On one level, this Wall Street Journal article is very promising. "The effort to overhaul the nation's health system will begin next year with one clear advantage over previous attempts: A wide variety of interest groups are rooting for it to succeed rather than plotting to kill it," they report. "That is a stark contrast to the last big health-care initiative in the early 1990s, when many of the same groups helped block any major change." Well, it's a stark contrast to 1994, when many of the groups helped block major change. But it's not a stark contrast to 1992, when many of the group swore their desire to see fundamental reform of the health care system. The transformation came when the administration proposed actual legislation that had actual impacts on actual profit streams. It's easy to be for "change." It's harder to be for legislation. And indeed, it's not hard to imagine them engaging the same path again. The WSJ lists a couple examples of industry openness that don't exactly warm my heart. "On Wednesday, the insurance industry's Washington trade group issued a statement saying it could accept new rules requiring companies to cover sick people, as well as healthy ones, as long as all Americans were required to have insurance, with subsidies for those who need them." In other words, they said that if we legislate that every American must purchase insurance coverage, they will sell insurance coverage, at some price, to every American. The WSJ is casting that as a concession, but it's not even in the ballpark of what a reform plan will demand, and AHIP is certainly reserving the right to oppose anything stronger. Similarly, the WSJ says that "in another sign of an early push for change, the powerful prescription-drug lobby has a new television ad out this week. 'Early diagnosis and preventative treatment can save lives and lower health-care costs,' spokesman Montel Williams says in the ad." This is, again, an argument for profits, not reform. The quiet message is that we don't need lower drug costs, we need more diagnostic care. We may indeed need more diagnostic care -- though I sort of doubt it -- but we certainly need lower drug costs, and PHRMA will go to war against that. None of this is to say reform won't, or can't, happen. Nor is to say that these industries might not eventually offer sufficient concessions. But what you're seeing now is early maneuvering, and we've seen that before. The question is how industry reacts to actual legislation, and that will partially depend on how likely that legislation is to pass. Bottom line is that you'll see a fairly constructive participation from the health care sector if they think reform is going to come and they can protect their interests in it, and you'll see aggressive opposition if they think they can kill reform or they think it will negatively affect their revenues. Industry doesn't have opinions, it has interests. And until they have something concrete to calculate their interests against, it's very hard to say how they'll come down.
