An Insider's Take on the Sausage Making of Health Reform

One of the reasons the Disease Management Care Blog is a blog is because that makes it read other blogs. And this particular piece from the Health Affairs blog is worth a look. Written by Stuart Butler of the Heritage Foundation, it gives a veteran insider's perspective on just what's happened in health reform. Whether or not you agree with the conservative politics, Mr. Butler's post offers up some insights you won't see elsewhere:

By the way... U.S. health care is larger than the entire economies of Britain or France. The likelihood that the final bill will even partially match its supporters' coming praises is quite remote.

Did the Obama Administration slyly 'lead from behind' when it came to health reform? While you may want to believe that Ms. DeParle et al were acting behind the scenes to fashion a grand Democratic achievement, think again. All those White House confabs were for show. The Senate and House were for dough.

The single payor zombie lives. Expect its supporters to respond to the demise of the public option by surreptitiously inserting shadowy language in the House-Senate Reconciliation that increases the chance of single payor happening in the coming years. However, expect years of budget deficits to get in the way. Let the games continue.

Ah, you Republicans, tsk tsk. The GOP calculated that there was no political advantage in either cooperating or, more importantly, offering up meaningful compromises. That more or less forced the Democrats - including Mr. Obama - to become partisan. Perhaps the Republicans wanted to avoid a Clintonesque co-opting of their ideas. Ironically speaking of which, if the Republicans had had a legislative majority, they may have been more willing to deal. My liberal friends, be careful what you wish for.....

No wonder the Democrats were in such a rush: While the White House managed to keep the health industry players from poisoning things with attack ads, the slow pace of the legislative process allowed Americans' natural inclination toward skepticism to grow. In the coming years, this may hamper other initiatives outside of health care and diminish their chances of holding onto large majorities in both houses of Congress.

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