BUT WHAT WILL...

BUT WHAT WILL BE THE CAUSE OF DEATH? I spent this morning at a Brookings/New America Foundation event on the future of employer-based health care. The consensus? The system, captain, she canna' take anymore!

The morning's most interesting speech came from Andy Stern, head of the SEIU and catalyst for last year's union split (which gets a dim review from Harold Meyerson in the upcoming issue of The American Prospect). And make no mistake, the guy can talk. Despite having a look and speaking style unsettlingly similar to Bill Maher's (if Maury Povich ever has a "Long Lost Brothers" show, and Maher or Stern is waiting uneasily on stage, you can be sure that the other is set to stride out from the wings), he gave a ripsnorting condemnation of the current system -- a decaying, dying structure -- and called on the room's business leaders and policy wonks to show some damn leadership and hasten what comes next.

It was powerful stuff, and Stern knew how to deliver it. His union, after all, represents more than a million health care professionals, and his federation's organizing efforts are being stymied by employers terrified of assuming health costs. But despite an effortless facility with the material, there was no "there" there. Stern demanded that we move past policy discussions -- "We've got the policy! There's tons of good policy!" -- and towards leadership and political will. How that'll look, he couldn't say. Indeed, leadership and political will are easy enough in health care. When all Bill Clinton was doing was showing leadership and political will, his poll numbers soared and the punditocracy was positive his reforms would get passed. It's when his policies solidified that all the stakeholders erupted, that the Republicans united, that business launched its airwave war, that his reforms crashed upon the shoals of their specifics.

When I asked Stern about that, he shrugged it off. "This isn�t 1993," he said, "it�s thirteen years later. Many of those from 1993 who now meet in their salons all admit it was a huge mistake. I think there�s a much more sober reality facing us because the numbers are so appalling and the situation is so bad. Not only are we morphing into catastrophic care, but employers are pulling money out of the system. [In 1993], we didn�t have one business leader get out in front. This will not change until the employer�s demand it. But this is a business crisis now." And maybe it is, but that's what we thought in 1993, too. Hence John Judis's classic article on how and why the business community unexpectedly abandoned health reform. Are things different now? Sure. Different enough? Who knows. But I would've been more comfortable if Stern's call to leadership seemed more of an agenda and less of a hope; more a promise that his unions would ruthlessly lash employers until they got with the program and less a belief that business would finally look at its balance sheet and start marching with the angels.

--Ezra Klein

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