could play out.