How Impressed Should We Be with the Kennedy "Consensus?"

by Tim Foley

Published February 20, 2009 @ 09:41PM PT

People are talking about today’s article by Robert Pear of the New York Times on the efforts by Sen. Ted Kennedy and his staff to engage lobbyists and interest groups across the political spectrum in advance of beginning the legislative process for health care reform in the Senate.  Since last summer, Kennedy’s staff has been meeting regularly and at times simultaneously with an eclectic group representing AARP, the A.F.L.-C.I.O., the American Cancer Society, the AMA, AHIP, the Business Roundtable, Easter Seals, the National Federation of Independent Business, PHaRMA, and the United States Chamber of Commerce.  Although the article promises big, the intelligence payoff is small.  After all these meetings, the working group has reached a consensus on a relatively minor point of policy – and on a point nearly all these groups have already agreed to in the first place.

Reactions to this news run the gamut.  Commenter Martin Bring brought the article up in response to my earlier post, and is clearly somewhat freaked by the closed-door nature of the discussions taking place.  I understand where he’s coming from, although it’s worth mentioning that this is how Congress normally works.  The transparency of process promised by the president particularly when it comes to health care is so refreshing largely because it’s so rare.  And the past 8 years have been much worse, with lobbyists from the energy industry, for example, writing the legislation themselves.  I’d be more concerned if Kennedy was the only power center, but there is one other one in the Senate (Baucus) and a pretty darn big one in the White House.  We can hope, for now, that their process will be more transparent and that when Kennedy takes up the matter in earnest, he will likewise be more forthcoming.

On the other hand, Jonathan Cohn on The Treatment and some other progressive bloggers are excited at the potential of an emerging consensus at all from such disparate groups, and Cohn’s summary of the debates surrounding the individual mandate – a requirement for every citizen to obtain coverage – is a must-read.  Of course the presidential campaign made the whole question of mandates hyper-important, as it was the main point of difference between Obama and the Edwards-Clinton plan.  Even post campaign, the “consensus” view coming from the various new players, including Baucus in his white paper and yesterday’s report from The Commonwealth Fund, is for the Obama plan plus an individual mandate.  The fact that so many of those with a vested interest in health care reform have reached their own consensus for a mandate seems filled with portent.

But how big a deal is this anyway?  In my estimation, not much. AHIP and the AMA, to name two, have already declared their support for an individual mandate.  And why not?  That directly translates to more paying customers for both.  If groups like the Business Roundtable, the NFIB and the Chamber of Commerce believe an employer mandate or a “pay or play” will likely be in the legislation, they also have a vested interest in making sure individuals are sharing the responsibility as well.  The mandate is that rare beast that’s a good selling point for liberal policy wonks – after all, it’s very hard to get to universal coverage, even with substantial subsidies unless you force the last few stragglers into the system – and conservative policy wonks who are looking for individual responsibility to match the government largess.  It’s worth reminding that when Massachusetts instituted their universal health care plan with an individual mandate, that mandate was the signature addition by Governor Mitt Romney.

The real reason why this is no surprise is an individual mandate does not cost those in the room anything.  It won’t be burdensome to their constituencies.  It’s a burden for those who will be unable to afford insurance even with subsidies – a group who’s not represented at all in the Kennedy meetings (and, incidentally, a group that’s exempted from the Massachusetts tax penalty).  I’m with Bob Laszewski when he says, “Every one of those 'stakeholders' in that room hasn’t given up one thing yet!”  Were the NY Times to report that a consensus had been reached on reforming the insurance industry (community rating, perhaps) or cutting costs or the terms of “pay or play” for business (5% of payroll?) or one of the truly tough questions about cost-cutting that would hit one or more of the stakeholders in the pocketbook, then I’d be impressed.

Still, I’m thankful these conversations are happening at all and for all the energy being put into them for Kennedy’s staff.  It shows an appetite for reform across the industries most likely to be affected by it… or at least a resignation to the likelihood.  But health care reform is going to require some sacrifice.  The minute it does, you’ll likely see any closed-door consensus disappear.

(Photo credit:  leon~ on Flickr.)