Obama and health care in Illinois

[Adelante]

The New Republic
Medical History by Jonathan Cohn
Obama's clean bill of health.
January 30, 2008

-snip

In 1996, when he first ran for state Senate, he indicated his support for universal health insurance–and a single-payer system, in which the government insures everybody directly (although he acknowledged it might not be feasible at the state level right away). Three years later, he was the lead Senate sponsor for the so-called Bernardin Amendment. Named after the famous Chicago archbishop, the amendment would have enshrined a right to health care in the Illinois constitution. Although a symbolic measure–the amendment did not specify what a “right to health care” entailed–it would have pressured the legislature to come up with some kind of coverage plan.

The amendment failed, but soon Obama was busy with a more concrete effort: expansion of public insurance programs to reach more of the uninsured. It was a tough political environment for trying such an initiative: Republicans, always skeptical of expanded government, controlled the state Senate. And they often did the bidding of the insurance industry, which didn’t like public programs encroaching on its turf. So Obama sought common ground.

The result, according to John Bouman, director of the Shriver Center on Poverty Law, was two main compromises, including one allowing those newly eligible for Medicaid to opt for private insurance instead. It was a significant concession, since it gave the insurance industry a chance to compete for the new business. But it also undermined one of the best rhetorical arguments of critics, since it appropriated one of their favorite mantras: “choice.” With that trope out of the way, Obama was able to fight for what he and the reformers thought mattered most: bringing insurance to a great many more people. And they won, prevailing over resistant conservatives. “He could not be accused of partisan aggression,” says Bouman. “But he got his way.”

In 2002, when Democrats won back control of the Senate, Obama became chairman of the Health and Human Services Committee. And it was from that perch that he adopted his other noteworthy health care cause, a measure called the Health Care Justice Act. The brainchild of grassroots activists tired of fighting losing battles to create a single-payer system for Illinois, the act, as originally proposed, would have created a task force, empowered it to develop a universal coverage plan, and then forced the legislature to vote on that plan. Predictably, it aroused the ire of insurers and other business interests, who, by all accounts, lobbied to derail the effort. “They–the insurers–pushed really hard,” says Jim Duffett, executive director of the Campaign for Better Health Care, the group championing the plan. “They also tried to use other people to push him really hard.”

Publicly, Obama used hearings to rally voter support for universal coverage. Inside the statehouse, he pursued a two-track strategy. He made common cause with doctors and hospitals, two groups that had become more sympathetic to universal coverage because of the financial burdens charity care placed on them. This gave cover to moderates who wanted to support the bill, while increasing pressure on the insurers to fall in line. At the same time, Obama carried on discussions with the insurance and business lobbyists directly, eventually granting them two key concessions: He altered the makeup of the task force to make it more industryfriendly and dropped the provision requiring a vote from the next year’s General Assembly. “We had significant concerns and looked to Senator Obama, who is an extremely bright and accessible individual,” Phil Lackman, who represents the Professional Independent Insurance Agents of Illinois, told me. “My experience is that he is willing to listen to anybody willing to talk to him.”

-snip

Expanding Medicaid or creating a task force is not even in the same league as shepherding a bill that would, potentially, seriously reduce the profits of insurers, drug companies, and other health care industries. And so it would be foolish to think that, just because this strategy worked in Springfield, it would work in Washington, too. (It’s worth noting that, despite the task force recommendations, Illinois actually hasn’t enacted universal coverage yet.) But it would also be foolish to suspect that Obama equates compromise with capitulation. “Do not conclude that he does not have firm principled bottom lines–he does,” says Bouman. “He doesn’t compromise for the sake of it or because he’s beaten. The talent is to achieve consensus on a good compromise and then push it through.” Indeed. And while Obama’s history can’t tell us whether, as president, he’d push hard enough, it can reassure us that he understands pushing is necessary. That should count for something, even to a wary liberal like me.

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[ZombieHorde]

1. Thanks for the post. K&R&NT

[sandnsea]

2. Obama has an excellent record

None of the candidates can truly compare. Some have made their choices and that's fine. But I think many others have fallen to propaganda and don't realize they're losing someone who has truly been in the corner of working people all his life.