The Changes We Need

Posted on | November 17, 2008 | Comments Off on The Changes We Need

Renewed energy and enthusiasm are not enough for health care reform. We need a paradigm shift.These are, as the Chinese curse reputedly called them, interesting times.

If the burst of new Democratic health care reform proposals is any indication, the fresh breeze of the Obama campaign’s "Yes We Can" optimism is blowing across the nation. Mr. Obama’s team is expected to make health care one of its priorities. First out, though, was Senate Finance Committee Chair Baucus (D-MT), who introduced an aggressive health care reform package that builds on Mr. Obama’s campaign platform of cost controls and extended coverage. Senator Kennedy (D-MA) and Representatives Dingell (D-MI) and Stark (D-CA) are expected to offer proposals soon, and undoubtedly there will be others.

The rub is that Congress’ old-guard lobbying system remains in place. Congress is awash in special interest contributions – $2.8 billion from 15,500 lobbyists in 2007 – that exchange money for influence over policy. When the Democrats retook Congress two years ago, they did not substantively change the lobbying rules.

So it is reasonable to ask whether a new day of governance in the common interest is possible. Can we make progress on health care or on any significant problem – climate change, education, energy policy, finance, the social safety net – without addressing the underlying problem of Congress’ receptiveness to special interest influence?

As the new health care proposals unfold, it is worth remembering that, early in the Clintons’ health care reform effort, things looked promising. There was general approval in the business and health care sectors. True, when industry practitioner input wasn’t welcomed, the process began to go south. But the real trouble came when the draft product appeared and some segments believed it threatened their interests. Health care and small business interests acted decisively against the plan, while the large business sector was indifferent. The public relations machine of the opposition demonized and killed the plan.

There is little reason to think that today’s organizations will be less action-oriented if they believe their interests are threatened. So what strategies are available to minimize resistance to changes America needs?

In an ideal world, the new Congress would emphasize that it is a new day by forcefully rejecting the practice of lobbying contributions (in favor of public campaign financing). That would effectively dispatch the problem of achieving health care reform and many other solutions as well. But that seems a stretch.

Alternatively, the leaders of America’s non-health care firms – who represent six-sevenths of the US economy – could overwhelm the health care industry’s resistance by galvanizing, mobilizing and championing reforms.

This is also a stretch, but it is not impossible. The relationships between health care costs, productivity and competitiveness weigh on every American business executive. There are Fortune CEOs – Lee Scott of Wal-Mart, Craig Barrett of Intel, Jim Sinegal of Costco, Howard Schultz of Starbucks, Steve Burd of Safeway – who have campaigned tirelessly on the issues central to serious reforms. Keynoting last week’s National Business Coalition on Health annual conference, Barrett told those assembled that "The only way health care is going to change is if people who pay the bill tell the industry to change."

It is impossible to overstate the profound importance of business leaders acting together in the common interest. This group currently exerts more influence over policy than any other. That said, businesses typically are mostly focused on their own niche issues. Information technology companies focus their lobbying on IT. Hospitality companies, insurance companies, energy companies all focus on what matters most to them.

But they could unite on the common interest. Especially as they gain increasing awareness that re-enforcing America’s social and market fabric strengthens the stability that has made it possible to successfully pursue the special interest in this country over the last 60 years.

At a time when America so sorely needs real change, when many signs point to the rapid erosion of the health system’s stability and sustainability, will America’s Congressional and business leaders stand together for changes that can strengthen the nation’s foundation? Will they stand against those who, in continuing pursuit of their own interests, undermine our institutions and our ability to advance?

If they will, then real change is upon us. If they will not, then we are destined to remain where we are now.