The Tough Road Ahead

John Commins, for HealthLeaders Magazine , December 11, 2008
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U.S. Rep. Jim Cooper (D-TN) concedes that any action to expand healthcare will be expensive, but he adds that finding funding remains an attainable goal—especially when taken in the context of the government's larger spending plan. "Even though it's a big price tag, it is not only necessary, it is affordable," says Cooper. "The $150 billion cost of providing health insurance for all Americans seems small in comparison to the $700 billion bailout package for Wall Street. Most Americans don't feel they're getting any real benefit from the $700 billion. But literally tens of millions of Americans will feel a direct benefit from universal health insurance."

Cooper says he believes Obama will use the so-called "Healthy Americans Act," also known as the Wyden-Bennett Bill, as a scaffold for any sweeping healthcare reforms because it already has widespread bipartisan support in Congress.

"The Democrats are smart enough now to realize that healthcare reform has to be bipartisan," Cooper says. "Regardless of the size of the incoming majority, healthcare is such a major area of the economy that any changes have to have substantial Democratic and Republican support. Thomas Jefferson said, 'Great initiatives cannot be undertaken on slender majorities.'"

Essentially, Wyden-Bennett provides for near-universal health insurance, in part, by relying on private insurance pools and by mandating individuals to carry insurance. Given Obama's Senate history and his pledge to govern in a bipartisan manner, Cooper says he expects the new president will fashion a measure that "borrows heavily from Wyden-Bennett."

"It covers everybody without a tax increase because it wrings savings out of the current healthcare system. It's basically reformed competition between private insurers; not to drop customers when they get sick, but to serve them in a cost-efficient way," Cooper says. "It's a Republican means to achieve a Democratic end of universal coverage."

Aaron remains unconvinced, however. Even if Obama can find a way to pay for healthcare reform, he must still take on well-funded, well-organized, and entrenched lobbies representing every player in the healthcare industry.

"The principal obstacles to reform are not the cost but the complexity of the interests and the policy changes involved," Aaron says. "President Clinton made a serious effort and it failed completely. There is a big head of steam now within the Democratic Party to take a run at healthcare reform again, and President Obama will have to do something. But his chances for full-blown success are not terribly good."

John Commins is an editor with HealthLeaders magazine. He can be reached at

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